Cirrhosis of the liver is a chronic condition in which healthy liver tissue is replaced by scar tissue, blocking the flow of blood and resulting in the loss of liver function. Even when irreversible liver complications are present, it is possible to alleviate some of these major issues, like portal hypertension, ascites and encephalopathy, with nutritional treatment.
Macronutrient Recommendations
Patients without encephalopathy, a decline in mental status and neuromuscular function resulting from liver failure, should consume a high-calorie and high-protein diet to minimize protein catabolism, or the breakdown of protein into amino acids and simple derivative compounds. Calorie recommendations are anywhere from 40 to 50 calories per kg of body weight, while protein recommendations are 1 to 1.5 g per kg. One kilogram is equivalent to about 2.2 lbs. of body weight. You may tolerate dairy and vegetable proteins better than meat proteins. You should consume fat and carbohydrate to spare protein, allowing it to carry out its intended functions, with anywhere from 25 to 50 percent of your total calories coming from lipids.
Other Recommendations
It may be helpful to supplement with certain vitamins and minerals like vitamin B complex, vitamins C and K, zinc, magnesium and phosphorus. Some of these minerals are malabsorbed in chronic liver disease. Iron supplementation may be necessary in cases of intestinal bleeding. Also, 4 to 6 smaller meals per day may help encourage intake and prevent low blood sugar levels.
Ascites
To address ascites, which is the accumulation of fluid in the cavity between the organs and the abdominal wall, nutrition treatment consists of restricting salt intake to less than 2000 mg per day and restricting fluid intake to 1500 ml per day if your sodium levels drop below a certain threshold, or 120 mEq/L. It is important to encourage protein intake and adequate caloric intake to replenish albumin and meet energy requirements, respectively. If the high-protein diet is high in salt, use a modular protein to supply you with protein.
Hepatic Encephalopathy
For patients with encephalopathy, treatment varies. In acute episodes, it is important to eliminate precipitating factors like electrolyte disturbances, GI bleeding and constipation. This may entail stopping the use of diuretics to restore fluid and electrolyte balance. For chronic encephalopathy, diet plays a greater role. Protein restriction is not recommended and intake should be 60 g or more per day. Branched-chain amino acids are recommended for those who cannot tolerate standard protein sources. A lacto vegetarian diet, which includes dairy products such as milk, cheese, yogurt, butter, cream and kefir, contains more of these amino acids.
References
- "Nutrition Therapy and Pathophysiology"; Marcia Nelms, Kathryn Sucher, Sara Long; 2007.
- RD411.com: Liver Disease: The Role of Nutrition
