CIRRHOSIS (PERMANENT LIVER DAMAGE)

Regeneration of liver cells occurs if appropriate diet therapy is initiated before the disease is well advanced. In early cirrhosis, the high protein, high carbohydrate diet outlined for infectious hepatitis is satisfactory. In advanced cirrhosis, however, further modification is needed. Energy requirements are increased to compensate for the extreme weight loss, which often occurs in cirrhosis.

Carbohydrate
Metabolically, stable cirrhotic patients behave similarly to normal individuals under prolonged starvation.

Fasting low blood sugar can occur because of the decreased availability of glucose from glycogen. Therefor, carbohydrate should provide most of the non-protein calories.

Protein
Cirrhotic patients do appear to have an increase protein requirement due to increased degradation in order to supply energy. In uncomplicated cirrhosis, protein requirements range from 0.8 to 1 gm / kg dry weight per day to achieve nitrogen balance. Unnecessary protein restriction may only worsen body protein losses and therefore, must be avoided.

Lipid (fat)
Cirrhosis is marked by impaired fat metabolism. Dietary fats are incompletely metabolized in liver failure. Therefore overfeeding regardless of energy source should be avoided because excess calories can contribute to fat synthesis and accumulation in the liver. A range of 10 to 15 % of calories as fat is generally recommended. Replacement of some of the dietary fat with medium chain triglycerides (found in coconut oil) may be useful.

Vitamin and minerals
Deficiencies of fat-soluble vitamins have been found in all types of liver failure. Therefore, supplementation is necessary.

Fluids and electrolytes
Cirrhosis is characterized by excess sodium and fluid retention with increased urinary potassium losses. In patients with ascites (water accumulation in the abdomen), sodium is commonly restricted to 2 g / day. More severe limitation may be imposed, however caution is warranted because of limited palatability. Fluid intake is usually restricted to 1 liter per day, depending upon the severity of the edema, ascites, and low sodium.

HEPATIC ENCEPHALOPATHY (HEPATIC COMA)
In coma due to liver problem, dietary treatment is geared towards reducing ammonia production. The fundamental principle in the dietary management of hepatic coma is to reduce the protein intake to a minimum thus decreasing the amount of ammonia produced. 0.6 to 0.8 gm/kg/day of protein can be given safely. Vegetable protein and casein based diets have shown promise in reducing encephalopathy. The high fiber content of vegetable protein diet also plays a role in excretion of nitrogenous compounds. As the patient improves, the protein intake is gradually increased by increment of 0.2 g/kg/day to tolerable levels. These patients pose problem in feeding because of anorexia, drowsiness and confusion to irritability. The sugar fat emulsions, glucose in beverages or fruit juices may be used initially through oral or tube feeding.