DIETARY MANAGEMENT IN CIRRHOSIS OF LIVER
Cirrhosis is a condition in which there is destruction of the liver cell due to necrosis, fatty infiltration and fibrosis. It is a serious and irreversible disease. It occurs after years of excessive alcohol intake in individuals whose diets are deficient in nutrients. Malnutrition aggravates injury to the liver and can lead to child hood cirrhosis seen between the age of 1 to 3 years.
The onset of cirrhosis may be gradual with gastrointestinal disturbances such as anorexia, nausea, vomiting and pain. The patient may suffer from weakness, muscle cramps, weight loss and fever. As the disease progresses jaundice occurs. Ascites which is the accumulation of abnormal amounts of fluid in the abdomen develops.
Principles of diet
A high calorie, high protein, high carbohydrate, moderate or restricted fat, high vitamin diet helps in the regeneration of liver and helps to prevent the formation of ascites. Low fat with supplementation of fat soluble vitamins and minerals should be given. Sodium should be restricted only when there is ascites. The diet should be attractive and palatable.
Energy : Since anorexia and ascites are present consumption of food is difficult. A highly nutritious high calorie diet is necessary because of prolonged undernourishment. The calorie requirement should be between 2000 - 2500 k cals.
Proteins : A high protein diet is helpful for regeneration of the liver. It also helps to compensate for the considerable loss of albumin in the ascitic Fluid. In the absence of hepatic coma, a high protein intake of 1.2 g/kg of body weight is recommended. The protein content of the diet varies according to the symptoms.
Fats : About 20 g of fat is given provided adequate amounts of protein is supplied.
Carbohydrates : Carbohydrates should be supplied liberally so that the liver may store glycogen. Liver function improves when an adequate store of glycogen is present.
Vitamins and Minerals : The liver is the major site of storage and conversion of vitamins into their metabolically active form. In cirrhosis the liver concentration of folate, riboflavin, nicotinamide, vitamin B12 and vitamin A are decreased.
Vitamin supplementation especially of B vitamins is required to prevent anaemia. Choline and methionine are useful if fatty infiltration is present.
Sodium is restricted to 400-800 mg/day in oedema and ascites. If there is no ascites very little salt is permitted to make the food more appetizing. Potassium salt is given for ascites and oedema to prevent hypokalemia.
Iron supplementation is essential as anaemia is common. A daily dose of 0.3 g of ferrous sulphate tablet 3 times after meals would also be beneficial. Folic acid 1 mg / day orally is given to treat macrocytic anaemia.