This document discusses nutrition for various liver conditions. It recommends for hepatitis patients a high protein, moderate fat and carbohydrate diet along with plenty of fluids. For cirrhosis, it suggests a similar diet with moderate sodium and soft foods if needed, as well as vitamin and mineral supplements. The goals are to aid liver regeneration and recovery through optimal nutrition while avoiding further strain on liver function.

2. By
Dr. Yousri Mostafa Hussein
Ph.D. Immunology (U.K)
Immunotherapy Course (USA)
Professor of Immunology and Molecular Biology
Head of Medical Biochemistry Department
Faculty of Medicine, Zagazig University

3. Dr. Yousri Mostafa Hussein
Professors of Immunology and Molecular Biology
Faculty of Medicine, Zagazig University
Dr. Dina Mohamad El Nemr
By:

4.  Aim for a healthy weight
 Be physical active each day.

5.  Let the food Pyramid guide your food choices.
 Choose a variety of grains daily, especially whole
grains.
 Choose a variety of fruits and vegetables daily
keep food safe to eat.
 Choose a diet: low in saturated fats and
cholesterol and moderate in total fat.
 Choose beverages and foods to moderate your
intake of sugars.
 Choose and prepare foods with less salt.

8.  Drugs are highly regulated by FDA.
 Supplements are considered safe until demonstrated
to be hazardous by FDA.
 Herbals and botanicals are totally unregulated.

9.  Vegetarian’s  vitamin D, B12.
 Pregnant women  folate.
 Elderly persons  Vit. B12 and folate.
 People at risk of osteoporosis  calcium, estrogen
and vitamin D.
 People at risk of losing blood  iron.
 People on restricted diets  vitamins and minerals.

10. Heart diseases:
 High saturated fat and cholesterol.
 Low intake of vitamins, veggies and fruits,
Cancer: Low intake of veggies, fruits and fiber.
Diabetes:
 High saturated fat.
 Low intake of veggies and fruits.
Osteoporosis: Low Ca and Vit. D intake
Obesity: Excessive energy intake and high fat.

12.  It is an in-depth evaluation of both objective
and subjective data related to an
individual’s food and nutrient intake,
lifestyle and medical history.
 The assessment leads to a plan of care, or
intervention, designed to help the individual
either maintain the assessment status or
attain a healthier status.

13. The data for a nutritional assessment falls into
five categories including:
1- Anthropometric measures:
These are the objective measurements of body muscle
and fat as height, weight, body measures…..
and others.
The Body Mass Index (BMI) is used to estimate
the body-fat mass:
)m()height(
(kg)Weight
22BMI (kg/m2) =
Obese when it’s > 30 kg/m2

14. 2- Biochemical tests:
There are some biochemical tests which might give a
clue about the nutritional state of a patient. These
tests include the assay of:
 Total plasma proteins, albumin, globulins,
fibrinogen and ferritin.
 Hemoglobin and hematocrite value.
 Products of protein metabolism as urea, creatinine,
uric acid, in addition to 24 hours urinary nitrogen.

15. 3- Immune system integrity:
 As lymphocyte count, skin tests ….. and others.
4- Clinical assessment:
 Observation of the clinical signs and symptoms of
good and poor nutrition.
5- Recording patient usual habits of eating:
 Cultural and social aspect and the psychological
state of the patient should be recorded.
 Religion of the patient should also be considered in
the planning of the dietary regimen.

16. 1) Primary nutritional deficiency:
This type results from the dietary deficiency of a given
nutrient as vitamin deficiency.
2) Secondary nutritional deficiency:
This might result from certain barriers to the use of
any nutrient as:
 Malabsorption syndrome.
 Celiac disease.
 Lactose intolerance … and others.

18.  Diet therapies are specially designed and
prescribed for medical and/or general
nutritional reasons.
 By combining foods appropriate for each
individual and drinking the proper amount of
water → can help maintain the best possible
health.

19. 1. To increase or decrease body weight.
2. To rest a particular organ.
3. To produce a specific effect as a remedy (as
regulation of blood sugar in diabetes).
4. To overcome deficiencies by the addition of food
rich in some necessary element (as supplementing
the diet with iron for treating microcytic anemia).

20. 1) Enteral oral feeding:
 As long as possible, regular oral feedings are
preferred. Supplements are added, if needed.
2) Tube feeding:
 If a patient is unable to eat, but the gastrointestinal
tract can be used tube feeding may provide the
needed support.
 A number of commercial formulas are available or
blended formula might be calculated and prepared.
These formulas provide water, energy, proteins and
micro-nutrients.

21. A) Mechanical complications of tube feeding:
1.Mechanical injury to soft tissues.
2.Aspiration of liquids leads to aspiration pneumonia.
This is the most serious complication and is life
threatening in many cases.
3.Block of the tube or its dislodgment.

22. B) Gastrointestinal complications:
1. Pharngitis and esophagitis.
2. Diarrhea
3. Inadequate gastric emptying
4. Emesis
5. Bleeding
C) Metabolic complications:
1. Disorders in acid base balance.
2. Disorders affecting blood glucose level.

23. 3) Parenteral Nutrition:
Venous infusion of
solutions containing
the recommended
nutrients.

24. Examples of nutritional solutions:
1. Basic parenteral solutions usually contain glucose,
amino acid and water. Electrolytes, minerals and
vitamins can also be added.
2. Solutions containing additional energy in the form of
emulsified fat. Intravenous fat solutions are isotonic
and well tolerated.
3. Solutions containing low dextrose and high fat
content. This is to provide fixed concentration of
energy to spare proteins. Utilized in:
 Patients with hyperglycaemia, respiratory failure and
liver diseases.
 Patients with large estimated energy requirements.

25. A) Complications due to catheter:
1. Catheter thrombosis
2. Sepsis
3. Ulceration of blood vessels.

26. B) Metabolic complications:
1. Hyperglycemia: Due to rapid infusion of
hypertonic dextrose solutions.
2. Non-calcular cholecystitis, due to biliary stasis.
3. Zinc deficiency due to diarrhea.
4. Abnormalities in liver enzymes, due to trapping of
fat in the hepatocytes.
5. Hypophosphatemia and hypokalemia, due to shift
to intracellular compartment.

27. Therapeutic diets can be divided into
three groups:
A) Diet of Altered Consistency.
B) Diet that Restrict Nutrients.
C) Diet that Supplement Nutrients.

28. 1) Clear liquid diets:
This type of diet usually contain sugar and some
electrolytes.
Because of its low calories and minimal protein
content its use is limited to short period.
It consists of foods that are in liquid state at body
temperature.

29. It’s used in:
 Acute gastroenteritis
 Acute illness.
 Preparation for diagnostic gastrointestinal
procedures.
 Post-operative ileus.
 Partial intestinal obstruction.
 Patients who haven’t taken any food by mouth
for long periods.

30. 2) Full liquid diet:
It contains enough calories, proteins, vitamins
and minerals.
Dairy products, eggs, soft cereals and fruit juice
are usually added to supplement this diet.
It’s low in residue and indicated in:
 Patients with difficulty in chewing or swallowing.
 Partial intestinal obstruction.
 Can be fed through a tube in patients with
prolonged coma.

31. 3) Mechanicals soft diet:
This diet includes foods permitted in the liquid diet
as well as foods containing easily digested
carbohydrates.
Eggs, cheese, ground meat, refined cereals, grain,
potatoes, starch, cooked fruits, vegetables and cakes
are often included.
It’s also low in residue and can be used for patients
who have difficulty in chewing or swallowing.
Mechanical soft diet that restrict spices and
seasonings “bland diet” is used for patients with
peptic ulcers.

32. 1) Sodium restricted diet:
In these types of diets, a certain nutrient is
designed to be restricted or even eliminated, to aid
in the management of certain disease states. The
most common types include:
Sodium is the main extra-cellular cation. In
diet, it originates from:
Sodium naturally occurring in certain foods e.g.
baking powder, baking soda.
Sodium added during food processing.
Table salt added.

33. Typical diets contain about 4-6 gm sodium/day,
hence sodium restriction can be divided into:
a. Mild sodium restriction (2-3 g/day).
b. Moderate sodium restriction (1gm/day).
c. Strict sodium restriction (0.5 g/day).
d. Severe sodium restriction (0.25 g/day): rarely
used.

34. Hypertension.
Conditions with sodium retention and edema
i.e. congestive heat failure.
Liver disease, especially those associated with
ascites.
Chronic renal failure.

35. 2) Protein restricted diet:
Intended for patients suffering from chronic liver
cirrhosis or hepatic encephalopathy.
Also, in chronic renal failure patients to decrease
symptoms of uremia.
The amount of protein restriction varies
according to the circumstances. The usual
amount given ranges from 15-50 gm/day
depending upon the symptoms are severe or mild.

36. 3) Fat restricted diet:
Useful in treatment of:
Malabsorption syndromes
Liver diseases
Cholecystitis
Arterial and coronary heart diseases
Hypertension.

37. The following items are allowed:
Beverages: as skim milk, coffee, tea and
fruit juice.
All kinds of bread, cheese: dry or fat free
meat, liver, fish, beef and lamb. Broiling,
baking or billing of meat is necessary.. Skin
of poultry must be removed.
Vegetables and fruits.

38. A) High calcium diet
Include mainly milk, cheese, yogurt, egg yolk,
beans, figs and green vegetables. Also, canned fish
with bones represents a rich source of calcium. The
average daily intake is about 700 mg.
Calcium provided by milk and milk products is
easily absorbed than that provided by vegetables.

39. Calcium rich diet is important for:
Children during growth.
Women in menopause, to prevent osteoporosis
that occur due to estrogen deficiency.
Children with lactose intolerance who can’t
tolerate liquid dairy products may be able to
tolerate non-liquid dairy products such as
cheese and yogurt.

40. B) High potassium diet:
Diet rich in potassium include:
Fruits as apricots, bananas,
oranges and pineapples.
Animal sources as beef and liver.
Usual diets provide about 3 gm potassium/day.
While, high potassium diet contains 4.5-7 gm/day.

41. It’s indicated in cases of:
Post-operative, due to intravenous administration
of solutions that don’t contain potassium.
Cushing disease
Diarrhea
Metabolic alkalosis.
Excessive use of diuretics.
High potassium diet might also have a direct
antihypertensive effects.

42. C) High fiber diet:
It includes:
Fresh fruit and vegetables
Whole bread and grains
Seeds and legumes
Bran products.
Typical diet contains about 8 gm fibers/day.

43. It is used for:
Treatment of gastrointestinal disorders as irritable
bowel.
Reduction of blood sugar in diabetic patients.
Reduction of cholesterol level in patients with
hypercholesterolemia.
Weight reduction.

44. Women who eat well balanced diet, high in
nutrients and avoid known risks (as smoking) tend
to have fewer complications during pregnancy, labor
and are more likely to deliver larger and healthier
babies.

45. Good nutrition before pregnancy is important
as the amount of “resources” childbirth requires
increased.
Pre-pregnancy nutrition is a process of
“building up” the immune system in preparation of
pregnancy and its’ one of the major factors in
determining the success rate of conceiving healthy
children.

46. The period of gestation is and exceedingly
rapid growth period. The human life grows from a
single fertilized ovum to a fully developed infant
weighing about 3 kgm.

47. To meet nutrient needs:
  calories and protein.
  folate to avoid neural tube defects.
  Fe synthesize blood
 Should make sure to get:
 Enough vit D, Ca: for bones
 Enough vit A (excess harmful to fetus).
Weight gain 25-35 pounds in average weight woman
during pregnancy.

48. Calories must be sufficient to:
Supply the increased energy demanded by
increasing metabolic workload.
Spare protein for tissue building.
The increased requirements during pregnancy are
due to:
Rapid growth of fetus.
Development of placenta.
Enlargement of maternal tissues.
Increased maternal circulating blood volume.
Formation of amniotic fluid (contain proteins).

49. Food sources for pregnant women include: milk,
meat, eggs and cheese for protein supply and also
provide calcium, iron and vitamins.
Food sources for iron
include liver, meat, fruits,
green vegetables, dried
beans and cereals.

50. Proper nutrition is important after delivery to
help mother recover and to provide enough food
energy and nutrients for a woman to breastfeed her
child.
Women with serum ferritin < 70 µg/L need
iron supplement to prevent iron deficiency anemia
during pregnancy and post-partum.

51.  Highest nutrient needs in life.
 Extra 300 calories/day as in 2nd and 3rd
trimesters.
  needs for: protein and most vitamins
including vit. A, B6 and folate.
 Sufficient water and fluid intake.

53.  Viral hepatitis are group of inflammatory diseases
caused by hepatitis viruses, including A, B, C, D …
and others.

54.  Bed rest is essential.
 A daily intake of 3000-3500 ml fluid guards against
dehydration, gives a general sense of well-being and
improves appetite.
 Optimal nutrition is the major therapy and provides
foundation for recovery of injured liver cells and
over-all return of strength.
 The ideal diet for hepatitis infection patients consists
of:

55.  Protein is essential for liver cell regeneration.
 It also provides lipotropic agents as choline and
methionine for conversion of fats into lipoproteins
removal from liver preventing fatty infiltration.
 Diet should supply from 75-100 gm of high quality
protein daily.

56.  Diet should supply 300-400 gm carbohydrates daily.
 Sufficient glucose must be provided to restore
protective glycogen reserves and to ensure the use of
protein for vital tissue regeneration.

57.  Adequate amount of fat make the food more
palatable and encourages the anorexic patient to eat.
 Moderate amount for easily used fat such as:
 Whole milk, cream, butter, margarine and vegetable
oil is beneficial.
 Diet should incorporate about
100-150 gm of such fat daily.

59.  2500-3000 Kcal are needed daily to provide energy
required for tissue regeneration process and to
renew strength and power.
 At first, the food may need to be in liquid form,
using concentrated or commercial formulas for
frequent feedings.
 As the patient can tolerate solid food appetizing and
attractive food is needed.

60.  Liver diseases may advance to chronic stage of
cirrhosis.
1. Proteins: In absence of impending hepatic coma
about 80-100 gm protein/day are needed to correct
severe under nutrition, regenerate functioning liver
tissue and replenish plasma proteins.
2. Low sodium: usually restricted to 500-1000 mg/day
to help reduce fluid retention.

61. 3. Texture: If esophageal varices develop soft foods
may be necessary.
4. Optimal general nutrition: The same principles
outlines for hepatitis are continued for cirrhosis
for the same reasons.
5. Caloric intake: Carbohydrates should be taken
freely.
6. Vitamins supplementations: Especially vit. B
complex, according to the patient’s need and
deficiency.
7. Fat intake: Moderate fat is used.
8. Alcohols: Completely prohibited, since their
detoxication represent a burden on the activity
of hepatic cells.