2 The Liver and Nutrient Metabolism
3 Nutrition Assessment in the Presence of Liver Disease
4 Malnutrition and Liver Disease
6 Effect of Malnutrition on Patient Outcome
7 Effect of Nutrition Supplementation on Patient Outcome
8 Nutrient Needs
9 Other Supplements 10 Summary
Because the liver performs hundreds of metabolic functions, nutritional status and nutrient metabolism are altered in individuals with liver disease. This chapter reviews relationships between nutritional status and liver disease, describes effects of malnutrition and nutrition support on outcomes, and defines nutrition therapies for patients with liver disease.
Objective nutrition assessment parameters are often confounded by symptoms of liver disease; therefore, subject global assessment criteria are often applied. The degree of malnutrition is influenced by the type and severity of liver disease. The cause of malnutrition
From: Clinical Gastroenterology: Nutrition and Gastrointestinal Disease Edited by: M.H. DeLegge © Humana Press Inc., Totowa, NJ
is multifactorial including diet inadequacy, malabsorption, gastrointestinal symptoms and altered nutrient metabolism.
Nutrition supplementation (through oral, tube feeding or parenteral routes) can be used to supply macro- and micronutrients to patients at nutritional risk. Protein should not be restricted for patients with liver disease. Calories, electrolytes, fluid, vitamins and minerals should be individualized for each patient taking into consideration his/her nutritional status, type and stage of liver disease, and medical treatments. There is not strong evidence to support the use of herbal supplements in individuals with liver failure.
KeyWords: Liver disease, Cirrhosis, Nutrition, Nutritional status, Nutritional support, Nutrition assessment, Nutrition therapy
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WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.