Dietary management for cirrhosis

Objectives

• To correct fluid and electrolyte balance.
• To promote regeneration of liver cells.
• To correct nutritional deficiencies.

Dietary modification

Energy: The energy requirements are increased to correct nutrition deficiencies and to promote liver regeneration. Since the patient is bed ridden his actual energy expenditure is reduced.

Proteins: In the absence of hepatic coma, the protein intake should be normal so as to overcome malnutrition, regenerate liver cells and replenish plasma proteins. However, if signs of hepatic coma appear, the protein intake is decreased depending on the individual’s tolerance.

Carbohydrates: A high carbohydrate diet is recommended to provide energy and protect the liver from further damage. Carbohydrates in the simple forms such as glucose, sugar, fruits and fruit juices and starches like cereals and root vegetables are advised.
Irritating fibres should be eliminated. Thus, dehusked pulses, refined cereals and low fibre vegetables and fruits should be selected.

Fats: Many cirrhotic patients suffer from malabsorption of fat and, therefore, fat restriction helps to such patients. The amount of fat to be included in the diet vary depending on individual’s tolerance. Inclusion of adequate amount of fat improves the palatability of the diet and promotes recovery.
Emulsified fats such as fat from milk, butter, cream, eggs should be given as they are easily digested. Medium chain triglycerides present in coconut oil are better tolerated since they are directly absorbed without undergoing digestion.

Vitamins: The availability of fat-soluble vitamins like vitamin A is affected due to the decreased intake and impaired absorption of fat. Thus, diet should include vitamin A rich foods and vitamin B supplements may have to be provided to replenish liver store and repair tissue damage.

Minerals: adequate amounts of calcium and magnesium should be provided in the diet. Sodium intake needs to be restricted because of water retention in the body.

Sample diet plan

To remember

• Serve soft foods that are smooth in texture.
• Acutely ill patients may require a fluid diet with 6-8 meals in a day.
• Recovering patients may be given a soft diet.
• Restrict salt in cooking and for table use.
• Patient should be encouraged to eat.
• Food served should be well cooked, attractive and appetizing.
• Likes and dislikes of the patient should be kept in mind.
• Avoid large meals.
• Foods to be included: sugar, honey, glucose, cereals, pulses, milk and milk products, eggs, fruits, and vegetables.
• Foods to avoid: fried and fatty foods, fats, oils, nuts and oilseeds, strongly flavoured vegetables and foods
• Avoid alcohol and restrict at least for a year after the attack.