विवरण
In liver disease, moderate protein intake helps prevent excessive ammonia production, supporting liver function. A balanced diet with controlled carbohydrates and healthy fats aids energy production and avoids excessive stress on the liver. Proper vitamin and mineral supplementation address deficiencies common in liver disease, supporting overall health. Maintaining adequate hydration is crucial, as it supports liver function and helps eliminate toxins from the body. A low-sodium diet helps manage fluid retention, a common complication in liver diseases such as cirrhosis. Tailoring caloric intake to individual needs prevents malnutrition and provides energy for daily activities. Eliminating alcohol and limiting exposure to toxins is essential in preserving liver function and preventing further damage. Omega-3 fatty acids from sources like fish or flaxseed may have anti-inflammatory effects, beneficial for liver health.
सारांश
- The webinar focuses on the learning objectives related to malnutrition in liver disease, including prevalence, causes, patterns, and consequences. It aims to help healthcare professionals recognize nutrition problems and understand the pathophysiology behind sarcopenia in liver disease, and learn to use nutrition screening and assessment tools to determine the risk of poor clinical outcomes due to sarcopenia. Treatment strategies to optimize patients with liver disease were discussed.
- Liver cirrhosis is often a result of several chronic liver diseases that are ignored until decompensation occurs, which is characterized by ascites, spontaneous bacterial peritonitis, gastrointestinal bleeding, and hepatic encephalopathy. This progression can ultimately lead to liver transplantation. Malnutrition is a prevalent yet under-reported problem in end-stage liver disease, including sarcopenia (loss of muscle mass) and loss of fat mass, or a combination of both (hepatic cachexia).
- The presentation outlined an algorithm for assessing malnutrition risk, with Child-Pugh Class C automatically considered high risk. For Child-Pugh A and B, BMI is considered, with underweight individuals at high risk. Various assessment tools were reviewed, including subjective global assessment, Royal Free Hospital Global Assessment, and dietary intake assessment. More advanced assessments for sarcopenia, like CT scans, DEXA, and BIA, are typically not done routinely but can be helpful, especially for patients awaiting transplants.
- Adjustments for fluid overload are essential in assessing nutritional status. Guidelines suggest subtracting specific weight amounts for mild, moderate, and severe ascites and edema to estimate dry weight. Modified BMI criteria are used to account for ascites severity, with lower BMI cutoffs indicating malnutrition in the presence of increasing ascites. While biochemical parameters like albumin and prealbumin are useful, they primarily reflect disease severity rather than nutritional status alone.
- Sarcopenia, or the loss of skeletal muscle mass and strength, is prevalent in decompensated cirrhotics. It is important to assess muscle strength rather than just muscle mass. Muscle strength can be measured using a hand grip dynamometer. Sarcopenia is linked to protein requirements, which are higher in cirrhotic patients due to reduced protein production and increased protein degradation. The causes of sarcopenia in cirrhosis are multi-factorial, including genetic reasons, portal hypertension complications, alcoholic cirrhosis, physical inactivity, increased hepatic gluconeogenesis, and increased ammonia production. Accelerated starvation is more common in liver disease leading to increased protein degradation and muscle consumption.
- Treatment strategies encompass addressing the underlying condition, providing optimal nutrition, and implementing exercise. Managing complications like infections and portal hypertension is key. For patients with hepatic encephalopathy, BCAA (branch chain amino acid) supplementation can be beneficial. Sodium restriction is important for managing ascites and edema, although salt restriction may make patients eat less. It is also important to control carbohydrate intake for those with glucose intolerance. Finally, treatment strategies involve managing fat malabsorption, and supplementing with high-calorie, high-protein supplements.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
Dr. Daphnee D K
Chief Clinical Dietitian Apollo Hospitals, Chennai Head, Dept of Dietetics, Apollo Hospitals, Chennai
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