How is nutrition managed in patients with liver disease?

Nutrition of patients with liver disease is important, which is no less important than antiviral, anti-infective, hepatoprotective and other drug treatments, especially the nutritional status of patients with decompensated cirrhosis, severe hepatitis and hepatocellular carcinoma has a direct impact on the patient’s prognosis, and relates to the success or failure of the therapeutic effect. It has been found that about 80.3% of cirrhotic patients suffer from malnutrition, such as emaciation, weight loss, reduction of muscle tissue, persistent fatigue, low albumin, slow recovery of liver function, recurrent ascites, and infections. Early nutritional supportive therapy can enhance quality of life, reduce complications, and improve prognosis. Many patients with chronic liver disease suffer from loss of appetite, poor gastrointestinal peristalsis and emptying ability, and ascites compression, resulting in eating less, drinking less, and absorbing less; discharge of ascites, gastrointestinal hemorrhage, high metabolism, and consumption of tumors are lost and consumed, presenting a “not enough to cover the expenses” deteriorating state. Because of malnutrition, physical strength decline, physical weakness leads to infection, water and electrolyte disorders and other complications, forming a vicious circle. Malnutrition is further exacerbated by patients’, families’ and medical staff’s biased concepts of nutritional neglect and excessive restriction. Scientific assessment of nutritional status, identify the causes of malnutrition, and formulate targeted nutritional interventions. The simplest and most effective way is to have small and frequent meals, and to have additional meals at night. For patients with liver disease, it is generally appropriate to have 35~40 calories and 1.2~1.5 grams of protein per kilogram of body weight per day, and the day’s food can be divided into 4~6 meals, with additional meals at night. A study of 50 cases of decompensated cirrhosis nutritional support therapy for 4 weeks showed that 86% of patients given nutritional support therapy improved nutritional status, 82% of ascites disappeared, (52% of the control group) complications of only 8% compared with 38% of the control group, the difference is obvious. Another study showed that intensive nutritional therapy promoted healing of endoscopically treated wounds of cirrhotic esophageal varices. In patients with hepatic encephalopathy, dairy and vegetable proteins are better tolerated than animal proteins such as fish and meat and should be prioritized. Nighttime meals for patients with chronic liver disease are given extra attention and recommended, “the liver is not strong without nighttime meals”. European scholars have found that the metabolic abnormalities caused by starvation of cirrhosis patients for one night (12 hours) are equivalent to the changes in normal people starved for three days. Many patients with liver disease wasting, low albumin is not easy to correct, liver function is difficult to return to normal, one of the important reasons, is the body fat and protein are oxidized and decomposed to participate in the energy supply, seriously affecting the regeneration of liver cells and liver function recovery. If liver disease patients have a meal at night, it will reduce the oxidative decomposition of body fat and protein. The time to add a meal is recommended between 9:30 and 10:30 p.m., with carbohydrates as the main focus, you can appropriately increase protein, moderate supplementation of vitamins and micronutrients. Specifically, you can choose lotus root powder, sesame paste, yogurt, milk, hot soy milk and new liver nutrients such as Nuva. If conditions are limited, adding the simplest steamed buns and rice porridge can also get some results. It can be gradually increased from a small amount and adjusted in time. For patients with diabetes or abnormal blood glucose, as long as the adjustment of insulin or glucose-lowering drugs generally do not need to strictly limit the intake of glucose. Each person’s condition is different, and the timing, type, and amount of additional meals should be analyzed on a case-by-case basis. After three weeks or more of a very simple nutritional intervention-adding meals at night-some patients will see a stabilization or even a rise in albumin, a gradual subsidence of ascites, and a significant reduction in the chance of abdominal infection. More patients will notice a reduction in fatigue, a better complexion, and an increase in body mass. Meanwhile with other treatment measures, the recovery will be faster and better.