Essay Example on Management Ensuring adequate nutrition

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Management Ensuring adequate nutrition can significantly improve quality of life in HCV patients Good nutrition results in improved compliance with pharmacologic therapy and has also been found to hinder disease progression by preventing the development of HCV complications like Cirrhosis and hepatic encephalopathy In the absence of Decompensated cirrhosis or comorbid conditions like Diabetes Mellitus HCV patients usually do not require special diets However it is imperative that they consume a balanced diet containing an adequate amount of calories and proteins to fight the infection as well as antioxidants to combat free radicals responsible for hepatocyte damage In addition frequent small meals have been found to improve nitrogen and substrate use diminish fat and protein oxidation and prevent depletion of glycogen stores 



Major principles in Management of malnutrition in Chronic HCV revolve around restoring muscle health In accordance with this most interventions are focused on providing a diet that is adequate in proteins and calories and integrate physical activity into the patient's lifestyle Because management of malnutrition in such patients is directed at addressing the underlying etiology it is important to obtain a good understanding of the nutritional intake patterns and barriers to healthy eating The best way to achieve that is through a detailed history and physical exam at each clinic visit as well as counseling sessions with a dietician who may be able to further draw up an individualized plan for each patient based on his her need Because a dietitian may not be available in many clinical settings physicians may need to familiarize themselves with guideline recommendations for both diet and activity HCV Patients who are unable to meet their caloric requirements due to a diminished nutrient intake and early satiety should be advised to take frequent small volume meals up to 4 6 times day Amodio et al 2013 Patients presenting with refractory ascites with a low MELD score and those suffering from portal hypertensive enteropathy may be offered TIPS in order to improve nutrient absorption 



Replacement of trace elements such as zinc magnesium and vitamin A may be considered in patients presenting with food aversion due to micronutrient deficiencies as per their symptoms and serum levels Enteral feeding via a feeding tube is only recommended for patients who are unable to consume food orally despite the above interventions as tolerance is often an important issue with a significant number of patients prematurely removing their feeding tubes themselves Therefore an oral route should be preferred as the first-line intervention even in the presence of complications like esophageal varices Due to the high risk of complications PEG tube placement is discouraged as well Patients with cirrhosis are prone to fluctuating sugar levels and are thus advised to avoid fasting longer than 6 hours as it may trigger a hypoglycemic episode and lead to additional complications Cirrhotic patients are also advised to take small frequent meals throughout the day as well as an evening snack of complex carbohydrates to decrease lipid oxidation and reduce skeletal muscle proteolysis It is generally recommended that HCV patients limit fat to 25 of the total calories in their diet


The general recommendation for diet composition is to limit Carbohydrates to 50 mostly in the form of complex sugars protein to 20 and total caloric intake to 30 40 kcal Kg day of the desirable body weight It is also recommended that the consumption of processed sugars like fructose be avoided given its association with increases in the severity of liver fibrosis in HCV patients with genotype 1 Petta et al 2013 Substances like alcohol that can significantly enhance the rate of disease progression should also be avoided DIETARY SUPPLEMENTATION For patients with advanced liver disease presenting with steatorrhea due to bile acid deficiency fat-soluble vitamins and medium-chain triglycerides that do not need bile for absorption may be supplemented in their diet These are often available as nutritional drinks and can be easily taken even by patients with reduced tolerance to oral intake Consuming vegetable-based proteins that contain fewer aromatic amino acids and supplementing the diet with branched-chain amino acids should also be considered in patients at risk for hepatic encephalopathy which is often accompanied by an impaired balance of these amino acids


Some studies have also implicated treatment with interferon and ribavirin in inducing this imbalance in the early stage of therapy which further suggests the importance of correcting this imbalance early in the course of the disease PHYSICAL ACTIVITY Moderate physical activity is recommended for all HCV patients and has shown improvements in muscle mass exercise capacity and quality of life in general Román et al 2014 Zenith et al 2014 Berzigotti et al 2017 Exercise will not affect the course of infection but it can help relieve fatigue stress and depression as well as improve appetite and strengthen immunity HCV patients can also benefit from physical activity due to its effect on obesity For patients with decompensated cirrhosis however physical activity needs to be carefully prescribed and individualized to each patient s exercise tolerance and presence of complications like esophageal varices Deconditioning and fatigue are major issues for patients with cirrhosis that represent significant barriers to physical activity Ney et al 2017 Formal guidelines for physical activity in cirrhosis are not yet available Therefore it is important that all patients undergo screening for varices and the required variceal prophylaxis before an exercise regimen is initiated García et al 1996 Bandi et al 1998

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