Lecture 4 Nutr in Hepatic Disorders

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NUTRITIONAL MANAGEMENT IN HEPATIC DISORDERS
Nur Fatimah, dr, SpGK, MS Departement of Medical Nutrition
www.themegallery.com
INTRODUCTION Liver : Is an Organ of Prymaary importance to the body The Largest Gland in the Body Play important part in digestion and metabolism Although only 10%-20% of functioning liver is required to sustain life, Removal of the liver will result in death within 24 hours
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Metabolic function of liver Carbohydrate, lipid and protein metabolism Storage and activation of vitamins and mineral Formation and excretion of bile Convertion of ammonia to urea Metabolism of steroids Detoxification
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Intermediate metabolism of carbohydrate
Heksose isomerization Maintain blood glucose (glycogenesis/lysis) Gluconeogenesis (from lactate, glucogenic amino acid)
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Intermediate metabolism of lipid
Synthesis acetyl CoA from fatty acid Synthesis and hydrolysis triglycerides, phospholipids, cholesterol and lipoproteins Synthesis of bile
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Intermediate metabolism of protein Synthesis of visceral protein (albumin, transferin, ceruloplasmin), coagulation factor, apolipoprotein Gluconeogenesis (produce new glucose from precursor as Lactid acid, glycogenic amino acid) Urea cycle. Synthesis of non essensial amino acid
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The Detoxification Process Detoxification is a process by which the body transforms toxins and medications into harmless molecules that can be eliminated. It takes place primarily in the liver and to a smaller degree in other tissues
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Detoxification Is Accomplished In Two Phases Phase ICertain enzymes change toxins into intermediate compounds Phase IIOther enzymes convert the intermediate compounds created in Phase I into harmless molecules that are eliminated by the body
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Phase I Enzymes in the cytochrome P-450 system use oxygen to modify toxic compounds, medications, and steroid hormones. This is the first line of defense for the detoxification of all environmental toxins, medications, supplements including vitamins, as well as many waste products that the body produces
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Occurs in the liver If there is increased Phase I clearance without increased Phase II clearance, this can lead to the build up of intermediates that may be more toxic than the original substance. Decreased Phase I clearance will cause toxic accumulation in the body
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Phase I Detoxification Requires Niacin Magnesium Copper Zinc Vitamin C Vitamins B2, B3, B6, B12 Folic acid Flavonoids
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Phase II In this phase large water-soluble molecules are added to toxins, usually at the reactive site formed by Phase I reactions. After Phase II modifications, the body is able to eliminate the transformed toxins in the urine or the feces
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Phase II Detoxification Has Six Phases Glutathione conjugation Amino acid conjugation Methylation Sulfation Acetylation Glucuronidation
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Summary of Phase I and Phase II Phase I and Phase II enzymes are the engines that run the detoxification process. They are fueled by vitamins, minerals, and other key food components. Therefore, if the patient is undernourished or lacks key vitamins or nutrients, they may not be able to detoxify
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Acute liver disorders:

1. Anoreksia 2. Nausea 3. Vomitus
Depletion of glycogen storage
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Chronic liver disorder: Maldigestion, malabsorption Energy metabolism Hypoalbuminemia Malnutrition Vitamin deficiency Detoxification??
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Subjective global assessment for nutrition management in live disease
History:
Weight change apetite Persistent GI problem (nausea, vomitus, diarrhea, constipation)
Physical:
Edema, ascites, muscle wasting.
Existing condition:
Hepatic encephalopathy, GI bleeding, renal insufficiency, infection
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Laboratory assessment:
Liver function nutritional status:
nitrogen balance, visceral protein, immunologic parameter.
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Nutritional therapy
Adequate energy intake Malabsorption: specific nutrient Adapted protein intake Micronutrient supplementation
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Nutritional therapy
Energy intake need: TEE = BEE + PA + SDA (TEF) + stress factor

Basal metabolic rate:
Harris Benedict formula:
Men Women : 66 + (13,7 x BW kg) + (5 x BH cm) (6,8 x age) : 665 + (9,6 x BW kg) + (1,7 x BH cm) (4,7 x age)
Correction factor:
Thermogenic effect of food (10% BMR) Physical activity Stress factor
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Nutritional therapy
Composition:
Protein:
Branch chain amino acid (valine, leucine, isoleucine)
Lipid :
Medium chain fatty acid (MCT)
Carbohydrates :
complex carbohydrates
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Nutritional therapy Consistency :

Adapted to liver capacity Step by step to increase consistency.
Frequency:
Small frequent
Methods :
Intake >60%: per oral Intake <60%: enteral Contra indication via GI: parenteral
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Nutritional therapy with specific condition
Ascites: sodium restriction Encephalopathy: BCAA Glucose intolerance; adapted to blood glucose Fat malabsorption: MCT
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Lecture 4 Nutr in Hepatic Disorders

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NUTRITIONAL MANAGEMENT IN HEPATIC DISORDERS

Nur Fatimah, dr, SpGK, MS Departement of Medical Nutrition

Intermediate metabolism of carbohydrate

Intermediate metabolism of lipid

Acute liver disorders:

Depletion of glycogen storage

Subjective global assessment for nutrition management in live disease

Energy intake need: TEE = BEE + PA + SDA (TEF) + stress factor

Nutritional therapy Consistency :

Nutritional therapy with specific condition

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