Final CTN Liver Cirrhosis Meal Plan

Case: RA, 55-year-old man presents to the hospital with complaints of fatigue for 2 months.
The patient
has a significant medical history of chronic heavy alcohol consumption of about one bottle of gin daily
for around 20 years. Physical examination revealed an anorexic patient weighing 50kg and 5’4 ft tall and
is oriented to person, time, place and date. The patient is also noted to have icteric sclera and loss of
appetite. There were no splenomegaly, negative fluid wave and shifting dullness noted. Laboratory
examination shows low hemoglobin, low sodium, elevated AST and ALT, and moderately prolonged PT.
Ultrasound of the abdomen shows liver with few irregular nodules on the surface, increased echogenicity
and focal atrophy. The patient is known to have a very light activity which includes seating and typing
activities. Laboratory results were reported in this table:
Diagnosis: Liver cirrhosis, compensated
Na, 132 mEq/L AST- 50 IU

K – 3.7 mEq/L ALT – 58 IU
Cl, 98 mEq/L Hct, 35%
Bicarbonate, 26 mEq/L Alkaline phosphatase -140 IU
BUN, 20 mg/dL LDH - 320 IU
SCr, 1.2 mg/dL Total Bilirubin, 1.8 mg/dL
Hgb, 11.5 g/dL PT, 16 seconds (INR 1.8)
COMPUTATIONS
A. Ideal Body Weight B. Energy for BMR
50 kg + 2.3 kg (for each inch over 5 Harris – Benedict Equation
feet) BMR = 66 + (13.7 x weight in kg) + (5 x ht. in cm) – (6.8 x
50 kg + (2.3 kg x 4) age in years)
IBW=59.2 kg =66+ (13.7 x 50 kg) + (5 x 162.56 cm) – (6.8 x 55 y/o)
=66 + (685) + (812.8) – (374)
=1189.8 or 1190kcal
C. % Ideal Body Weight D. Total Caloric Requirement
ABW / IBW x 100 % TCR = BMR x Activity Factor x Injury Factor
50 kg / 59kg x 100 % *Activity Factor = 1.3
% IBW =84.75 % *Injury Factor = 1.4
BMR = 1190 kcal
TCR = 1,190 kcal x 1.3 x 1.4
= 2165.8 or 2170 kcal
GUIDELINES FOR MEETING NUTRITIONAL GOALS

Non-protein Energy Protein Intake (g/kg/day)
(Kcal/kg/day)
Patients with compensated cirrhosis 25-35 kcal/kg/day 1-1.2 g/kg/day
Patients with complicated cirrhosis 35-40 kcal/kg/day 1.5 g/kg/day

assoc. with malnutrition
If stage I or II Hepatic Encephalopathy 0.5-1.5 g/kg/day
is present
If stage III or IV Hepatic 0.5 g/kg/day

Encephalopathy is present
PRINCIPLES FOR DIETARY MANAGEMENT(Liver Cirrhosis, compensated)

Chronic liver disease is often associated with muscle and body fat loss. So a high potein diet is
important for people with chronic liver disease as the protein is used to maintain muscles and body
tissues (including the liver) and to keep the function of the body normally.
Patients with liver cirrhosis should receive 35–40kcal/kg per day[9] with a protein intake up to
1.6g/kg per day.[1,9] For those with compensated liver cirrhosis this goal can be achieved with a
normal diet without any restrictions in carbohydrates, proteins or fat
Eating six to eight smaller meals and snacks throughout the day can help you get more nutrition
than having three normal sized meals. Small frequent meals is recommended.
The patient should receive a late evening snack to compensate for the overnight fasting period and
to avoid gluconeogenesis
Replace tea, coffee or water with fluids that provide energy (such as milk, juice) especially if you
are on a fluid restriction.
Add eggs, legumes, yoghurt or low salt cheese to your meat dishes or salads.
Oral feeding with the addition of oral supplements is generally the rule in many hospital units as
far as cirrhotic patients are concerned. The study of Campillo et al. showed that oral dietary intake
improved after a long hospital stay with oral nutritional support and the help of a dietician within a
period of 2–3 weeks in the majority of patients.
It is important to state that alcohol abstinence should be seriously considered. Alcohol intake not
only aggravates liver function but has a potential negative role in deteriorating malnutrition.
References: health.qld.gov.au
http://www.medscape.com/viewarticle/575158_4
Distribution of CHO, CHON and Fats
PROTEIN REQUIREMENT
Protein requirement = 1.2 g/kg x 50kg
= 60g
= 60g x 4
= 240 kcal for proteins
Energy from Non-protein = TER- Kcal from protein

= 2170 kcal - 240kcal
=1930 kcal
CHO (70%) = 1930 x 0.70 = 1351 kcal
= 1351 /4
= 337.75 grams or 338 grams
Fats (30%) = 1930 x 0.30 = 579 kcal
= 579/9
= 64.33 grams or 64 grams
Diet RX: Kcal 2170 CHO 338g (62%) CHON 60g (11%) FATS 64g (27%)
338g 60g 64g
FOOD EXCHANGE CHO CHON FATS ENERGY

Veg A 4 6 (3) 2 (1) - 32
Veg B 3 9 (3) 2 (1) - 44
Fruits 8 80 (10) - - 320
Milk 4 48 (12) 32 (8) 40 (10) 680
Sugar 6 30 (5) - - 120
338g-173= 173
165/23= 7
exchange
Rice 7 161 (23) 16(2) - 708
75-52= 23/8= 52
3 exchange meat
Meat, LF 1 - 8 (8) 2(2) 50
62 -42= 20/5 = 42
4 exchange fat
Fats 4 - - 20 (5) 180
Total 37 334 60 62 2134
FOOD No. of Breakfast AM Snack Lunch PM Snack Dinner Late

exchange Evening
Snack
Veg A 4 2 2
Veg B 3 1 1 1
Fruits 8 2 2 2 1 1
Milk 4 2 1 1
Sugar 6 2 1 1 2
Rice 7 2 2 2 1
Meat, LF 1 1
Fats 4 2 2
TOTAL 37 9 5 8 3 7 5
24 hour meal plan
BREAKFAST
FOOD EXCHANGE MENU CHO CHON FAT
Veg B 1 ½ cup cooked 3 1
mashed kalabasa
Fruits 2 2 medium slice 10 20
x 6 x 2 cm, ripe
papaya
Milk 2 8 24 16 10
Sugar 2 4 tsp 10
Jam/Jelly/Preserve
Rice 2 4 pcs 7 x 4cm pan 46 4
de sal
TOTAL 9 103 21 10
AM SNACK
Fruits 2 2 small 10 x 4 20
cm saging saba
Sugar 1 1 tsp brown 10
sugar
Fats 2 2 ½ medium 12 10
x 7 cm avocado
TOTAL 30 10
LUNCH
VEG A 2 2 CUP, COOKED (45G) AMPALAYA, DAHON AT BUNGA 6 2
(BITTERMELON) MIXED WITH NILAGANG ATAY
VEG B 1 ½ CUP, COOKED (45G) KALABASA, BUNGA (SQUASH FRUIT) 3 1
MIXED WITH NILAGANG ATAY
FRUITS 2 6 SEGMENTS 8X4X3 CM SUHA(POMELO) 20
RICE 2 1 CUP COOKED RICE 46 4
MEATS,LF 1 1 SLICE 4 ½ X 3 X1 CM ATAY (LIVER) OF PORK NILAGA 8 2
TOTAL 8 75 15 2
PM SNACK
FOOD EXHANGE MENU CHO CHON FAT
SUGAR 1 ½ TBSPS UBE HALAYA 5
FATS 2 1 MEDIUM 12X7CM AVOCADO RED 10
TOTAL 3 5 10
DINNER
FOOD EXCHANGE MENU CHO CHON FATS
VEG A 2 1 CUP, RAW PETSAY SLICE IN TINY BITS 3 1
(CABBAGE) 25G MIXED WITH SEAWEED WRAP
VEG B 1 ½ CUP DRIED GAMET (SEAWEED) WRAPPER 3 1
FRUITS 1 1 MEDIUM SLICE 11X6 CM MANGO, MEDIUM, RIPE 10
WRAPPED WITH SEAWEED AND RICE.
MILK 1 1 GLASS COW’S FRESH MILK 12 8 10
RICE 2 1 ½ OF SLICE BIKO 10 X 5X1 CM MIXED WITH 46 4
PETSAY AND MANGO WRAPPED BY SEAWEEDS
TOTAL 7 74 14 10
LATE EVENING SNACK

FOOD EXCHANGES MENU CHO CHON FATS
FRUITS 1 1 CUP STRAWBERRY 10
MILK 1 4 LEVEL TEASPOONS POWDERED MILK 12 8 10
SUGAR 2 ½ BAR – 8CM PEANUT BRITTLE 10
RICE 1 1 SLICE- 3X2X2CM CHOCOLATE CAKE 23 2
TOTAL 5 55 10 10

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Case: RA, 55-year-old man presents to the hospital with complaints of fatigue for 2 months.

Na, 132 mEq/L AST- 50 IU

GUIDELINES FOR MEETING NUTRITIONAL GOALS

Patients with complicated cirrhosis 35-40 kcal/kg/day 1.5 g/kg/day

If stage III or IV Hepatic 0.5 g/kg/day

PRINCIPLES FOR DIETARY MANAGEMENT(Liver Cirrhosis, compensated)

Energy from Non-protein = TER- Kcal from protein

FOOD EXCHANGE CHO CHON FATS ENERGY

FOOD No. of Breakfast AM Snack Lunch PM Snack Dinner Late

LATE EVENING SNACK

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