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Nut Mgt for CLD - Intervention (MNT) (Goals (Optimise energy intake…
Nut Mgt for CLD - Intervention (MNT)
Goals
Optimise energy intake
Prevent wt loss
Improve/maintain optimal nut. status
Particularly relevant for transplant candidates
Optimise protein intake
Prevent muscle wastage
Prevent adverse effects assoc w re-feeding
Monitor fat soluble vitamins and trace elements
Replace if deficient
Improve overall dietary intake
Outpatient setting
Reduce dietary sodium intake if fluid overload
MNT Strategies - EN/TPN
Enteral Nutrition
Unable to meet rqts' orally
Functional GIT
Naso-enteric tube
Malnourished
PEG placement not recommended
Formula:
Polymeric
Nutrient dense
Low volume
Low Na/K
Low fat if steatorrhea exists
Parental Nutrition
Non-func GIT
Malnourished
Severe vom/diarrhoea
Solution
Low volume
Standard or modified electrolyte
Normal fat solutions
MNT Strategies - Emerging therapies
Night feeding
Reduce pro catabolism
Encourage a late night E&P snack
Reduce period of fasting
BCAA's
No improvement in HE
Overall improvement in Nut status of cirrhotic pts
Cost/palatability hinder compliance
Inconclusive evidence
Probiotics
May be as effective as lactulose in HE
MNT Strategies - Fat
Low fat if steatorrhea
MCT better tolerated
Usually no restriction
MNT Strategies - Protein
1.0-1.5g/kg/day
May be restricted early in HE until cause is identified (0.6-0.8g/kg/day)
Pro restriction no longer advised
MNT Strategies - Energy
Oral supplements
Divide into 4-6 meals/day
145-160kJ/kg/day
EN if indicated
MNT Strategies - Sodium
NAS diet 2300-2800mg if no ascites/oedema
Low salt diet, <1800mg, for severe ascites, hyponatremia
Lower Na diet not very effective in refractory ascites
Na restricted diet can impact overall dietary intake and contribute to malnutrition