Valentina Medici MD Associate Professor Division of Gastroenterology and Hepatology University of California Davis Dietary choices and recommendations Liver disease stage Presence of associated conditions ID: 759517
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Slide1
Diets and Nutrientsin PSC
Valentina Medici M.D.
Associate Professor
Division of Gastroenterology and
Hepatology
University of California Davis
Slide2Dietary choices and recommendations
Liver disease stage
Presence of associated conditions
(ulcerative colitis, obesity, diabetes)
Age
Cultural background
Slide3PSC Mild or no liver disease
PSC Advanced liver disease
Post liver transplant
Slide425-35 Kcal/Kg/day
PSC- early stages
Healthy choicesNo specific restrictions
Daily calorie requirement
Whole grains
Monounsaturated fats-mix in Omega-3 fatty acids
(avocados, olive oil, olives, nuts, soybeans)
Low saturated fats and refined sugars
Favor lean proteins (plant-based proteins)
Slide5Bile flow: reduced breakdown and
absorption of fat in
the intestinal tract
Fat
malabsorption
and deficiency
Slide6PSC
Protein synthesis
Fat absorption
Sodium and fluid
retention
Blood sugar
Slide7Malnutrition and survival
Malnutrition
predictor of poor quality of life
and increased mortality
Sarcopenia higher mortality among liver
transplant patients
Slide8Psoas muscle thickness- CT scan
Durand, J
Hepatology 2014
Transversal psoas muscle
thickness
is associated with mortality
Slide9PSC- Advanced Liver Disease
Decreased oral intake
Decreased intestinal absorption
Increased energy expenditure
The fuel sources used by patients with cirrhosis after a
10-hour fast
are the same as
3-day fast
in a subject with healthy liver
Rapid loss of lean body mass and wasting
Slide10Nocturnal nutritional supplementation improves total body protein status
Plank,
Hepatology 2008
Daytime
vs
nighttime supplementary nutrition
Slide1135-40 Kcal/Kg/day
PSC- advanced stages
Daily calorie requirement
25-30% calories from fat1.5 gram/kg/day protein
Example: 150lbs person
would need 70-100 grams of protein per day (or ~30 grams of protein per meal)
Slide12Golden rules
Small/frequent meals
Short fasting time
Bedtime snack (proteins)
Early morning breakfast (complex carbohydrates and proteins)
High proteins (1.5 grams/Kg/day)
Avoid skipping meals
<2000 mg of sodium daily if ascites/edema
Slide13Proteins
High-Biological Value Sources
Eggs
(whites) or egg substitutes
Milk
, yogurt, cottage
cheese
Chicken
, Fish,
Turkey
Other Good Sources
Beans
and legumes Soy products, tofu
Whole grains such as Quinoa, and Wild Rice
Nuts – whole or as a butter product
Slide14Fats
Include healthy fats in your diet:
Monounsaturated
and polyunsaturated fats
(olive
, canola and peanut oils, avocados, safflower, sesame, soy, corn and sunflower-seed oils, nuts and
seeds).
Flaxseed is a good source of Omega 3’
s
Limit
unhealthy fats:
Saturated
Fats: fatty meat, poultry skin, bacon,
sausage
Trans fats (margarine
, shortening, some fried
foods
)
Slide15Vitamins
Signs of deficiencyRecommended daily intakeVitamin ASkin scaling, follicular hyperkeratosis25,000 IU for 4-12 weeks (repletion)Vitamin D3osteoporosis2,000 IU + 1200 -1500 mg of calciumVitamin Eneuropathy800 IU dailyVitamin Kbleeding90 mcg
Slide16Medium-chain triglycerides
Triglycerides with a fatty acid chain length shorter than long-chain triglyceridesSoluble in water, rapidly hydrolyzed and absorbed
MCT
LCT
Slide17Osteoporosis(Hepatic osteodystrophy)
Weight-bearing exercises
No smoking
No alcohol
Vitamin D and calcium
Bisphosphonate
Slide18Supplements
Ensure Plus or Boost Plus
In case of overweight:
Glucerna
, Boost Glucose-Control, or 1 can of Boost VHC at bedtime
Slide19Coffee and PSC
Controls (n=564)PSC patients(n=480)% of life drinking coffee66%46%Coffee drinker at age 1836%32%Lifetime cups of coffee/month4745Never coffee drinker (%)16%24%
Lammert, Clin Gastroenterol Hepatol 2014
Coffee drinking at the age of 18 years (p = .048) was independently and negatively associated with PSC
Andersen, Clin Gastroenterol Hepatol 2014
Slide20Probiotics
Beneficial effects in liver diseasesSubstances derived from the gut, could damage the liver and the biliary tractOne study on 14 pts with PSC + IBD, probiotics vs placebo, 3 months no differences in pruritus, fatigue, Bilirubin, alkaline phosphatase, GGT, AST, ALT
Vleggaar
FP,
Eur
J
Gastroenterol
Hepatol
2008
Slide21Curcumin and PSC
Yellow-orange dye obtained from tumericAnti-oxidant, anti-fibrotic propertiesPreclinical data in PSC in-vitro modelOngoing clinical trial (clinicaltrials.gov)
Slide22Post-liver transplant
Avoid raw food, shellfish
Avoid grapefruit juice (interaction with
tacrolimus
)
Healthy eating
Slide23Thank you!