NUTRITION AND

GASTRONTESTINAL DISEASES

Prepared by Dr. Samar H. El- Nakhal

 Liver Anatomy
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 It's a large organ in the

body (1500-1600g).
 Blood flows to liver via:
75% portal vein
25% hepatic artery
 Blood drains from the
liver to hepatic veins to
inferior vena cava to Rt.
atrium.
 Liver is capable to
regenerate itself when
part of it is removed.
Dr. Samar El-Nakhal
 Liver Functions
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 Synthesis of many substances to maintain

body functions.
 Storage of important nutrients.
 Transformation and disposal of waste
products, drugs and toxins.

Dr. Samar El-Nakhal

 Synthesis
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 Glycogen synthesis.
 Proteins synthesis:
Serum albumin, coagulation factors and
carrier proteins.
 Lipids: cholesterol and lipoproteins are
synthesized by the liver.
 Bile formation: which helps in the absorption
of fats.

Dr. Samar El-Nakhal

 Storage
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 Liver stores important substances such as

glucose in the form of glycogen.
 Liver stores fat soluble vitamins, vitamin B12 and

minerals such as copper and iron.

Dr. Samar El-Nakhal

 Transformation and Waste Disposal
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 Liver removes harmful substances such a

ammonia and toxins from blood, and breaks
them down or transforms them into less harmful
compounds.
 Liver converts ammonia to urea which is
excreted into urine by kidneys. In the presence
of severe liver disease, ammonia accumulate in
the blood, which is toxic especially to the brain.

Dr. Samar El-Nakhal

 Diet for Liver disease
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 A diet for liver disease should provide nutrients

needed to stay healthy, while at the same time
limiting nutrients that can cause further liver
damage.
 Carbohydrates, proteins, fats, vitamins, and
minerals all go to the healthy liver, after
digestion, where they are broken down, stored
or metabolized.

Dr. Samar El-Nakhal

 Diet for Liver disease
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 When the liver is damaged, these nutrients still

come to the liver after they have been
digested.
 But, once they arrive, the liver cannot process

them and they build up. This accumulation

causes more liver damage.

Dr. Samar El-Nakhal

 Diet for Compensated Liver Disease
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 Consume low-sodium diet (4 g of salt).

 Protein requirements in most patients with
compensated chronic liver disease are not
different from normal (0.8 g/kg).
 Adequate protein intake:

 Promotes liver cells to regenerate, and

 Helps to maintain muscle bulk.

Dr. Samar El-Nakhal

 Malnutrition in Decompensated Liver
10
Disease
 Assessment of nutritional status in liver disease
is often complicated by the effect of impaired
liver function.
 Malnutrition is common among patients with
decompensated liver disease, as they usually
experience weight loss, edema and muscle
wasting.
 Malnutrition is due to decreased intake of
food, or decreased ability to process food.

Dr. Samar El-Nakhal

 Diet for Decompensated Liver
11
Disease
Diet for a person with decompensated liver
disease would include:
 A limited amount of sodium.

 More carbohydrate.

 A balanced amount of protein.

 A moderate amount of fat. Fat provides

calories, essential fatty acids, and fat-soluble
vitamins.

Dr. Samar El-Nakhal

 Sodium and Decompensated Liver
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Disease
 Liver damage can cause portal hypertension
(high blood pressure in the portal vein).
 Portal hypertension can result in ascites, a fluid
accumulation in the abdominal cavity.
 Limiting sodium and fluids can help in limiting
ascites.

Dr. Samar El-Nakhal

 Sodium and Decompensated Liver
13
Disease
 Sodium restriction to 0.8 g of sodium/day (2 g
of salt), is the cornerstone of the management
for ascites.

 Patients following low sodium diet for 2-3

months usually lose their salt craving
indefinitely.

Dr. Samar El-Nakhal

 2 gram Salt Diet (0.8 g Sodium)
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 High-Na and moderate-Na foods, canned

and processed foods are omitted.
 Table salt is not allowed at meals or during
cooking. Replace salt shaker with herb shaker.
 Regular bread is limited (2 pita are allowed,
additional bread must be salt free).
 No more than 2 cups of milk per day.

Dr. Samar El-Nakhal

 Carbohydrates and Decompensated
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Liver Disease
 Healthy liver makes glycogen from glucose.
Glycogen is then broken down when the body
needs energy.
 A damaged liver cannot do this. Without

glycogen, a consistent supply of carbohydrate

is needed from the diet to make sure the body
has enough energy and to maintain normal
blood glucose level.

Dr. Samar El-Nakhal

 Carbohydrates and Decompensated
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Liver Disease

 Carbohydrates, in the form of small frequent

meals, should be the major source of calories
(60-70%) for people with liver disease.
 Adequate CHO intake has “protein-sparing
action”.
 Fasting would not be safe for patients with
decompensated liver disease.

Dr. Samar El-Nakhal

 Protein and Decompensated liver
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Disease

 Patients with cirrhosis require a balanced

diet rich in protein, helping liver cells to
regenerate and to preserve muscles.

 Protein in amounts of 1 to 1.5 g/ kg/ day is

recommended in patients with chronic liver
disease including cirrhosis.

Dr. Samar El-Nakhal

 Protein and Decompensated liver
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Disease
 However, in people with severely damaged
livers, proteins are not properly processed.
Waste products such as ammonia are toxic to
the body and may accumulate affecting the
brain (hepatic encephalopathy). In this case,
protein may be restricted transiently.
 Protein-restricted diet in decompensated liver
disease should provide at least 0.6 g of
protein/kg/day (no benefit with much sever
restriction).
Dr. Samar El-Nakhal
 Food contents of protein
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 .

Food item Protein in food

100 gram of meat 22-25 gram (g)
1 Egg 5-6 g
Cup of milk 7.5 g
Cup of cooked beans, lentil 18 g
100 g of nuts 20 g

Dr. Samar El-Nakhal

 Gall Bladder Stones
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 The formation of cholesterol stones is the

consequence of cholesterol crystallization from
gall bladder bile.
 Cholesterol will only crystallize into stones

when the bile is supersaturated with cholesterol

relative to the bile salts.

Dr. Samar El-Nakhal

 Gall Bladder Stones
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 This can occur as a consequence of excess

cholesterol secretion into bile.
 A high-cholesterol diet increases biliary
cholesterol secretion and increases cholesterol
gallstone.

Dr. Samar El-Nakhal

 Gall Bladder Stones
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 Decrease the intake of cholesterol and

saturated fats.
 Increase the intake of phytosterol.

 Increase the intake of NSP.

 Decrease the intake of refined carbohydrates.

 Be well hydrated.

Dr. Samar El-Nakhal

 Coeliac Disease(gluten-sensitive
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enteropathy)
 Coeliac disease is a condition in which there is
inflammation of the mucosa of the upper small
bowel that improves when gluten is withdrawn
from the diet, and relapses when gluten is
reintroduced.
 Gluten is the entire protein content of the
cereals wheat, barley and rye.
 Gliadin is the damaging factor in wheat.

Dr. Samar El-Nakhal

 Coeliac Disease(gluten-sensitive
24
enteropathy)
 Management is with a gluten-free diet for life,
by dietary elimination of wheat, barley and
rye.
 Oats are tolerated by most coeliac patients.

 Rice, corn, meat, dairy products, fruits and

vegetables are naturally gluten-free and are

all safe.
 Breast-feeding and the age of introduction of

gluten into the diet are significant.

Dr. Samar El-Nakhal
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???

Dr. Samar El-Nakhal

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Thank you

Dr. Samar El-Nakhal