Cirrhosis of the liver
Cirrhosis is permanent scarring of the liver. Diet gives enough energy and protein, restricts salt for ascites, and adds a late-evening snack.
At a glance
Dietary principles
| Nutrient | Recommendation | Why |
|---|---|---|
| Energy | About 35 kcal/kg (use dry weight if there is ascites) | Most patients are malnourished and lose muscle fast |
| Protein | 1.2-1.5 g/kg; milk, curd, paneer, dal, egg, fish; vegetable and dairy proteins are better tolerated in encephalopathy | Prevents muscle loss. Older books cut protein to 20-40 g in encephalopathy; current guidelines (ESPEN) avoid long cuts |
| Carbohydrate | Main energy source; 4-6 small meals plus a late-evening snack | The scarred liver stores little glycogen, so long fasts break down muscle |
| Fat | Moderate; MCT oil if fat is not absorbed | Gives energy in small volume |
| Sodium | About 2 g sodium (5 g salt) a day in ascites: no added salt, no pickles, papads or salted snacks | Salt holds water and worsens ascites and oedema |
| Fluid | Normal; restrict to 1-1.5 litres only if blood sodium is very low | Prevents worsening dilutional hyponatraemia |
| Vitamins and minerals | Zinc, thiamine (in alcoholics), B-complex, vitamins A, D, E, K | Poor intake, poor storage and alcohol cause deficiencies |
| Texture | Soft, well-cooked food if varices are present | Hard, rough foods may injure swollen veins |
Foods to include and avoid
| Food group | Include | Avoid or limit |
|---|---|---|
| Cereals | Rice, idli, soft chapati, ragi, oats, salt-free bread | Salted bakery items, instant noodles |
| Protein foods | Milk, curd, paneer (unsalted), moong and masoor dal, egg, steamed fish | Processed meats, dried salted fish, cheese spreads |
| Vegetables and fruits | All fresh vegetables and fruits, well cooked if varices | Pickled vegetables |
| Salt and seasonings | Lemon, herbs, jeera, ginger, tamarind for taste | Table salt, pickles, papads, chips, sauces, baking soda, ajinomoto (MSG) |
| Drinks | Water, unsalted buttermilk, fruit juices | Alcohol in any form; salted lassi |
Sample one-day menu (cirrhosis with ascites, no added salt)
| Meal | Menu |
|---|---|
| Early morning | Milk with sugar; 2 marie biscuits |
| Breakfast | Idli (3) cooked without salt, with mint-coriander chutney and lemon; boiled egg |
| Mid-morning | Papaya or apple |
| Lunch | Rice, moong dal, beans poriyal, curd (all cooked without added salt) |
| Evening | Ragi porridge with jaggery |
| Dinner | Soft chapati (2), paneer curry (unsalted), bottle gourd kootu |
| Late-evening snack | Rice kheer, or milk with bread, at bedtime |
Weigh the patient daily: a weight gain of over 0.5 kg a day usually means fluid, not flesh. The salt-free tray tastes flat, so the dietitian uses lemon, tamarind, ginger and jeera to keep the patient eating.
2 marks: “What is ascites?” Collection of fluid in the abdominal cavity, common in cirrhosis; treated with sodium restriction and diuretics.
5 marks: “Write a note on hepatic encephalopathy and its dietary management.” Toxins such as ammonia affect the brain; confusion, tremor, coma; adequate energy, protein not cut long-term, vegetable and dairy proteins, small meals, late-evening snack.
10 marks: “Discuss the causes, symptoms and dietary management of cirrhosis of the liver.” Define, causes, symptoms and complications (ascites, varices, encephalopathy), principles table, foods to include and avoid, one-day menu.
Cirrhosis diet: enough food, enough protein, no salt, no alcohol, and a bedtime snack.