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Goal

To stabilize liver function and enhance nutritional status by optimizing the intake of protein, sodium, and fluids. Proper dietary management is key to controlling the progression of cirrhosis and managing complications such as ascites and esophageal varices.

Guidelines for subjects with

1. Liver cirrhosis.
2. Liver cirrhosis with ascites.
3. Esophageal varices.

General principles

1. Patients in stable condition (without edema or hepatic encephalopathy) should maintain a balanced diet with adequate protein and calories.
2. Appropriately consume balanced natural nutrients from the six food categories; top options include meat (as in pork, beef, lamb, and chicken), fish (seafood), soy bean products, eggs, cereals, vegetables, fruits, and oil. Avoid processed foods and strictly avoid any moldy items.
3. Low sodium diet is required once patients’ condition of edema and ascites gets worse. Have patients consume concentrated and solid foods with daily salt intake of 1-4 grams. Monitor patients’ urination frequency and water intake.
4. When patients undergo diuretics, watch out their serum potassium and sodium level; if serum potassium level falls below 3.5 mEq/L, have them consume more potassium-rich foods.
5. Once patients suffer from steatorrhea, reduce their intake of fried and pan-fried foods like sausage ,French fries and fat meat. It is highly recommended that patients work with enriched commercial formula containing medium chain fatty acid.
6. Patients with esophageal varices should reduce stimulating food intake like coffee and spicy sauces; also avoid rough, and hard to chew food. Instead intake soft and mild food; chew slowly and take a small bite. Increase food intake.
7. Quit drinking, smoking, and betel nut chewing. Alcoholic stimulation often places great burden on the liver, tobacco as well as betel nuts would accelerate and deteriorate patients’ liver cirrhosis, and increase patients’ chances of getting liver cancer.
8. Do not use Chinese herb without doctor’s permission. The so-called “good for liver “or the incredible herbal remedy often worsens patients’ health condition.
9. When patients suffer from poor appetite, have them increase their intake frequency with less than regular amount for each meal (4-6 meals per day). Give high-nutrition or high-calorie-density foods (such as pudding, corn soup or ice cream, etc.) to meet the patient's taste and nutritional needs as much as possible. Snack before going to bed can shorten fasting time and improve protein metabolism and nitrogen balance.
10. Develop a daily habit of defecation. Because patients with liver cirrhosis often have the problem of hemorrhoids, daily defecation habits are very important for preventing hemorrhoids. If patients suffer from defecation difficulty, accumulated feces formed in the intestine could result toxic substances that might incur hepatic coma once such toxins invade patients’ brain. Constipation also increases esophageal bleeding; when there is stool with darken color, seek for treatment for it could be a symptom of esophageal variceal bleeding.