Nutrition in the Management of Liver Disease and the Associated Health Disparities

Shauna Dixon, Chimene Castor EdD, CHES, MS. RD, LDN

Howard University, Dept. of Nutritional Sciences , Division of Allied Health Sciences, Washington DC 20059

ABSTRACT
Introduction/ Background The liver is a vital organ and gland in the
human body, it performs over 500 functions that are needed for survival,
there are many diseases that can affect these processes. The highest
prevalence for liver disease is found in American Indian/ Alaska Natives
populations, while the highest prevalence for hepatocellular carcinoma is
found in the Asian/ Pacific Islanders population. There are several causes
for liver disease, which include excessive alcohol intake and drug use and
hereditary liver diseases.
Method The purpose of this study is to examine nutritional status in
relationship to liver disease, using the nutrition care process. It was
completed by executing a literature review of current pertinent information
in reference to liver disease and its relation to nutrition. An interview was
performed and with the patient and medical team, and the electronic
medical records were reviewed. The patient presented was African
American and presented with the following liver diseases hepatitis C, liver
cirrhosis, hepatocellular carcinoma and ascites.
Results The patient refused lifestyle changes that included lowering
sodium intake.
Discussion and Conclusion Upon completing this case study and literature
review it was shown that the communities that are mostly impacted by liver
disease and hepatocellular carcinoma are American Indians/ Alaska Natives
and Asian Pacific Islander respectively. Nutritional recommendations for
liver disease patients in general is to focus on suppression of hepatotoxic
agents and the provision of optimal macronutrient supply in terms of
energy, protein, carbohydrates and lipids together with micronutrients such
as vitamins and minerals.

HEALTH DISPARITIES
Prevalence: 3.0 million people (2011)
Ambulatory care visits: 635,000 (2009) (cirrhosis only)
Procedures: 6,342 (2011) (liver transplants)
Hospitalizations: 1.2 million (2010)
Mortality: 42,923 deaths (2010)
Prescriptions: 731,000 (2004)

Females

Measurement
Height
Weight
BMI
IBW
%IBW

Values
66in. (167.6cm.)
180lbs. (81.8kg)
29kg/m2
130lbs 13lbs
138%

Parameter
Energy Needs

Value
= 1364kcal
Stress Factor = 1.3
Activity Factor = 1.2
Total kcal= 2128kcal
= 1.2-1.4g/kg = 98g115g
= 1500ml (approx. 6
cups)

RESEARCH POSTER PRESENTATION DESIGN 2015

www.PosterPresentations.com

Food preferences include:

Grilled Cheese
Ham and Cheese sandwiches
Fried pork chops with french fries
Soda
Current PO intake 75-100% - per nursing

NUTRITION DIAGNOSIS

Sodium

P.E.S #1
Problem - Poor nutrition quality of life (NB-2.5), increased nutrient needs
(protein) (NI-5.1) and impaired nutrient utilization (NB-2.1)
Etiology - related to undesirable food choices and past drug abuse
Signs and Symptoms - as evidenced by a right leg ulcer for 20-25 years
and cirrhosis of the liver.

Problem - Altered nutrition related lab values (NC-2.2)

Etiology - related to hepatocellular carcinoma, hepatitis C, and cirrhosis
Signs and Symptoms - as evidenced decreased hemoglobin 8.8,
hematocrit 28.1, WBC 2.6, platelets levels 82, and elevated AST 73, ALT
67 and bilirubin levels 1.3.

GOALS
Increase intake of protein 98g- 115g
limit the intake sodium to 2g.

Normal
Range

11/10

11/15

135-148
mEq/L

133 L

133 L

2g Sodium Diet with 2100 kcal with double portions of protein,

3 meals per day including an evening snack, 1500ml (6 cups) of fluid per
day
A Multivitamin with vitamin C

9.3 L

8.8 L

NUTRITION EDUCATION

Hemoglobin 12-16g/dL
Hematocrit

35-45%

27.1 L

28.1 L

Platelets

150-450 x
103 per uL

89 L

82 L

Blood Urea
Nitrogen
(BUN)

7-25 mg/dL

5L

WBC

4.5-11 x103
per uL

2.3 L

2.6 L

Alanine
7-35 U/L
Transaminas
e (ALT)

65 H

67 H

Bilirubin
Level

1.2

1.3 L

0.21.2mg/dL

PO intake at least 75% of nutrient needs daily

Nutrition relates labs- WNL
Weight - is expected to decrease to the fact that she is on diuretic therapy for
her ascites and CHF

CONCLUSION
In summary the communities that are mostly impacted by liver disease are
American Indians/Alaska Natives and Asian Pacific Islanders. Studies
show that it is least likely for an African American to have liver diseases in
comparison to their counterparts. My patient who is an African American
woman was found to have the hepatitis C, cirrhosis, hepatocellular
carcinoma and ascites. Nutritional recommendations for liver disease
patients in general is to focus on suppression of hepatotoxic agents and the
provision of optimal macronutrient supply in terms of energy, protein,
carbohydrates and lipids together with micronutrients such as vitamins and
minerals. (Bmeur et al., 2014) While ESPEN guidelines may recommend
4 to 7 meals per day with at least one late evening meal to improve
nitrogen economy and substrate utilization in stable cirrhotic patients,
given my patients psychosocial status I am recommending 3 meals a day
with a snack. Outpatients should be given late night snacks in order to
prevent muscle wasting. (McClain et al., 2013) Late night snacks prevent
muscle wasting by minimizing gluconeogenesis, reducing protein
utilization and favoring a positive nitrogen balance.

NUTRITION INTERVENTION

Total

Race

Food/ Nutrition Related Assessment

P.E.S #2

NEEDS ASSESSED

LABS REVIEWED

Total

MONITERING AND EVALUATION

ANTHROPOMETRICS

Fluid

Total

Total
Age-Adjusted Death Rates
per 100,000 persons

The case is as follows RB is a 69-year-old African American female

presented to the emergency room with chief complaint of an infected leg
ulcer that was excessively bleeding. Patient has a past medical history of 2025 year right leg stage IV ulcer, osteomyelitis, hepatitis C, liver cirrhosis,
hepatocellular carcinoma, ascites, hypertension, congestive heart failure
(CHF), and asthma. Patient has a history of alcohol, tobacco, heroin and
cocaine abuse. Her medical charts states that she drank and smoke
approximately: 2 16oz beers 3-4 times per week, 2 fifths (1500ml) of wine
per day and a fifth (375ml) of vodka per day and she smoked 2-3
cigarettes per day. She is currently enrolled in a methadone clinic x 1 year for
her prior heroin abuse. She works as a cashier, lives with her son and is
receiving supplemental security income (SSI) and disability.

Protein

Liver Cancer
Cancer Incidence and Mortality Rates per
100,000 Persons by Race & Gender : U.S., 19992012
Males

NUTRITION ASSESSMENT

CASE STUDY

High protein foods and food safety

NUTRITION COUNSELING
Fluid restriction

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