Hepatitis

Hepatitis is a disease of the liver. It is a condition in which inflammation of liver occurs, resulting in damage of the liver cells. Hepatitis can be acute or chronic and caused due to different strains of viruses such as A, B, C, D and E.

Hepatitis A is an infectious disease caused by hepatitis A Virus (HAV). It is common among children and young adults. It is caused due to contaminated water, food and sewage and transmitted by fecal-oral route.

Hepatitis B and C are caused by HBV and HCV. It is severe and prolonged in nature and can be fatal. It is transmitted by blood transfusion, improperly sterilized medical instruments, dental drills, skin puncturing instruments in contact with blood, sexual contact and saliva.

Hepatitis D is caused by HDV, co-infection with HBV or superinfection using HBV carrier.

Hepatitis E is caused by HEV and transmitted by oral fecal route. It is seen in unsanitary crowded areas.

The symptoms of Hepatitis are generally itchy skin, fatigue and fever, lack of appetite, nausea and vomiting, weight loss, jaundice, enlarged liver and spleen, mood swings, pain in the joints of the body, autoimmune problems and associated with high risk of cancer.

Various other causes of Hepatitis are Viral and Non-viral infections, use of certain drugs, alcohol consumption, poisons, autoimmune disease, metabolic disorders and biliary obstruction.

The goals of dietary management are to maintain optimal nutritional status, regenerate liver tissue and prevent further liver damage, prevent breakdown of body protein tissue, promote positive nitrogen and energy balance, replenish the depleted reserves, prevent symptoms of encephalopathy and to prevent the relapse and promote recovery.

A high protein, high carbohydrate, moderate fat intake diet is recommended. Following is the recommended nutrient intake for the management of hepatitis:

Nutrients	Note
Energy, Kilocalories (KCal)	Energy requirements are increased by 15-30%. 3000 KCal and above is recommended (35-40 Kcal/kg of IBW) to ensure weight gain and replenishment of glycogen reserves during convalescence phase.
Carbohydrates(g)	They should provide 60% of total calories. 300-400g of carbohydrates is recommended. It should be available for protein sparing action. It should improve glycogen stores. Dietary fiber should be reduced or should be given in soft cooked form.
Protein(g)	Protein intake is increased by 50% - 100% in mild and moderate cases, decreased in impending cirrhosis (1g/kg IBW).  1.5-2g per kg IBW is recommended. High protein supplement beverages are recommended in between meals. It helps to prevent negative nitrogen balance and hypoproteinemia (low protein levels in blood). It prevents tissue degeneration and fatty infiltration of cells.
Fat (g)	Moderate fats (20%) are recommended. Medium chain triglycerides are preferred as they are easily digestible and assimilated. E.g. Dairy fat, cream, butter, coconut oil etc.
Vitamins and minerals	Vitamin B and C, folic acid, calcium, magnesium and zinc, Sodium restriction. B-carotene rich foods should be included. Include fresh fruits and vegetables in soft cooked form like mashed pureed vegetables, vegetable soups, fruit juices, fruit jellies, jams, milk shakes, stewed fruits etc.
Fluids	They are increased in diarrhoea- clear and full fluids Clear fluids- coconut water, tea/coffee (without milk), barley water, strained vegetable/pulse/meat soup, strained juices, strained carrot juices/rice kanji water, etc. Full fluids- Milk based beverages such as tea, coffee, milk shake, souffle, baked custard, soup, juice, egg nog, fruit jellies etc.

A high energy, high protein diet is recommended for patients with mild to moderate hepatitis. If vomiting and diarrhoea is severe, a full fluid or a semi solid soft diet is seen. Small, frequent, easy to digest, bland meals should be served. The meals should look attractive; provide variety in colour, texture, taste, flavour and mouth feel. Moist methods of cooking such as boiling, pressure cooking and steaming are preferred.

Post by Faiz Lahori