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NUTRITION AND HEPATITIS C VIRUS INFECTION Department of Nutritional Sciences, University of ArizonaThe virus Unlike other hepatitis viruses, HCV is a member of the flaviviridae viral family.1 Like other hepatitis viruses, HCV infects the liver and directly damages liver tissue. A Consensus Statement on HCV from the National Institutes of Health can be obtained online at: <http://odp.od.nih.gov/consensus/cons/105/105_statement.htm>. The liver's role in nutrition Calorie needs for hepatitis C Example: 150 pound man x (14 to 16) =2100 to 2400 calories per day Whole food, nutrient-rich choices that include whole grains, fruits, and vegetables are a priority. The government's current Food Guide Pyramid, available online at usda.gov: 8001/py/pmap.htm> shows how to follow a balanced, nutritious eating style using proper serving sizes from each of the pyramid's food groups. If you choose from the bottom three groups you will receive plenty of complex carbohydrates, fiber, vitamins, and minerals. Protein needs for hepatitis C Example: 150 pound woman x (0.5 to 0.7) = 75 to 105 grams of protein per day The Food Guide Pyramid also defines protein food choices and appropriate serving sizes. The milk and meat groups provide high quality protein foods. There is some evidence that vegetable proteins are better for people with liver disease because of the specific amino acids they contain.6 Vegetable proteins include soy products (i.e., soy milk, soy cheese, tofu), beans, nuts, and seeds. This certainly does not mean you need to avoid animal proteins, but you may want to try to incorporate vegetable proteins to help meet increased requirements and balance out your nutritional intake. For ideas, check out the Vegetarian Food Pyramid at <http://www. vegsource.com/nutrition/pyramid.htm> and the Vegan Food Pyramid at <http://www.vegsource.com/nutrition/pyramid_vegan.htm>. Alcohol and hepatitis C Vitamins, minerals, and hepatitis C It is important to know that iron deficiency is not common in liver disease. The anemia experienced by most hepatitis patients is not iron-deficiency anemia. Because iron is stored in the liver, iron should not be supplemented by patients with hepatitis C infection because of the potential for toxicity. High iron levels may reduce the response to interferon, a medication taken by many hepatitis C patients. If you have elevated serum iron or cirrhosis, iron supplements should be completely avoided (including iron present in multivitamin/ mineral supplements).5 If you do not have elevated serum iron or cirrhosis, iron present in multivitamin/mineral supplements is appropriate, but further supplementation is not recommended. Strict vegans who avoid all animal products may need a vitamin B12 supplement to avoid pernicious anemia. Intramuscular B12 injections, oral supplements, or intranasal gels (that are better absorbed) are used to treat B12 deficiency.9,10 Research is also being conducted on an enhanced uptake formulation of vitamin B12 called CobamaxTM.10 If you do have anemia, to find out what kind of anemia you have, ask your medical doctor to check serum vitamin B12, RBC folate, and serum iron levels. Hepatitis C medications Example: 150 pound man x 0.5 = 75 ounces of fluid per day Check with your doctor or a registered nutrition professional to see which specific fluids are best for you individually. Generally, avoiding sugar-sweetened beverages is a good rule of thumb; this can minimize extra, empty calories and can help you manage blood fat (especially triglyceride) and blood sugar levels. Table 1 shows nutrition-related side effects that may occur with interferon.
A very common side effect with ribavirin treatment is anemia. This is usually not the kind of anemia that is due to insufficient iron, folate, or vitamin B12 intake, so supplementation with these nutrients probably won't alleviate the anemia. Nutrition and cirrhosis ?
Generally, no more than 2000 mg to 3000 mg of sodium should be ingested each day to minimize water retention and facilitate blood-pressure control. In addition to avoiding salty foods, salt in cooking, and salt at the table, it is necessary to select low-sodium foods in order to maintain sodium intake below 3000 mg per day. If varices are present in the esophagus or stomach, a soft diet should be consumed, and the patient should avoid any rough foods such as pretzels or nuts that could scratch those blood vessels and cause bleeding. Blood potassium levels need to be monitored, but potassium supplementation should only occur with a prescription and regular monitoring from your physician. Many cirrhosis patients need supplementation with the B-complex vitamins: zinc, magnesium, and phosphorous. Nutrition and hepatic encephalopathy Example: 150 pound woman x (0.23 to 0.34) = 34.5 to 51 grams of protein per day. Registered dieticians Registered nutrition professionals can help you to meet caloric needs by designing individualized meal plans. An RD is your best source of accurate and responsible nutrition information. If you do not know an RD in your area, you can receive assistance online from the Nationwide Nutrition Network of the American Dietetic Association at: <http://www.eatright.org/finddiet.html>. At this site, you can search for an RD by geographic location or by specialty expertise. You can also seek the advice of the HIV-experienced RDs listed on the Questions and Referrals web page at the HIV ReSources website: <http://www. hivresources.com/QandR.htm>. Jennifer Muir Bowers, MS, RD, is the Undergraduate Program Coordinator for the Department of Nutritional Sciences at the University of Arizona. She is also completing a doctoral degree in Nutritional Sciences and Immunology. |
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