Dietary management of liver disease.

This paper is only intended to present a brief outline of the benefits, or otherwise, of using a modified diet to treat the symptoms of those liver conditions most commonly met with in the clinical situation. Liver disease may have a nutritional origin, as in the fatty liver seen in kwashiorkor, when the diet has contained sufficient energy in the form of carbohydrate but is deficient in protein. The fatty liver of obesity or of mismanaged long-term parented nutrition, is also related to malnutrition. The provision of a diet containing sufficient amino acids may reverse these conditions if the diet can be instituted before the liver damage is too severe. Alcoholic cirrhosis was long thought to be particularly prevalent in those alcoholics who took an inadequate diet, but it now seems more likely that alcohol is itself a toxic agent and those who are susceptible will sustain liver damage regardless of whether their diet has, or has not, been nutritionally adequate. Women, for example, appear to be more at risk from the toxic effect of alcohol than men are (Morgan & Sherlock, 1977). It has been recognized for centuries that the liver is fundamentally concerned with the digestion and metabolism of food. Diseases of the liver are often accompanied by anorexia, nausea, vomiting and food intolerance and it is therefore not surprising that a variety of dietary measures have been advocated in their management, and indeed are still advocated today. The dietitian discussing dietary modifications with patients will hear many patients say they have been advised to avoid spicy foods because of their liver disease, and many patients, especially from the Middle East, will insist that their doctor has told them they must not eat citrus fruit, presumably on the grounds that the yellow colour of the fruit may increase the colour of their jaundice. There would appear to be little scientific evidence behind either of these dietary restrictions. For most patients with liver disease, other than those liver diseases of nutritional origin, dietary treatment is aimed at relieving the symptoms of the disease and there is little reason to suppose that modifying the diet will cure the underlying disease. It is important to remember this before imposing a diet which may be unpleasant for the patient and difficult to comply with. The aim of the diet should be to improve the quality of life for the patient, and any modified diet advised should be as pleasant and tolerable as possible. The three most usual symptoms, or complications, of liver disease for which we may wish to instigate dietary measures are jaundice, ascites and hepatic encephalopathy.