Clinical Nutrition: Liver Cirrhosis, Malnutrition & Dietary Plan

This case study addresses the clinical nutrition of a patient, Mr. Levitt, who presents with multiple micronutrient deficiencies and global acute malnutrition, likely stemming from a 25-year history of alcohol abuse and subsequent liver cirrhosis. The analysis identifies ascites as a complicating factor in interpreting the patient's weight due to fluid accumulation in the peritoneal cavity, which is linked to portal hypertension and the body's compensatory mechanisms leading to sodium and water retention. The recommended dietary approach emphasizes limiting sodium intake to manage ascites. Furthermore, the study highlights the importance of addressing protein-energy malnutrition, common in liver cirrhosis patients, by recommending a high-protein (0.8-1g/kg/day) and high-calorie (25-35 calories/kg body weight) diet, delivered through frequent small meals to improve energy intake and mitigate nausea. The overall dietary strategy involves a high-calorie, high-protein, and low-sodium diet to support liver regeneration, achieve nitrogen balance, and manage fluid retention.

Running head: CLINICAL NUTRITION
Clinical Nutrition
Student’s Name
Institutional Affiliation

CLINICAL NUTRITION 2
Clinical Nutrition
Question 2
It would be true to conclude that Mr Levitt suffers multiple micronutrient deficiency.
This is associated to abuse of alcohol for a period of 25 years. Abuse of alcohol and
development of liver cirrhosis are associated with multiple micronutrient deficiency (Rolfes,
Pinna and Whitney, 2014). The liver has numerous functions in the body. In a case of liver
cirrhosis, the liver is usually scarred due to death of hepatic cells (Rolfes, Pinna, Whitney,
2014). Therefore, the function of the liver is greatly reduced. This explains the presence of
ammonia in blood and low albumin levels. It is the function of the liver to detoxify harmful
substances such as ammonia. It can also be concluded that he suffers from global acute
malnutrition. This is because he has lost 30 pounds and he appear thin. Global acute
malnutrition is very common in patients suffering from liver cirrhosis especially that caused
by abusing alcohol (Nelms and Sucher, 2015). The albumin levels are low as evidenced by
the tests carried out. This is caused by the malfunctioning liver.
The medical condition that makes difficult to interpret his present weight is ascites.
Due to the accumulation of fluids in the peritoneal cavity (ascites), the weight is exaggerated
and does not represent the true body weight. It is therefore difficult to interpret the weight
due to ascites. There are a series of changes that occur in the body that lead to retention of
fluids in the peritoneal cavity. The first abnormality that occurs is development of portal
hypertension. Due to the abnormality, the body responds by releasing vasodilators (Sizer,
Piché and Whitney, 2012). These lead to decreasing the arterial blood flow and a consequent
decrease in arterial pressures. Nitric oxide has been implicated in causing vasodilation. The
vasodilation happens progressively. This prompts the body to activate vasoconstrictor
mechanisms to maintain homeostasis. The result is retention of water and sodium. This

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explains the reason why dilutional hyponatremia is observed in the patients. The process
explains how the distension of the abdomen occurs due to the retention of fluids and
electrolytes. The main dietary approach that is used to manage ascites is limiting the sodium
intake. The daily sodium intake should be limited to 2000mg or less daily. The patient should
drastically reduce the amount of sodium intake. One of the best strategies to ensure this is to
reduce the amount of table salt that is added to their food. Reducing the amount of sodium
intake will help in minimizing fluid retention in the peritoneal cavity. It will also minimize
the portal hypertension. Therefore, the dietary measure is not only necessary but vital in the
management of ascites.
Question 3
Extensive evidence suggests that protein energy malnutrition is associated with
increased morbidity and mortality among patients suffering from liver cirrhosis. Although
there are many factors that cause protein malnutrition, the main cause is alteration in protein
metabolism. As observed earlier, most of the hepatic cells are scarred in patients with liver
cirrhosis. A high protein diet is necessary to promote regeneration of liver cells (Whitney and
Rolfes, 2018). Therefore, Mr Levitt should take 0.8-1g of protein/ kg/day. This will help
ensure nitrogen balance. A diet that is high in calories is necessary to avert the malnutrition.
To ensure adequate energy intake, Mr Levitt should take about 25 to 35 calories /kg body
weight. The general diet that I would recommend for Mr Levitt is one that is high in proteins
and calories (high calorie-high protein diet) and low in sodium (low sodium diet). To increase
the energy intake, Mr Levitt could take frequent small feeds. This will help overcome nausea
that may be present and ensure adequate energy intake.

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References
Nelms, M., & Sucher, K. (2015). Nutrition therapy and pathophysiology. Nelson Education.
Rolfes, S. R., Pinna, K., & Whitney, E. (2014). Understanding normal and clinical nutrition.
Cengage Learning.
Sizer, F. S., Piché, L. A., & Whitney E. (2012). Nutrition: concepts and controversies.
Cengage Learning.
Whitney, E. N., & Rolfes, S. R. (2018). Understanding nutrition. Cengage Learning.