Nutrition and the Nutrition and the LiverLiver

The liver is the major organ The liver is the major organ responsible for regulating and responsible for regulating and responding to your body's responding to your body's metabolic demands. metabolic demands. Your liver must be functioning well Your liver must be functioning well to maintain normal metabolism of to maintain normal metabolism of carbohydrates, fats, and protein; it carbohydrates, fats, and protein; it is also responsible for processing is also responsible for processing and using several vitamins. and using several vitamins.

Carbohydrate Metabolism:Carbohydrate Metabolism: The most common sources of dietary The most common sources of dietary

carbohydrate are sugars, such as carbohydrate are sugars, such as sucrose (table sugar), fructose (corn sucrose (table sugar), fructose (corn syrup), and lactose (milk sugar), and syrup), and lactose (milk sugar), and starches, such as breads, pasta, grains, starches, such as breads, pasta, grains, cereals, fruits, vegetables, and potatoes. cereals, fruits, vegetables, and potatoes.

When you eat carbohydrates, specialized When you eat carbohydrates, specialized enzymes in the pancreas and gut enzymes in the pancreas and gut process them to yield simple sugars process them to yield simple sugars (glucose, galactose, fructose, maltose). (glucose, galactose, fructose, maltose).

Carbohydrate Metabolism……….Carbohydrate Metabolism……….

These sugars are absorbed by intestinal lining cells, enter These sugars are absorbed by intestinal lining cells, enter the portal circulation, and travel to the liver via the portal the portal circulation, and travel to the liver via the portal vein. vein.

During overnight fasting, blood sugar levels relatively low During overnight fasting, blood sugar levels relatively low level, insulin secretion is suppressed, and blood insulin level, insulin secretion is suppressed, and blood insulin levels diminish. levels diminish.

After a meal, blood sugar increases (stimulating the release After a meal, blood sugar increases (stimulating the release of insulin from the pancreas), and insulin levels rise. Insulin, of insulin from the pancreas), and insulin levels rise. Insulin, which rises in response to a meal, is the hormone that which rises in response to a meal, is the hormone that stimulates the liver to take in more glucose and to move stimulates the liver to take in more glucose and to move the glucose into storage -- mainly in the form of glycogen. the glucose into storage -- mainly in the form of glycogen.

the liver can then release glycogen to muscles for energy the liver can then release glycogen to muscles for energy during periods of fasting or exercise. during periods of fasting or exercise.

Although the liver can store considerable amounts of Although the liver can store considerable amounts of glycogen, it is the first energy source used during periods of glycogen, it is the first energy source used during periods of prolonged fasting or caloric deprivation, and it can be prolonged fasting or caloric deprivation, and it can be depleted rapidly. After glycogen, the body taps other depleted rapidly. After glycogen, the body taps other energy sources -- including protein and fat.energy sources -- including protein and fat.

Protein Metabolism:Protein Metabolism:

We take in dietary protein from dairy products, We take in dietary protein from dairy products, produce, and meats.produce, and meats.

Enzymes produced by the pancreas and intestine Enzymes produced by the pancreas and intestine break down the protein into its amino acids and break down the protein into its amino acids and small peptides. The intestine rapidly absorbs the small peptides. The intestine rapidly absorbs the amino acids with specific transport systems amino acids with specific transport systems within its lining cells and then delivers the amino within its lining cells and then delivers the amino acids to the liver via the portal vein. When they acids to the liver via the portal vein. When they reach the liver, they are used for energy or for reach the liver, they are used for energy or for making (synthesizing) new proteins. making (synthesizing) new proteins.

The newly synthesized proteins perform specific The newly synthesized proteins perform specific body functions.body functions.

Fat Metabolism:Fat Metabolism:

In general, fats are neutral lipids In general, fats are neutral lipids (triglycerides), acidic lipids (fatty acids), (triglycerides), acidic lipids (fatty acids), and sterols (cholesterol, plant sterols). and sterols (cholesterol, plant sterols). Triglycerides (dairy products, meats, oils, Triglycerides (dairy products, meats, oils, butter, margarine) are the most common butter, margarine) are the most common type of dietary fat and represent a major type of dietary fat and represent a major source of energy. The liver is uniquely source of energy. The liver is uniquely suited to regulate and process suited to regulate and process triglycerides. triglycerides.

Fat Metabolism………..Fat Metabolism………..

Dietary triglyceride is digested in the intestine by lipase, an Dietary triglyceride is digested in the intestine by lipase, an enzyme secreted by the pancreas in response to meals. enzyme secreted by the pancreas in response to meals.

Bile, secreted by the liver, makes the digested fat soluble Bile, secreted by the liver, makes the digested fat soluble and promotes its absorption. Absorbed fat is then and promotes its absorption. Absorbed fat is then repackaged and transported into blood, where the liver repackaged and transported into blood, where the liver ultimately removes it from the circulation.ultimately removes it from the circulation.

Fat that reaches the liver is processed in three ways: (1) Fat that reaches the liver is processed in three ways: (1) stored as fat droplets in liver cells, (2) metabolized as a stored as fat droplets in liver cells, (2) metabolized as a source of energy, and (3) repackaged, secreted back into source of energy, and (3) repackaged, secreted back into blood, and delivered to other cells in the body. blood, and delivered to other cells in the body.

The liver is also intimately involved with the processing of The liver is also intimately involved with the processing of dietary cholesterol and is the main source of newly dietary cholesterol and is the main source of newly synthesized cholesterol in the body. Liver disease may be synthesized cholesterol in the body. Liver disease may be associated with both high or low blood cholesterol levels. In associated with both high or low blood cholesterol levels. In general, as liver disease progresses in patients with general, as liver disease progresses in patients with hepatitis C, the blood level of cholesterol drops.hepatitis C, the blood level of cholesterol drops.

Bile:Bile:

The liver produces and secretes a fluid The liver produces and secretes a fluid (bile) that enters the intestine to aid in (bile) that enters the intestine to aid in digestion and absorption. Bile is clear digestion and absorption. Bile is clear yellow to golden-brown and contains water, yellow to golden-brown and contains water, electrolytes (salts), cholesterol, bile salts electrolytes (salts), cholesterol, bile salts (detergents), phospholipids, and proteins.(detergents), phospholipids, and proteins.

Bile helps to activate enzymes secreted by Bile helps to activate enzymes secreted by the pancreas and is essential for the the pancreas and is essential for the digestion and absorption of fat or fat-digestion and absorption of fat or fat-soluble vitamins.soluble vitamins.

Vitamins:Vitamins: The liver plays a role in several steps of vitamin The liver plays a role in several steps of vitamin

metabolism... Vitamins are either fat-soluble metabolism... Vitamins are either fat-soluble (Vitamins A, D, E, and K) or water-soluble (Vitamins A, D, E, and K) or water-soluble (Vitamin C and the B-complex vitamins). (Vitamin C and the B-complex vitamins).

Patients with advanced liver disease may become Patients with advanced liver disease may become deficient in water-soluble vitamins, but this is deficient in water-soluble vitamins, but this is usually due to inadequate nutrition and poor food usually due to inadequate nutrition and poor food intake. Vitamin B12 storage usually far exceeds intake. Vitamin B12 storage usually far exceeds the body's requirements; deficiencies rarely occur the body's requirements; deficiencies rarely occur due to liver disease or liver failure. When dietary due to liver disease or liver failure. When dietary intake drops, however, thiamine and folate intake drops, however, thiamine and folate commonly become deficient. Oral commonly become deficient. Oral supplementation is usually all that you need to supplementation is usually all that you need to restore thiamine and folate stores to the normal restore thiamine and folate stores to the normal range. range.

Vitamins………….Vitamins………….

Fat-soluble vitamins require not only adequate dietary Fat-soluble vitamins require not only adequate dietary intake but also good digestion and absorption by the body. intake but also good digestion and absorption by the body.

Bile in the gut is required for the absorption of fat-soluble Bile in the gut is required for the absorption of fat-soluble vitamins into the body because these vitamins are vitamins into the body because these vitamins are relatively insoluble in water.relatively insoluble in water.

Bile acts as a detergent, breaking down and dissolving Bile acts as a detergent, breaking down and dissolving these vitamins so they may be properly absorbed. these vitamins so they may be properly absorbed.

If bile production is poor, oral supplementation of vitamins If bile production is poor, oral supplementation of vitamins A, D, E, and K may not be sufficient to restore vitamin levels A, D, E, and K may not be sufficient to restore vitamin levels to normal. The use of a detergent-like solution of liquid to normal. The use of a detergent-like solution of liquid vitamin E (TPGS) improves the absorption of vitamin E in vitamin E (TPGS) improves the absorption of vitamin E in patients with advanced liver disease. The same solution patients with advanced liver disease. The same solution may also improve the absorption of vitamins A, D, and K if may also improve the absorption of vitamins A, D, and K if the latter are taken simultaneously with the liquid vitamin the latter are taken simultaneously with the liquid vitamin E.E.

Nutrition for people with Nutrition for people with Cirrhosis Cirrhosis

At this stage the diet is generally At this stage the diet is generally high in high in complex carbohydratescomplex carbohydrates (breads, cereals, (breads, cereals, grains, legumes, dried beans and peas, pasta, grains, legumes, dried beans and peas, pasta, rice). These foods are important because they rice). These foods are important because they provide our bodies fuel source called blood provide our bodies fuel source called blood glucose (also referred to as "blood sugar").glucose (also referred to as "blood sugar").

During cirrhosis, individuals frequently experience During cirrhosis, individuals frequently experience low blood sugar (hypoglycemia) or high blood low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia). sugar (hyperglycemia).

Your body is better able to maintain a healthy, Your body is better able to maintain a healthy, sustained level of energy from complex sustained level of energy from complex carbohydrates ("starches") rather than from carbohydrates ("starches") rather than from simple carbohydrates ("sugars").simple carbohydrates ("sugars").

Think of your body as an automobile. Your body's "gasoline" Think of your body as an automobile. Your body's "gasoline" is blood glucose. Sugars found in candy, fruits, sweet is blood glucose. Sugars found in candy, fruits, sweet pastries, and milk products supply the body with "gasoline", pastries, and milk products supply the body with "gasoline", but your body uses it quickly.but your body uses it quickly.

The result is that your energy level usually rises and then The result is that your energy level usually rises and then falls too quickly with sugars than it would with complex falls too quickly with sugars than it would with complex carbohydrates, especially those with higher fiber content. carbohydrates, especially those with higher fiber content. This is not to say that simple sugar foods cannot be eaten, This is not to say that simple sugar foods cannot be eaten, only in smaller proportion to complex carbohydrates and in only in smaller proportion to complex carbohydrates and in more controlled portions. more controlled portions.

Protein is needed for repair and maintenance of blood and Protein is needed for repair and maintenance of blood and body tissues, including liver tissue. Persons with cirrhosis body tissues, including liver tissue. Persons with cirrhosis tend to better tolerate the protein from dairy and plant tend to better tolerate the protein from dairy and plant sources than from meat sources, and therefore may benefit sources than from meat sources, and therefore may benefit from a more vegetarian type diet. from a more vegetarian type diet.

Daily protein needs in grams will vary according to your Daily protein needs in grams will vary according to your nutritional state and the status of your disease.nutritional state and the status of your disease.

Persons with cirrhosis often begin to experience Persons with cirrhosis often begin to experience difficulty digesting and absorbing fat in the diet. The difficulty digesting and absorbing fat in the diet. The result is result is steatorrhea,steatorrhea, and thereby may require and thereby may require dietary fat modification.dietary fat modification.

Fatty liver is also a condition that can occur which is Fatty liver is also a condition that can occur which is the accumulation of fat in the liver. In either of the accumulation of fat in the liver. In either of these cases, reducing the fat to 25% of total these cases, reducing the fat to 25% of total calories (about 40-70 grams of fat daily) is calories (about 40-70 grams of fat daily) is recommended.recommended.

Use of a special prescription type of fat called MCT Use of a special prescription type of fat called MCT oil is sometimes necessary. MCT (medium-chain oil is sometimes necessary. MCT (medium-chain triglycerides) does not require bile for absorption triglycerides) does not require bile for absorption into the blood stream, so is advantageous when the into the blood stream, so is advantageous when the liver can no longer produce adequate bile for liver can no longer produce adequate bile for digestion and absorption of dietary fat (lipid).digestion and absorption of dietary fat (lipid).

MCT can be used in place of other fats in cooking MCT can be used in place of other fats in cooking and some recipes and is also available in certain and some recipes and is also available in certain types of liquid nutritional drinks.types of liquid nutritional drinks.

Vitamin deficiencies can occur during this stage Vitamin deficiencies can occur during this stage of the disease. Fat-soluble vitamins A, D, E, and K of the disease. Fat-soluble vitamins A, D, E, and K may need to be taken in their water-soluble formmay need to be taken in their water-soluble form

Deficiencies of the minerals zinc, calcium, and Deficiencies of the minerals zinc, calcium, and magnesium can also occur during cirrhosis and magnesium can also occur during cirrhosis and may require supplementation.may require supplementation.

Sodium typically needs to be restricted with Sodium typically needs to be restricted with cirrhosis.cirrhosis.

Considering that the person with cirrhosis must Considering that the person with cirrhosis must usually limit sodium to 2,500 milligrams per day, usually limit sodium to 2,500 milligrams per day, these foods leave little room for other necessary, these foods leave little room for other necessary, more healthy foods in the diet. Remember that more healthy foods in the diet. Remember that sodium acts like a "sponge" in the body and can sodium acts like a "sponge" in the body and can cause your body to hold on to more fluid, cause your body to hold on to more fluid, predisposing you to abdominal fluid retention predisposing you to abdominal fluid retention seen in cirrhosis called ascites.seen in cirrhosis called ascites.

Protein and Hepatitis CProtein and Hepatitis C

Proteins are the major building blocks that the body uses to Proteins are the major building blocks that the body uses to make body components such as muscles, hair, nails, skin, make body components such as muscles, hair, nails, skin, and blood. Proteins also make up important parts of the and blood. Proteins also make up important parts of the immune system called antibodies, which help fight off immune system called antibodies, which help fight off disease.disease.

Someone with liver damage such an approach to nutrition Someone with liver damage such an approach to nutrition can actually be downright dangerous. The trouble is that a can actually be downright dangerous. The trouble is that a damaged liver cannot process as much healthy liver. And, damaged liver cannot process as much healthy liver. And, when a damaged liver gets unduly overloaded with protein,when a damaged liver gets unduly overloaded with protein, encephalopathyencephalopathy ( a state of mental confusion that can lead ( a state of mental confusion that can lead to coma) may occurto coma) may occur

Finally, diets high in protein have been demonstrated to Finally, diets high in protein have been demonstrated to enhance the activity of the cytochrome P450 enzyme enhance the activity of the cytochrome P450 enzyme system, which is responsible for drug metabolism. This system, which is responsible for drug metabolism. This enhanced activity increases the likelihood that a drug may be enhanced activity increases the likelihood that a drug may be converted into a toxic byproduct capable of causing liver converted into a toxic byproduct capable of causing liver injury.injury.

Protein intake must be adjusted in accordance with Protein intake must be adjusted in accordance with a person's body weight and the degree of liver a person's body weight and the degree of liver damage present. Approximately 0.8 grams of damage present. Approximately 0.8 grams of protein per kilogram (2.2 pounds) of body weight is protein per kilogram (2.2 pounds) of body weight is recommended in the diet each day for someone recommended in the diet each day for someone with stable liver disease.with stable liver disease.

People with unstable liver disease or People with unstable liver disease or decompensated cirrhosis need to lower the decompensated cirrhosis need to lower the percentage of protein content in their diets so that percentage of protein content in their diets so that it falls between approximately 10 to 15 %. And, it falls between approximately 10 to 15 %. And, they need to eat only vegetable sources of protein.they need to eat only vegetable sources of protein.

A diet high in animal protein ( which typically A diet high in animal protein ( which typically contains a lot of ammonia) may precipitate an contains a lot of ammonia) may precipitate an episode of encephalopathy among these people. episode of encephalopathy among these people. Vegetarian diets, on the other hand, have a low Vegetarian diets, on the other hand, have a low ammonia content and have been shown to be much ammonia content and have been shown to be much less likely than animal protein diets to induce less likely than animal protein diets to induce encephalopathy. encephalopathy.

Syarat-syarat diit pada penyakit hati:Syarat-syarat diit pada penyakit hati:

1. Tinggi kalori, tinggi hidrat arang, lemak sedang, 1. Tinggi kalori, tinggi hidrat arang, lemak sedang, protein disesuaikan dengan tingkat keadaan klinik protein disesuaikan dengan tingkat keadaan klinik penderita. Diit diberikan secara berangsur, penderita. Diit diberikan secara berangsur, disesuaikan dengan nafsu makan penderita dan disesuaikan dengan nafsu makan penderita dan toleransi penderita terhadap protein.toleransi penderita terhadap protein. 2. Cukup mineral dan vitamin2. Cukup mineral dan vitamin 3. Rendah garam/ cairan dibatasi bila ada ascites.3. Rendah garam/ cairan dibatasi bila ada ascites. 4. mudah dicerna dan tidak merangsang4. mudah dicerna dan tidak merangsang 5. bahan makanan yang menimbulkan gas 5. bahan makanan yang menimbulkan gas

dihindarkan dihindarkan

Macam diit dan indikasi pemberianMacam diit dan indikasi pemberian

Diit Hati I:Diit Hati I:– Penderita cirrhosis hepatis berat, dan penderita Penderita cirrhosis hepatis berat, dan penderita

hepatitis infeksiosa akut dalam keadaan prekoma hepatitis infeksiosa akut dalam keadaan prekoma atau segera sesudah penderita dapat makan atau segera sesudah penderita dapat makan kembalikembali

– Berupa cairan yang mengandung KH sederhana : Berupa cairan yang mengandung KH sederhana : sari buah, sirop, teh manis.sari buah, sirop, teh manis.

– Bila tak disertai ascites cairan diberikan kurang Bila tak disertai ascites cairan diberikan kurang lebih 2 liter/ hari, bila ada ascites dan diuresis lebih 2 liter/ hari, bila ada ascites dan diuresis belum sempurna : cairan maksimum 1 liter/ hari.belum sempurna : cairan maksimum 1 liter/ hari.

– Rendah kalori, protein, kalsium, besi, thiaminRendah kalori, protein, kalsium, besi, thiamin– Sebaiknya tidak diberikan lebih dari 3 hariSebaiknya tidak diberikan lebih dari 3 hari– Untuk menambah kalori bisa diberikan infus Untuk menambah kalori bisa diberikan infus

glukosaglukosa

Bahan makanan yang Bahan makanan yang diberikandiberikan

Sari buahSari buah 1000 g1000 g 5 gls5 gls SiropSirop 400 g400 g 2 gls2 gls Gula pasirGula pasir 100 g100 g 10 sdm10 sdm

Nilai gizi:Nilai gizi:

KaloriKalori 10251025 besibesi 9,3 mg9,3 mg

ProteinProtein 77 gg vit. Avit. A 2775 SI2775 SI

LemakLemak 11 gg thiaminthiamin 0,6 mg0,6 mg

KHKH 247247 gg vit.Cvit.C 635 mg635 mg

KalsiumKalsium 0,20,2 gg natriumnatrium 31,4 mg31,4 mg

Pembagian makan sehariPembagian makan sehari

Pukul 07.00Pukul 07.00teh manisteh manis 1 gls1 gls Pukul 08.00Pukul 08.00sari pepayasari pepaya 1 gls1 gls Pukul 10.00Pukul 10.00air jerukair jeruk 1 gls1 gls Pukul 12.00Pukul 12.00sari pepayasari pepaya 1 gls1 gls

siropsirop 1 gls1 gls Pukul 15.00Pukul 15.00air jerukair jeruk 1 gls1 gls Pukul 18.00Pukul 18.00sari pepayasari pepaya 1 gls1 gls

siropsirop 1 gls1 gls Pukul 20.00Pukul 20.00teh manisteh manis 1 gls1 gls

Diit hati IIDiit hati II Bila keadaan akut/ prekoma sudah diatasiBila keadaan akut/ prekoma sudah diatasi Penderita sudah mempunyai nafsu makanPenderita sudah mempunyai nafsu makan Diberikan dalam bentuk cincang/ lunakDiberikan dalam bentuk cincang/ lunak Protein dibatasi 30 g/ hariProtein dibatasi 30 g/ hari Lemak yang mudah dicernaLemak yang mudah dicerna Rendah kalori, kalsium, besi dan thiamin Rendah kalori, kalsium, besi dan thiamin

sebaiknya diberikan beberapa hari saja.sebaiknya diberikan beberapa hari saja. Bila ada ascites hebat, diuresis belum baik : Bila ada ascites hebat, diuresis belum baik :

diberikan diit rendah garam Idiberikan diit rendah garam I

Diit hati IIDiit hati II Bila keadaan akut/ prekoma sudah diatasiBila keadaan akut/ prekoma sudah diatasi Penderita sudah mempunyai nafsu makanPenderita sudah mempunyai nafsu makan Diberikan dalam bentuk cincang/ lunakDiberikan dalam bentuk cincang/ lunak Protein dibatasi 30 g/ hariProtein dibatasi 30 g/ hari Lemak yang mudah dicernaLemak yang mudah dicerna Rendah kalori, kalsium, besi dan thiamin Rendah kalori, kalsium, besi dan thiamin

sebaiknya diberikan beberapa hari saja.sebaiknya diberikan beberapa hari saja. Bila ada ascites hebat, diuresis belum baik : Bila ada ascites hebat, diuresis belum baik :

diberikan diit rendah garam Idiberikan diit rendah garam I

Bahan makanan yang diberikanBahan makanan yang diberikan BerasBeras 120 g120 g 4 gls bubur nasi4 gls bubur nasi MaezenaMaezena 20 g20 g 4 sdm4 sdm DagingDaging 50 g50 g 1 ptg sedang1 ptg sedang TelorTelor 25 g25 g ½ butir½ butir SayuranSayuran 200 g200 g 2 gls2 gls BuahBuah 300 g300 g 3 ptg pepaya sedang3 ptg pepaya sedang Gula pasirGula pasir 100 g100 g 10 sdm10 sdm MargarinMargarin 25 g25 g 2 ½ sdm2 ½ sdm

Nilai gizi :Nilai gizi :KaloriKalori 14751475 besibesi 9,3 mg9,3 mgProteinProtein 2727 gg vit.Avit.A 8892 SI8892 SILemakLemak 3030 gg thiaminthiamin 0,5 mg0,5 mgKHKH 278278 gg vit.Cvit.C 170 mg170 mgKalsiumKalsium 0,20,2 gg natriumnatrium 360 mg360 mg

Diit hati IIIDiit hati III Sebagai makanan perpindahan dari diit hati IISebagai makanan perpindahan dari diit hati II Penderita dengan nafsu makan cukupPenderita dengan nafsu makan cukup Diberikan dalam bentuk lunak/ biasaDiberikan dalam bentuk lunak/ biasa Protein diberikan 1 g/ kgBB/hariProtein diberikan 1 g/ kgBB/hari Lemak sedang dalam bentuk yang mudah dicernaLemak sedang dalam bentuk yang mudah dicerna Cukup kalori, besi, vitamin A dan vitamin C, Cukup kalori, besi, vitamin A dan vitamin C,

kurang kalsium dan thiaminkurang kalsium dan thiamin Bila ada retensi cairan/ ascites berikan rendah Bila ada retensi cairan/ ascites berikan rendah

garamgaram Bila ascites hebat/ diuresis belum baik berikan RG Bila ascites hebat/ diuresis belum baik berikan RG

II

Bahan makanan yang diberikanBahan makanan yang diberikan berat (g)berat (g) urt urt BerasBeras 250250 5 gls tim5 gls tim MaezenaMaezena 2020 4 sdm4 sdm DagingDaging 100100 2 pt sdg2 pt sdg TelurTelur 2525 ½ butir½ butir TempeTempe 5050 2 pt sdg2 pt sdg SayuranSayuran 200200 2 gls2 gls BuahBuah 300300 3 pt pepaya sdg3 pt pepaya sdg MinyakMinyak 2525 2 ½ sdm2 ½ sdm Gula pasirGula pasir 6060 6 sdm 6 sdm

Nilai gizi :Nilai gizi : KaloriKalori 20132013 besibesi 16,6 mg16,6 mg ProteinProtein 5454 gg vit.Avit.A 8432 SI8432 SI LemakLemak 4646 gg thiaminthiamin 0,8 mg0,8 mg KHKH 349349 gg vit.Cvit.C 170 mg170 mg KalsiumKalsium 0,30,3 gg natriumnatrium

233 mg233 mg

Diit hati IVDiit hati IV Makanan perpindahan dari diit hati IIIMakanan perpindahan dari diit hati III Pada penderita hepatitis infeksiosa dan cirrhosis Pada penderita hepatitis infeksiosa dan cirrhosis

hepatis yang nafsu makannya baik, dapat hepatis yang nafsu makannya baik, dapat menerima protein, tidak menunjukkan gejala menerima protein, tidak menunjukkan gejala cirrhosis hepatis aktif.cirrhosis hepatis aktif.

Bentuk lunak/ biasaBentuk lunak/ biasa Mengandung kalori tinggi, protein tinggi,lemak Mengandung kalori tinggi, protein tinggi,lemak

cukup,KH tinggi, vitamin dan mineral cukup.cukup,KH tinggi, vitamin dan mineral cukup. Bila ada retensi air berikan rendah garam ( diit Bila ada retensi air berikan rendah garam ( diit

hati IV rendah garam).hati IV rendah garam). Bila ascites hebat dan tanda-tanda diuresis belum Bila ascites hebat dan tanda-tanda diuresis belum

baik berikan RG I.baik berikan RG I.

Makanan yang diberikanMakanan yang diberikanberat (g)berat (g) urt urt BerasBeras 350350 5 gls nasi5 gls nasi DagingDaging 100100 2 pt sdg2 pt sdg TelurTelur 100100 2 butir2 butir TempeTempe 100100 4 pt sdg4 pt sdg Kacang hijauKacang hijau 2525 2 ½ sdm2 ½ sdm SayuranSayuran 200200 2 gls2 gls BuahBuah 200200 2 pt pepaya sdg2 pt pepaya sdg MinyakMinyak 2525 2 ½ sdm2 ½ sdm Gula pasirGula pasir 4040 4 sdm4 sdm SusuSusu 200200 1gls 1gls

Nilai gizi :Nilai gizi : KaloriKalori 25542554 besibesi 28,0 mg28,0 mg ProteinProtein 9191 gg vit.Avit.A 9176 SI9176 SI LemakLemak 6464 gg thiaminthiamin 1,3 mg1,3 mg KHKH 404404 gg vit.Cvit.C 133 mg133 mg KalsiumKalsium 0,70,7 gg natriumnatrium 414 mg414 mg

Bahan makanan yang tidak boleh Bahan makanan yang tidak boleh diberikandiberikan

Sumber lemak : semua makanan dan daging Sumber lemak : semua makanan dan daging yang banyak mengandung lemak: seperti daging yang banyak mengandung lemak: seperti daging kambing, babi.kambing, babi.

Bahan makanan yang menimbulkan gas : ubi, Bahan makanan yang menimbulkan gas : ubi, kacang merah, kol, sawi, lobak, ketimun, durian, kacang merah, kol, sawi, lobak, ketimun, durian, nangka.nangka.

Cara memesan diit : diit hati I/II/III/IV Rendah Cara memesan diit : diit hati I/II/III/IV Rendah garam I/II/III ( DH I/II/III/IV RG I/II/III)garam I/II/III ( DH I/II/III/IV RG I/II/III)

Diit pada penyakit kandung Diit pada penyakit kandung empeduempedu

Tujuan :Tujuan :

1. memberi istirahat pada kandung empedu dan 1. memberi istirahat pada kandung empedu dan mengurangi rasa sakit.mengurangi rasa sakit.

2. memberi makanan dan minuman secukupnya 2. memberi makanan dan minuman secukupnya untuk memelihara berat badan normal dan untuk memelihara berat badan normal dan keseimbangan cairan tubuh.keseimbangan cairan tubuh.

Syarat-syaratSyarat-syarat 1. lemak rendah untuk mengurangi kontraksi kandung 1. lemak rendah untuk mengurangi kontraksi kandung

empedu, diberikan dalam bentuk mudah dicerna.empedu, diberikan dalam bentuk mudah dicerna. 2. Kalori, protein, KH : cukup, bila terlalu gemuk jumlah 2. Kalori, protein, KH : cukup, bila terlalu gemuk jumlah

kalori dikurangi.kalori dikurangi. 3. tinggi vitamin terutama yang larut dalam lemak.3. tinggi vitamin terutama yang larut dalam lemak. 4. mineral cukup4. mineral cukup 5. cairan banyak untuk membantu pengeluaran kuman- 5. cairan banyak untuk membantu pengeluaran kuman-

kuman atau sisa-sisa metabolisme dan mencegah kuman atau sisa-sisa metabolisme dan mencegah

dehidrasi.dehidrasi. 6. tidak merangsang dan diberikan dengan porsi kecil 6. tidak merangsang dan diberikan dengan porsi kecil

tetapi sering untuk mengurangi rasa kembungtetapi sering untuk mengurangi rasa kembung

Macam diit dan indikasi pemberianMacam diit dan indikasi pemberian

DIIT RENDAH LEMAK IDIIT RENDAH LEMAK I

1.1. Untuk penderita cholecystitis akut dan Untuk penderita cholecystitis akut dan cholelithiasis dengan kolik akut.cholelithiasis dengan kolik akut.

2.2. Diberikan berupa buah-buahan dan minuman Diberikan berupa buah-buahan dan minuman manismanis

3.3. Rendah kalori dan semua zat-zat kecuali Rendah kalori dan semua zat-zat kecuali vitamin A dan Cvitamin A dan C

4.4. Sebaiknya diberikan selama 2-3 hariSebaiknya diberikan selama 2-3 hari

Bahan makanan yang diberikan sehariBahan makanan yang diberikan sehari

berat (g) urtberat (g) urt BuahBuah 10001000 10 pt pepaya sedang10 pt pepaya sedang SiropSirop 400400 2 gls2 gls Gula pasirGula pasir 100100 10 sdm10 sdm

Nilai gizi :Nilai gizi : KaloriKalori 996996 besibesi 17 mg17 mg ProteinProtein 55 gg vit.Avit.A 3650 SI3650 SI LemakLemak 00 gg thiaminthiamin 0,4 mg0,4 mg KHKH 244244 gg vit.Cvit.C 780 mg780 mg KalsiumKalsium 0,20,2 gg

Pemberian makan sehariPemberian makan sehari

Pukul 07.00Pukul 07.00teh manisteh manis 1 gls1 gls Pukul 08.00Pukul 08.00pisang pisang 1 gls1 gls Pukul 10.00Pukul 10.00pepayapepaya 2 ptg sdg2 ptg sdg Pukul 12.00Pukul 12.00pisangpisang 2 bh sdg2 bh sdg

siropsirop 1 gls1 gls Pukul 15.00Pukul 15.00pepayapepaya 2 ptg sdg2 ptg sdg Pukul 18.00Pukul 18.00pisangpisang 2 bh sdg2 bh sdg

siropsirop 1 gls1 gls Pukul 20.00Pukul 20.00pisangpisang 1 ptg sdg 1 ptg sdg

teh manisteh manis 1 1 glsgls

Pemberian makan sehariPemberian makan sehari

Pukul 07.00Pukul 07.00teh manisteh manis 1 gls1 gls Pukul 08.00Pukul 08.00pisang pisang 1 gls1 gls Pukul 10.00Pukul 10.00pepayapepaya 2 ptg sdg2 ptg sdg Pukul 12.00Pukul 12.00pisangpisang 2 bh sdg2 bh sdg

siropsirop 1 gls1 gls Pukul 15.00Pukul 15.00pepayapepaya 2 ptg sdg2 ptg sdg Pukul 18.00Pukul 18.00pisangpisang 2 bh sdg2 bh sdg

siropsirop 1 gls1 gls Pukul 20.00Pukul 20.00pisangpisang 1 ptg sdg1 ptg sdg

teh manisteh manis 1 gls1 gls

Bahan yang diberikan sehariBahan yang diberikan sehari

berat (g)berat (g) urt urt BerasBeras 100100 3 gls bubur nasi3 gls bubur nasi DagingDaging 100100 2 pt sdg2 pt sdg TelurTelur 5050 1 butir1 butir TempeTempe 100100 4 pt sdg4 pt sdg SayuranSayuran 200200 2 gls2 gls BuahBuah 400400 4 pt pepaya sdg4 pt pepaya sdg MargarinMargarin 1010 1 sdm1 sdm Gula pasirGula pasir 3030 3 sdm3 sdm

Nilai gizi :Nilai gizi : KaloriKalori 13381338 besibesi 21,8 mg21,8 mg ProteinProtein 5757 gg vit.Avit.A 9138 SI9138 SI LemakLemak 3333 gg thiaminthiamin 0,8 mg0,8 mg KHKH 211211 gg vit.Cvit.C 211 mg211 mg KalsiumKalsium 0,40,4 gg

Diit rendah lemak IIIDiit rendah lemak III

Untuk penderita penyakit kandung empedu yang Untuk penderita penyakit kandung empedu yang tidak gemuk dan cukup mempunyai nafsu makan.tidak gemuk dan cukup mempunyai nafsu makan.

Dalam bentuk lunak/ biasaDalam bentuk lunak/ biasa Cukupkalori dan semua zat giziCukupkalori dan semua zat gizi

Bahan makanan yang diberikan sehariBahan makanan yang diberikan sehari BerasBeras 250250 5 gls nasi tim5 gls nasi tim MaezenaMaezena 2020 4 sdm4 sdm DagingDaging 100100 2 pt sdg2 pt sdg TelurTelur 5050 1 butir1 butir TempeTempe 100100 4 pt sdg4 pt sdg SayuranSayuran 250250 21/2 gls21/2 gls BuahBuah 200200 2 pt pepaya sdg2 pt pepaya sdg MargarinMargarin 1010 1 sdm1 sdm Gula pasirGula pasir 8080 8 sdm8 sdm Susu skimSusu skim 2020 4 sdm4 sdm

Nilai gizi :Nilai gizi : KaloriKalori 20732073 besibesi 21,8 mg21,8 mg ProteinProtein 7474 gg vit.Avit.A 10473 SI10473 SI LemakLemak 3434 gg thiaminthiamin 0,9 mg0,9 mg KHKH 369369 gg vit.Cvit.C 143 mg143 mg KalsiumKalsium 0,70,7 gg

Bahan makanan yang tidak boleh diberikanBahan makanan yang tidak boleh diberikan

Sumber lemak : semua makanan yang digorengSumber lemak : semua makanan yang digoreng semua makanan/daging yang mengandung semua makanan/daging yang mengandung

lemak tinggi : mayonais, daging kambing, dan lemak tinggi : mayonais, daging kambing, dan babi.babi.

Bahan makanan yang menimbulkan gas : ubi, Bahan makanan yang menimbulkan gas : ubi, kacang merah, kol, sawi, lobak, durian, nangka, kacang merah, kol, sawi, lobak, durian, nangka, mentimun.mentimun.

Bumbu yang merangsang : cabe, bawang,merica, Bumbu yang merangsang : cabe, bawang,merica, asam, cuka, jahe.asam, cuka, jahe.

Minuman yang mengandung soda dan alkohol.Minuman yang mengandung soda dan alkohol.

Vitamin B3Vitamin B3

Transfer ADP-ribosa Transfer ADP-ribosa moietiesmoieties dari B3 (Niacin) dari B3 (Niacin) turunan NAD ke arginin, lysine, atau turunan NAD ke arginin, lysine, atau asparagin residu dari nucleoprotein yang asparagin residu dari nucleoprotein yang terjadi pada terjadi pada DNA repairDNA repair dan replikasi DNA dan replikasi DNA dikatalisis oleh dikatalisis oleh poli-ADP-ribose polymerase poli-ADP-ribose polymerase (PARPs(PARPs). Terdapat lima atau lebih PARPs ). Terdapat lima atau lebih PARPs yang berbeda berada pada daerah DNA yang berbeda berada pada daerah DNA untai ganda yang pecah, dan beratus-ratus untai ganda yang pecah, dan beratus-ratus molekul ADP-ribose terpolimerisasi permenit molekul ADP-ribose terpolimerisasi permenit sehingga apabila terjadi defisiensi vitamin sehingga apabila terjadi defisiensi vitamin B3 akan berkembang menjadi B3 akan berkembang menjadi ketidakstabilan dari DNAketidakstabilan dari DNA

Mikronutrien antioksidan ( Vitamin Mikronutrien antioksidan ( Vitamin E,vitamin C, E,vitamin C, ββ-caroten, dan selenium )-caroten, dan selenium )

Defisiensi dari mikronutrien antioksidan Defisiensi dari mikronutrien antioksidan dapat menyebabkan kerusakan pada dapat menyebabkan kerusakan pada kromosom dan lesi oksidatif pada struktur kromosom dan lesi oksidatif pada struktur membrane. Vitamin C selain bersifat sebagai membrane. Vitamin C selain bersifat sebagai antioksidan juga sebagai coenzim untuk antioksidan juga sebagai coenzim untuk proses hidroksilasi yang tergantung copper, proses hidroksilasi yang tergantung copper, dan dan -ketoglutarat berikatan dengan besi. -ketoglutarat berikatan dengan besi. Vitamin C juga berfungsi untuk merubah Vitamin C juga berfungsi untuk merubah radikal tocoferoxyl menjadi radikal tocoferoxyl menjadi -tocoferol -tocoferol ( vitamin E). Vitamin C dapat menetralisir ( vitamin E). Vitamin C dapat menetralisir reaktif oksigen spesies (ROS) sehingga reaktif oksigen spesies (ROS) sehingga melindungi inti dan struktur membran. melindungi inti dan struktur membran.

Vitamin B6.Vitamin B6.

Vitamin B6 bersama dengan B12 dan Vitamin B6 bersama dengan B12 dan folat membantu regulasi siklus folat membantu regulasi siklus methionine dan keseimbangan methionine dan keseimbangan antara antara remethylasiremethylasi homosistein dan homosistein dan transsulphurasi transsulphurasi menjadi cysteine. menjadi cysteine. Cystathione Cystathione ββ-sintase dan -sintase dan γγ--cystathionase adalah enzyme pada cystathionase adalah enzyme pada jalur transulfurase dan keduanya jalur transulfurase dan keduanya tergantung dari vitamin B6tergantung dari vitamin B6

Vitamin A.Vitamin A.

Asam retinoat berinteraksi dengan Asam retinoat berinteraksi dengan reseptor dalam inti, untuk reseptor reseptor dalam inti, untuk reseptor steroid dan hormon thyroid, dimana steroid dan hormon thyroid, dimana merupakan ligan dari faktor transkripsi. merupakan ligan dari faktor transkripsi. All-trans RA berikatan dengan All-trans RA berikatan dengan RA RA reseptorreseptor (RAR), dimana (RAR), dimana 9-cis RA9-cis RA berikatan dengan berikatan dengan Retinoic-X receptorRetinoic-X receptor (RXR). Ikatan heterodimer RAR/RXR (RXR). Ikatan heterodimer RAR/RXR dengan elemen spesifik respon asam dengan elemen spesifik respon asam retinoat (RARE) pada regulasi retinoat (RARE) pada regulasi transkripsi gen DNA.transkripsi gen DNA.