Monica Adhikari
Consultant Dietician, Great Ormond Street Hospital, London.

The human liver is one of the most important organs involved in the metabolism and storage of nutrients.

Carbohydrate metabolism
The liver plays a major role in carbohydrate metabolism. Galactose and fructose - products of carbohydrate digestion, are converted into glucose in the hepatocyte. Liver stores glucose as glycogen and then returns it to the blood when glucose levels become low.

Protein metabolism
Proteins are converted to substrates that are utilized in energy and glucose production. Liver detoxifies ammonia by converting it to urea, 75% of which is excreted by the kidneys. Synthesis of vital protiens of the blood takes place in the liver.

Fat metabolism
Fatty acids from the diet are converted in the liver to produce energy.

Vitamins and minerals
The liver stores all of the fat - soluble vitamins in addition to zinc, iron, copper, magnesium and vitamin B12.

HEPATITIS (JAUNDICE)
The objectives of dietary treatment in hepatitis are to aid in the regeneration of liver tissue and to prevent further liver damage. A high caloric diet daily is needed to promote weight gain and to ensure maximum protein utilization. In general 25 to 35 Kcal/kg estimated weight is prescribed.

Carbohydrate
An intake of 4-6 gm/kg carbohydrate ensures adequate glycogen reserves needed for the maintenance of liver function for protection against further injury to the liver and for its protein sparing action.

Protein
An intake of 1 ½ to 2 grams protein per kg of body weight is recommended.

Fat
Diets restricted in fats are not necessary in the majority of patients with hepatitis. In fact, restricting fats all together may retard recovery if calories are thereby limited. Fats from dairy products, cooking fats are easily utilized and add palatability to the diet without large amounts of bulk. If there is anorexia (loss of appetite), fats may cause nausea and should be limited to amounts tolerated by the patient.

Foods of liquid of soft consistency may be preferable if there is anorexia in the initial stages of illness, progressing to wider selection of foods with recovery. The patient must be convinced of the importance of the diet in promoting recovery and preventing relapses. Anorexia is frequently a problem; hence every effort must be made to encourage the patient to eat. Foods must be well prepared and attractively served with consideration given to the individual food preferences. Judicious use of spices and condiments may help to stimulate the appetite. Small to moderate portion at mealtime with high protein between meal supplements are frequently more acceptable than larger meals. Some individuals need assistance in feeding themselves and should be allowed adequate time to eat a leisurely pace.