This document discusses diet and nutrition in patients with liver disease. It categorizes the nature and severity of liver disease using models like Child Pugh Score and MELD. It also discusses assessing patients using Subjective Global Assessment, which considers their medical history, physical exam findings, and nutritional status. Various micronutrient deficiencies seen in liver disease are outlined. Methods for evaluating nutritional status like anthropometry, laboratory tests, and energy expenditure measurements are also summarized.

3. دکترهمایونی Diet in liver disease

4. Nature & Severity of liver disease should be categorized Child Pugh Score Model for end-stage liver disease ( MELD ) Compensated Versus decompensate Subjective Global assessment ( SGA )

5. Subjective Global Assessment

6. Historical Component Weight loss Change in dietary intake Presence of GI symptom Functional Capacity Metabolic demand

7. Physical examination Component Edema Ascitis Muscle Wasting Subcutaneous fat loss

8. Micronutrient deficiency

9. Dermatitis Zinc Vitamin A Niacin

10. Night blindness Photophobia Hyperkeratosis Vitamin A

11. Burning of the mouth Burning of the Tongue Glossitis Angular stomatitis Vita B12 Folate

12. Easy Bruising Vitamin C Vitamin K

13. Paresthesia Thiamin Pyridoxin

14. Pallor ( Anemia ) Iron deficiency B12

15. DTR B12 B1

16. Laboratory investigations Albumin Creatinin INR Vitamin A , D , E , Thiamin Selenium , Zinc , Vitamin B12 , Folate

17. Delayed Hypersensitivity & Total lymphocyte count

18. Antropometry Change in composition of body compartment

19. MAMC Mide Arm Muscle Circumference ( Lean tissue store )

20. SFT Skin Fold Thickness

21. Miscellaneous Tests DEXA Dual energy X-Ray absorptometry Deutrium oxide dilution In vivo neutron activation analysis Bioelectrical impendence analysis

22. Energy Expenditure Resting Energy Expediture Harris Benedict equation

23. Low Salt Low Protein High Carbohydrate

24. Protein Content Essential amino acids Biologic Value