14 WORLD GASTROENTEROLOGY NEWS MAY 2017 Editorial | Expert Point of View | WCOG at ACG 2017 | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events remission, it may be sufficient to eat according to the guidelines of a light full diet. But the primary goal is to prevent malnutrition before it starts. Patients with severe diarrhea must assure adequate fluid intake. In very severe inflammatory flares, patients may need to be maintained on par-enteral nutrition for several weeks. If possible, nutritional intake through the bowel, either as oral liquid diet or tube feeding, should be preferred to nutrition provided by intravenous infusion. A frequent complication in patients with Crohn’s disease is the develop-ment of narrowing of the bowel (ste-nosis). Patients with stenosis should avoid high-fiber foods. Patients with very significant narrowing may require strained foods or formula diets that do not contain dietary fiber. Patients with fatty stools should replace some of their dietary fat intake with eas-ily digested mid-chain triglycerides (MCT fats). So, it is important to emphasize that there is no one single diet for all patients with IBD and there is no specific “Crohn’s or colitis diet!” It is because each patient reacts differently. Diet and Liver Disease The liver is the main metabolic organ in the body. The liver has many different functions: production of proteins, cholesterol and bile acids; regulation of the blood sugar level; the neutralization and elimination of products of the body’s own metabo-lism and substances such as drugs, intestinal and environmental toxins as well as gut-derived bacterial products and storage of nutrients, minerals or vitamins. So it is very important to protect the health of the liver. There are some foods that can be included in the diet that some believe can promote a healthy liver. Some consider those are “liver cleansing” foods. These are two categories of food: one encourages the process of detoxification, while others are rich in antioxidants (to protect the liver during detoxification). These include artichokes, carrots, garlic, legumes (peas, soybeans and beans), leafy green vegetables (like spinach), lemons, limes, apples and avocados. While there may be no absolute restrictions in diet for patients with liver disease, in general they should follow the principles of a balanced, healthy diet. Moreover, those patients absolutely avoid alcohol in any form. For all liver diseases the recommen-dations are: • most calories should be provided from carbohydrates, such as grains, fruits, vegetables and honey. • a good source of protein are lean meat, low-fat cheese, skimmed milk, eggs and fish. • the amount of fat should be limited to 40-60 g per day, and are the best vegetable fats, such as olive oil and nuts. • coffee consumption should be encouraged, as coffee has been re-lated to a healthier liver in several studies. Up to now there is no proof that cir-rhosis of the liver can be improved or cured. The positive effect of dietetic treatment, on the other hand, is well-established. A “liver-adapted” diet is just as important as medications. In compensated type of cirrhosis of the liver, no dietetic treatment is required. In decompensated liver cirrhosis, it is important to assure that the patient is getting the required amounts of nutrition. These patients, who are often affected by a significant protein and energy deficit, should actually be taking 1.5 g of protein per kg each day, or about 100-120 g of protein per day in most cases regardless of the presence of hepatic encephalopathy in order to prevent malnutrition and sarcopenia. Salt restriction is just recommended in cases of ascites. Healthy food and refreshments at break time A “liver-adapted” diet is just as important as medications.
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