caloric and nutritional needs of the patient should be individually assessed
depending on age, activity, ideal body weight and body condition. Reduced
efficiency and regulation of lipid, protein and carbohydrate, metabolism
secondary to liver disease.
disease may disrupt hepatic detoxification and excretory functions. Dietary
modification to decrease the quantity of products handled by the diseased liver
may reduce the clinical signs and retard deterioration. Dietary management must
aim to reduce the detoxification and excretion workload of the liver yet still
provide adequate high quality nutrition to prevent deleterious catabolic
goals of nutritional therapy are to supply adequate nutrition to meet the
requirements of the recuperating patient, replenish associated deficits and
promote hepatic regeneration.
management of hepatic diseases requires a highly palatable diet. Practical
measures such as the use of highly odorous food, the warming of food prior to
feeding, the maceration of food to enhance its texture and prompting learned
stimulate eating. The smell of food is vital in soliciting and maintaining the
patient’s interest: strong meat, fish or cheese odours are often favoured.
Metabolic Requirements in Liver Disease
feeding with a highly digestible diet is recommended to minimize catabolism of
body tissue, reduce the release of potentially neurotoxic fatty acids from
adipose tissue and moderate hypoglycaemia.
Hepatic Encephalopathy (HE) is when
mild, an initial approach of frequent feeding (4-6 small meals
daily) of a highly digestible, nutritionally complete diet may aid management.
In more severe cases a highly
digestible, protein-restricted, high biological value (>75) protein diet is
recommended e.g. cottage cheese. Diary proteins have a high biological value
but are generally low in arginine. A
dietary source of arginine, an important component, of the urea cycles, is
essential in the treatment of HE, especially in cats.
Supplementation with an arginine
source, such as egg protein, should be considered. Egg protein has a high
biological value, is highly digestible, rich in arginine, but has a high
Fish meal protein is generally a
high biological value protein source which is highly palatable, especially to
cats but may be high in purine, potentially leading to increased uric acid
production, further predisposing patients to urate stone formation.
Alternative protein sources include
protein sources include vegetable proteins (Soy flour, corn grits, rice) which
have a favourable amino acid profile, a low content of both methionine and
Ideally the diet should be based on
a highly digestible carbohydrate (e.g. rice, pasta), be adequate in vitamin
content and highly palatable to combat inappetance often associated with
hepatic disease. Dietary management aims to ensure that adequate, highly digestible,
high quality, dietary protein is supplied to meet the animal’s metabolic needs
without exceeding the detoxification capacity of the compromised liver.
Food Values of some common ingredients
used in homemade diets (per gram)
Some animal proteins contain high levels of copper and should be
avoided. Organ meat, especially liver, should be avoided. Other meats high in
Duck, Lamb, Salmon, Pork
Protein sources that are relatively moderate to low in copper
Turkey, Chicken, White fish, Beef, Eggs, Cheese
liver diseases may be associated with reduced bile acid production but
steatorrhoea and intestinal malabsorption are usually mild with liver disease.
Fatty acids may aggravate HE by the direct action of short and medium chain
length fatty acids on the central nervous system and indirectly by reducing the
conversion of ammonia to urea, aggravating post-prandial hyperammonaemia and
providing a further indication for the use of a reduced fat diet.
It can be hypothesized that a low
fat, low protein, high carbohydrate diet may be of benefit in the management of
HE due to its stimulation of insulin production, resulting in fall in fatty
acid levels, but veterinary clinical data substantiating fatty acid
modification in the management of liver disease are currently unavailable.
digestible carbohydrates such as rice and pasta are absorbed in the proximal
gastrointestinal tract and provide a non encephalogenic energy source for
animals with liver disease.
role of fibre in the management of hepatic encephalopathy remains unclear.
Fibre may increase nitrogenous losses due to the abrasive desquamation of
and vitamin deficiencies associated with hepatic disease may occur due to a
combination of poor dietary intake, reduced intestinal absorption and increased
demands reduced by liver disease.
vitamin supplementation with B vitamins should ensure that nutritional
regiments meet maintenance requirements. However, ascorbic acid supplementation
should be at levels of up to 25 mg/day to compensate for decreased synthesis.
supplementation with Vitamin E (500 mg/day for dogs, 100 mg/day for cats)
provides an important hepatocellular protective effect against copper toxicity
and lipid peroxidation injuries.
Vitamin A supplementation is unwarranted and
dangerous (Maximum canine and feline dietary levels 40,000 IU/400 Kcal) due to
the risk of synergism between vitamin A and cytotoxins in provoking hepatocyte
– Certain breeds, most notably the Bedlington and West Highland White Terriers
are prone to disorders of hepatic storage of copper leading to hepatotoxity.
Dietary therapy may aid the medical management of the condition via restricted
levels of dietary copper and the use of Zinc supplementation (2 m/Kg/day).
copper restriction is best obtained by avoiding offal (eg. Liver and sweetbreads).
Zinc may reduce intestinal absorption of copper.
– Portal hypertension secondary to liver disease may be associated with
hypovolaemia, ascites and altered renal retention of sodium and water. Sodium
restriction has been advocated to reduce to reduce portal hypertension. Extreme
dietary Sodium restriction may, however, cause hyponatraemia; thus electrolyte
concentrations should be monitored carefully if sodium-restricted diets may be
difficult to formulate. A diet containing approximately 0.30-0.40 g/1000 kcal
of Sodium is recommended to provide a moderate, yet practical, level of dietary