High-Protein, High-Energy, Diabetes

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Part of the Liver Disease pack, this leaflet provides information for people with diabetes and liver disease who are following a high-protein, high-energy diet.

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To limit the progression of damage to the liver, which leads to cirrhosis and risks decompensation of the liver and liver failure.

To help patients:

  • Improve their nutritional status through increased lean body mass and strength
  • Meet their nutritional requirements
  • Understand malnutrition, liver disease and symptom management to enable them to meet their nutritional requirements.
  • Avoid enteral feeding via a food first approach to dietary intervention.
    • Malnourished – meet nutritional requirements.
    • Ascities – reduce salt advice.
    • Diabetes – dietary management.

The Target Group will understand:

  • what liver disease is
  • how to manage their eating and drinking to minimise risks/side effects of their liver disease
  • the importance of eating regularly, and monitoring carbohydrate and protein intake
  • what varieties of fortified drinks and other supplements are needed
  • how to reduce salt/fat/sugar, as appropriate for their disease state.

Note that the Target Group must be given personalised advice related to their own condition and symptoms following feeding assessment that include height, weight, dry weight, skin folds and grip strength.

  • ESPEN Practical Guideline: Clinical nutrition in liver disease, 2020.
  • European Association for the Study of Liver (2018) EASL Clinical Practice Guidelines on nutrition in chronic liver disease.
  • European Association for the Study of Liver (2018) EASL Clinical Practice Guidelines: Management of alcohol-related liver disease.
  • European Association for the Study of Liver (2018) EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis.
  • NICE Guideline (NG49) 2016. Non-alcohol fatty liver disease (NAFLD): assessment and management.
  • Hydes, T. J. et al. Mechanisms, screening modalities and treatment option for individuals with non-alcoholic fatty liver disease and type 2 diabetes. Diabetic medicine, 2020.
  • Bica, C. et al. Non-alcoholic fatty liver disease: a major challenge in type 2 diabetes mellitus. Exp Ther Med. 2020 Sep;20(3):2387-2391.
  • JHEP Reports 2021. Non-alcoholic fatty liver disease: A patient guideline.
  • Manual of dietetic practice, 6th Edition. J Gandy. 2019.
  • Lujan, P.V. et al. Overview of non-alcoholic fatty liver disease (NAFLD) and the role of sugary food consumption and other dietary components in its development. Nutrients. 2021 Apr 24;13(5):1442.
  • Guo, Y. et al. Effects of late evening snack on cirrhotic patients:a systematic review and meta-analysis. Gastroenterology Research and Practice. 2018.
  • Chen, C.J. et al. Significant effects of late evening snack on liver functions in patients with liver cirrhosis: A meta-analysis of randomized controlled trials. Journal of Gastroenterology and Hepatology. 2019;34:1143-1152.
  • Tsien CD, McCullough AJ, Dasarathy S. (2012) Late evening snack: exploiting a period of anabolic opportunity in cirrhosis. Journal of Gastroenterology and Hepatology 27: 430–431.
  • European association for the Study of Liver (2010) EASL clinical practice guidelines on the management of Ascites, spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis. Journal of Hepatology 53: 397 – 417.
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NDR-UK Ref No: 9346
Publication Format: A5 leaflet
Classification: DT
Pack size: 10
Publication date: 11/06
Last Review: 2023
Last Update: 2023

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