High-protein high-energy diet

For patients with cirrhosis, the recommended daily protein intake is 1.2 to 1.5 g/kg of body weight. A high-protein high-energy diet ensures lean body mass stores are maintained and not used as an energy source.

A high-protein high-energy diet involves:

• eating high-protein foods at each meal and snack (eg lean meat and poultry, fish, eggs, dairy foods, nuts and legumes; choose foods low in salt if required)
• increasing energy intake (eg add oil, butter, margarine, salad dressing, dairy foods, sugar, honey)
• eating small frequent meals (every 2 to 3 hours) if appetite is poor
• consuming a snack with carbohydrate and protein before bed (eg yoghurt, a milk drink, toast with nut spread, cheese and dry biscuits, dried fruit and nut mix).

Oral nutritional supplements are recommended for patients unable to meet nutritional requirements through regular diet and fluids alone. Enteral nutrition support may be required in some patients; for example, patients with acute encephalopathy, or when oral intake is unsafe or inadequate for a prolonged period. Insertion of a nasogastric tube is appropriate in these circumstances. Branched-chain amino acids may be useful in patients who cannot tolerate meat protein, and can improve hepatic encephalopathy (see Management of hepatic encephalopathy).

Consider consulting an accredited practising dietitian to ensure nutrition is adequate, especially if there are other dietary considerations (eg vegetarian diet, fluid restriction, patients with diabetes).

A patient fact sheet on a high-protein high-energy diet is available on the Gastroenterological Society of Australia website.