Diseasespecific diets

Specifically formulated disease-specific diets have been developed for patients with disorders such as encephalop-athy associated with chronic liver disease, and respiratory failure. Malnourished patients with cirrhosis who present with encephalopathy, or who have a previous history of episodes of encephalopathy, present a difficult problem of nutritional management. Branched-chain amino acid-enriched diets have been advocated to normalize plasma amino acid profiles with the aim of improving nutritional state and preventing worsening of encephalopathy. Patients with respiratory failure on ventilators are adversely affected by diets with high carbohydrate loads which increase CO2 production. Diets with a higher fat energy component allow earlier weaning from artificial ventilator support as a result of decreased CO2 production and reduced respiratory quotient.

Research is being undertaken on the use of nutritional substrates or supplements such as fish oils, arginine, glutam-ine and nucleotides, designed to modify or modulate the immune and metabolic response to stress. As yet the clinical value of such diets is unclear and recommendations cannot yet be given on their use.

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