The liver has a vital role in intermediary and whole-body metabolism. Thus, it is the major organ responsible for a whole spectrum of body functions ranging from glucose provision via the breakdown of glycogen and gluconeogenesis to the storage of vitamins; the secretion of bile; lipogenesis; lipid catabolism; the synthesis and secretion of a number of export proteins such as albumin, prothrombin, and various secretory proteins; amino acid deamination; the production of urea; the detoxification of toxins; and steroid hormone metabolism. As a consequence, any adverse effect on the liver will have devastating consequences not only on its functions but also on the functions of other tissues such as the brain and the heart. However, there are many different types of liver diseases, each with distinct etiologies and nutritional treatment regimens. Each of the facets mentioned above must be placed within the context of the particular disease under scrutiny. Nevertheless, some of the elements in a particular disease entity can be cross-transferable to some other types of liver diseases.
The understanding of liver disease and nutrition requires a holistic understanding not only of the causative elements that precipitate the disease but also the nutritional factors and regimens that reverse the deteriorating hepatic function. By implication, holistic knowledge is also gained via a broad understanding of the nutritional elements in a wide range of liver diseases. Finding this knowledge in a single coherent volume of treatise would be very vital in the treatment of liver diseases. It is precisely in this context that Nutrition, Diet Therapy, and the Liver addresses these aspects ina comprehensive yet succinct way.
Nutrition, Diet Therapy, and the Liver is composed of the following four sections: Overviews, General Nutritional Support, and Nonspecific Conditions; Steatosis and Metabolic Liver Disease; Cancer, Viral, and Immune Diseases; and The Young and Aging Liver, End-Stage, and Transplantation.
Contributors in the first section emphasize the fact that nutrition has an important role to play not only in the development of liver disease but also in the reversal of liver dysfunction. It is well known that mortality is significantly increased in a malnourished compared with a nourished or even an overnourished population. For example, vitamin A deficiency will lead to an exacerbation of alcoholic liver disease. Moreover, the general nutritional status of a patient with liver disease will also have a bearing on the outcome. Artificial nutritional support is also important in the treatment of patients, such as those with hepatitis, whose survival is markedly improved by enteral or parenteral feeding.
In the second section, the contributors cover various aspects of alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) and the consequent steatohepatitis that encompasses the whole spectrum of triglyceride accumulation, inflammation, fibrosis, and, eventually, end-stage cirrhosis of the liver, which accounts for 14–20% of liver transplants worldwide. The initial stage of triglyceride accumulation leads to insulin resistance and accompanying metabolic syndrome. This leads to mitochondrial dysfunction resulting in the generation of reactive oxygen species (ROS). ROS is further increased in iron overload. ROS, in turn, causes more peroxidation of polyunsaturated fatty acids, generating more ROS, which down-regulates apolipoprotein B synthesis, which is in turn essential for exporting hepatic triglycerides in the form of very low density lipoproteins. ROS also depletes hepatic antioxidant glutathione; increases proinflammatory cytokines such as tumor necrosis factor a; suppresses adiponectin and proteasome activity; down-regulates asialoglycoprotein receptors resulting in apoptosis; leads to chemoattraction inflammatory cells to invade the liver; and activates stellate cells that produce and deposit more collagen, the hallmark of liver fibrosis. On the other hand, S-adenosylmethionine (SAMe), zinc, low levels of omega-3 fatty acids, and low-protein diets may be beneficial in the treatment of ALD and NAFLD in clinical practice, presumably by counteracting ROS and proinflammatory cytokines.
The authors of the third section focus on the mounting evidence in support of alcohol abuse, hepatitis viruses, and immune diseases as important predisposing factors in the incidence of hepatocellular carcinomas. Obviously, oxidative stress leading to ROS may be one of the major mechanisms involved in the pathogenesis of liver cancer. Therefore, dietary supplementation with antioxidants such as vitamins E and C as well as with methyl donors such as SAMe or betaine to restore liver glutathione, the natural antioxidant, may protect against alcohol-, autoimmune-, or viral-induced hepatocellular carcinomas. In addition, branched-chain amino acids and vitamins A, D, and K may also protect against hepatocarcinomas.
Finally, in the fourth section, the contributors evaluate the importance of nutrition in the treatment of liver diseases in infants versus adults, including recovery after liver transplantation. Thus, compared with the young, ROS generation within mitochondria seems to be increased with aging and may cause severe injury to mitochondrial DNA. There is also a progressive decline in the hepatic cytochrome P450 system with aging, resulting in impaired xenobiotic metabolism in the aged liver. Shortening of telomeric ends of chromosomes also correlates with aging and decline in the replicative potential of liver cell replicative senescence. Treatments with potential antioxidant cocktails including SAMe and betaine seem to show promise in recovery, even in patients with end-stage liver transplants.
The contributors to this volume are authors of international and national repute and leading experts in their respective fields. Emerging fields of science and important discoveries are also incorporated in this book and represent a one-stop shopping of material related to nutrition and the liver. Nutrition, Diet Therapy, and the Liver will be an essential reference book for nutritionists, dieticians, hepatologists, clinicians, health care professionals, research scientists, pathologists, molecular biologists, biochemists or cellular biochemists, and general practitioners, as well as those interested in nutrition or hepatology in general.
About the Author
- Victor R. Preedy is a professor in the Department of Nutrition and Dietetics at King’s College.
- Raj Lakshman is the deputy associate chief of staff for R&D and the chief of lipid research at the Veterans’ Administration Medical Center in Washington, D.C. He is also a professor in the Department of Biochemistry and Molecular Biology and in the Department of Medicine at George Washington University.
- Rajaventhan Srirajaskanthan is a specialist registrar in gastroenterology and hepatology at St. Thomas’ Hospital in London.
- Ronald Ross Watson is a professor in the College of Public Health at the University of Arizona.
Section I Overviews, General Nutritional Support, and Nonspecific Conditions
- 1. Liver Metabolism: Biochemical and Molecular Regulations
- 2. Regulation of Hepatic Metabolism by Enteral Delivery of Nutrients
- 3. Assessment of Nutritional Status and Diagnosis of Malnutrition in Patients with Liver Disease
- 4. Managing Liver Dysfunction in Parenteral Nutrition
- 5. Lipid Metabolism and Control in Nonalcoholic Fatty Liver Disease
- 6. Using Parenteral Fish Oil in NASH
- 7. Iron Overload in Nonalcoholic Fatty Liver Disease: Implications for Nutrition
- 8. Nutritional and Clinical Strategies on Prevention and Treatment of NAFLD and Metabolic Syndrome
- 9. Emerging Nutritional Treatments for Nonalcoholic Fatty Liver Disease
- 10. Dietary Fatty Acids and the Pathogenesis of Liver Disease in Alcoholism
- 11. Long-Term Management of Alcoholic Liver Disease
- 12. Nutritional Therapy for Inherited Metabolic Liver Disease
- 13. Biomarkers of Malnutrition in Liver Cirrhosis
- 14. Malnutrition in Liver Cirrhosis: Effects of Nutritional Therapy
- 15. General Dietary Management of Liver Cancer
- 16. Vitamins in Hepatocellular Carcinoma
- 17. Supplementation with High Doses of Vitamins E and C in Chronic Hepatitis C
- 18. Diet Therapy in Virus-Related Liver Disease
- 19. Nutritional Care for Infants with Cholestatic Liver Diseases
- 20. Nutritional Considerations in Pediatric Liver Transplantation
- 21. Use of an Antioxidant Cocktail for Insulin Resistance Associated with Age and a High Sugar Diet: A Hepatic Mechanism
- 22. Nutrition in End-Stage Liver Disease
- 23. Nutrition in Adult Liver Transplantation
Book Details
- Hardcover: 373 pages
- Publisher: CRC Press; 1 edition (2010)
- Language: English
- ISBN-10: 1420085492
- ISBN-13: 978-1420085495