Dietary Management of Hepatitis C

Mary HoodBBV Dietitian

14 Beckford StHamilton

01698 201433

Infectious Diseases Unit - Monklands

01236 712246/7

Side effects of HCV Therapy

• Flu like symptoms

• High temperature, shaking

• Weight loss

• Reduced appetite

• Fatigue

• Taste changes

• Depression

• Nausea, vomiting

• Headaches

• Skin rashes

• Anal itch

• Joint problems

• Abdominal pain

• Mood swings

Myths!!!

• Myth 1. The treatment is horrendous

• Myth 2. Everyone will lose weight

• Myth 3. You will always be given nutritional supplements as part of your treatment

All patients have a different experience with food intake and weight.

Patients will be individually assessed and nutritional plan agreed

Malnutrition Universal Screening Tool-“MUST”

“Must”

5 step screening tool to identify Adults who are malnourished or at risk of malnutrition

Step 1 ; Measure height and weight to get BMI – note score

Step 2: Calculate percentage weight loss – note score

Step 3: Establish acute disease effect –note score

Step 4: Add steps from 1, 2 and 3 to obtain risk of malnutrition

Step 5: Use management guidelines and /or local policy to develop care plan

National Institute for Health and Clinical Excellence (NICE)

British Dietetic Association (BDA)

National Nurses Nutrition Group (NNNG)

NICE Guidelines for Nutrition Support in Adults (2006)

Nutrition Support should be considered in people at risk of malnutrition as defined by any of the following:

- a body mass index (BMI) of less than 18.5 kg/m²

- unintentional weight loss greater than 10% within last 3-6 months

- a BMI of less than 20 kg/m² and unintentional weight loss greater than 5% within last 3-6 months

- have eaten little or nothing for more than 5 days and/or likely to eat little or nothing for 5 days or longer

- Have poor absorptive capacity and/or high nutrient losses and/or have increased nutritional needs for causes such as catabolism

Weight and HCV??

• Patients who are overweight pre-treatment should be advised to lose weight

• Patients who are overweight and on treatment for HCV can be supported to lose weight

• Absorption of the Pegylated Interferon injection can be difficult in patients with a high BMI

• BMI should ideally be <30 kg/m²

• SIGN 92 (2006) suggests that weight loss may have a beneficial effect on the degree of Liver damage associated with BBV infections

Major Problems!!!

• Weight loss and Body image

• Mental health related to above

• Poverty

• No cooking skills

• No family support

• Chaotic lifestyle- adherence to treatment

Nutritional Advice on HCV treatment

• Telaprevir = 12 weeks

Approximately 30g of fat required for absorption of tablets

3 tablets taken 2 x per day with food

• Boceprevir = 12 weeks

Requires to be taken with food

• Ribavarin = 24 or 48 weeks, taken with food and extra fluid required

• Pegylated Interferon injection = no dietary requirements

Nutritional Advice on HCV Treatment

• General healthy eating for Liver

• Foods that are good to include in the diet

• Foods that should be avoided or reduced

• Advice to cope with flu-like symptoms

• Increase fluid

• Taste changes

• Nausea

• Constipation

Patient Experience

• Patient 1: Weight kgs BMI kg/m²

• Start of treatment 50.0 19.5

• During treatment 49.0 19.1

• End of treatment 49.9 19.5

• Comments: Patient was underweight at start and end of

treatment.

• Followed nutritional advice and was able to maintain weight throughout treatment

Patient Experience

• Patient 2. Weight kgs BMI kg/m²

• Start of treatment 81.3 24.4• During treatment 75.3 22.6• End of treatment 72.3 21.8

• Comment: Patient had normal BMI at start and end of treatment

• Patient was given a variety of nutritional supplements but did not like any of them

• Patient gave up treatment due to weight loss and body image despite weight and BMI being normal?

Patient Experience

• Patient 3 Weight kgs BMI kg/m²

• Start of treatment 55.6 17.7

• During treatment 65.0 20.7

• End of treatment 63.0 20.1

• Comment: Patient was underweight at start but with support had a normal BMI and the end of treatment.

• Patient commented that he would not have continued with the treatment if he did not have Dietetic support

Conclusion

• All patients with HCV should be encouraged

to have treatment

• All patients are supported by a team of Doctors, Nurses, Dietitian and many other health professionals

• The treatment is not as Horrendous as the storries suggest

• All patients have a very different experience during treatment and do not all lose weight.

References

Hepatitis C Scotland pages: http://www.hepcscotland.co.uk

The British Liver Trust: http://www.britishlivertrust.org.uk

The Hepatitis C Trust: http://hepctrust.org.uk

NHS Lanarkshire Sexual Health Website: http://www.lanarkshiresexualhealth.org

Di Bisceglie A, Hepatology 2000;31(4) ;1014-8.

Manns MP, et al. Nat Rev Drug Discov. 2007;6:991-1000.

www.hep-druginteractions.org

Thank you for listening to me today.

Any Questions?