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Hepatitis C: Nutrition Care
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Canadian Guidelines for Health Care Providers Canadian Guidelines for Health Care Providers

Endorsed by:
♦ ♦ ♦ ♦ ♦

Canadian Association for the Study of the Liver Canadian Association of Hepatology Nurses Canadian Hemophilia Society Canadian Liver Foundation Hepatitis C Society of Canada

Funding for the development and dissemination of these guidelines was provided by Health Canada, Community Acquired Infections Division: . These guidelines are designed to serve as a general framework to assist decision making for nutritional management of patients infected with the hepatitis C virus and are based on the best information available at the time of publication. The particular needs of individuals infected with the hepatitis C virus will determine how these guidelines are used. The skill and judgement of the health care provider is important in making health care decisions. The opinions expressed in this document do not necessarily reflect the official policies or views of Health Canada.

Copyright 2003, Dietitians of Canada. All rights reserved. This document, as well as an online professional education program and patient education handouts, are available from the Dietitians of Canada website at . Permission is granted to download and reproduce the documents in their entirety. Également disponible en français sous le titre, Hépatite C : Soins nutritionnels – Lignes directrices canadiennes pour les intervenants de la santé.

Table of Contents
Acknowledgements ............................................................................................ i Executive Summary ........................................................................................... ii Practice Essentials ............................................................................................ iv Introduction ....................................................................................................... 1 Target Audience for the Guidelines Rationale for the Guidelines Results of Needs Assessment How the Guidelines Were Developed

Chapter 1: A Primer on Hepatitis C ................................................................. 3 Description of the Issue Who Is at Risk Diagnosis of HCV Current Treatment Strategies How HCV Affects the Liver Stages of Liver Disease Factors Implicated in Progression of Liver Damage The Role of the Liver in Nutrition How HCV Affects Nutritional Status Proven Benefits of Nutrition Healthy Eating for Persons Infected with HCV Healthy Eating Guidelines in Canada Alcohol and Hepatitis C Importance of a Healthy Body Weight Importance of Physical Activity

Chapter 2: Healthy Lifestyle Overview ........................................................... 7

Chapter 3: Nutrition Intervention in Hepatitis C......................................... 10 Guidelines for Nutrition Intervention in Hepatitis C Nutrient Guidelines Overview Oxidative Stress Vitamin and Mineral Supplements Stage of Hepatitis C — Nutrition Considerations Enteral and Parenteral Nutrition Factors to Consider in Clinical Nutrition Evaluation Counselling Guidelines and Recommendations

Chapter 4: Assessment of Nutritional Status .............................................. 24 Chapter 5: Dealing with Symptoms and Treatment Side Effects .............. 29 Common Symptoms and Treatment Side Effects Associated with Hepatitis C Strategies for Coping with Symptoms and Treatment Side Effects The Naturopathic Approach Vitamin/Mineral Supplements Herbal Products

Chapter 6: Complementary and Alternative Therapies .............................. 30

Chapter 7: Nutritionally At-Risk Groups....................................................... 35 Concomitant Medical Conditions At-Risk Population or Lifestyle Groups Ability to Plan, Shop and Cook Nutrition Labelling Food Safety...
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