Question

Mr. Collins is a 55-year-old physician’s assistant with a history of chronic hepatitis C. Past history was remarkable for a needle stick injury on the job that occurred two years ago. Following the injury, he initially experienced sporadic episodes of mild flu-like symptoms with fever, chills, and diaphoresis. Over the past six months, his complaints increased to include generalized muscle weakness, fatigue, and weight loss. Mr. Collins is 5’9" tall and weighs 150 pounds with a usual weight of 162. On examination he was noted to have hepatomegaly and be markedly pale with icteric (jaundiced) conjunctiva and skin.

Mr. Collins complains of a poor appetite. He generally eats two meals a day and prefers meat, potatoes, salted snacks, and an occasional beer. He dislikes sweets, and some vegetables and fruits. He states that he often has nausea and feels bloated after eating, but is unable to pass the gas. He feels most comfortable when his stomach is empty.

Suppose Mr. Collins develops steatorrhea. Recommend daily energy (based on his EER; light activity), protein, and total fat intakes for him.

Answer 1

Recommendations for Mr. Collins' daily energy and nutrient needs must compensate for his potential malabsorption due to chronic hepatitis C and steatorrhea. He may need a higher protein intake to maintain muscle mass and a moderate fat intake focusing on medium-chain triglycerides for easier absorption. Close monitoring by healthcare professionals is crucial for his nutritional management.

Step-by-step explanation:

Suppose Mr. Collins develops steatorrhea, which is a type of bowel movement that is fatty and pale, indicating that fat is not being digested properly. This symptom suggests possible malabsorption due to his chronic hepatitis C condition. Hence, recommendations on daily energy, protein, and total fat intake must consider his need for a well-balanced diet that compensates for his potential malabsorption while considering his current weight loss and symptoms.

Mr. Collins' estimated energy requirement (EER) would consider his light activity level, age, weight, and height. A standard equation used for such calculations is EER = 662 - (9.53 × age in years) + physical activity level × ((15.91 × weight in kg) + (539.6 × height in m)). However, specific calculations would require more information such as his physical activity level coefficient.

For protein intake, considering his muscle weakness and weight loss, an increased amount might be beneficial to help preserve muscle mass. Typically, the recommendation for adults is about 0.8 grams per kilogram of body weight per day, but with conditions such as hepatitis C and signs of malnutrition, this might be increased to 1.0-1.5 grams per kilogram per day.

The total fat intake recommendation for liver disease patients, especially those experiencing steatorrhea, is to be moderate in fats, particularly long-chain triglycerides, which are harder to digest. Medium-chain triglycerides (MCTs) are easier to absorb and might be considered for supplementation. A registered dietitian can provide personalized advice that takes into account Mr. Collins' unique dietary needs, medical conditions, and preferences. Ultimately, careful monitoring by health professionals, including dietitians and his primary healthcare provider, is essential for managing Mr. Collins' overall health and nutrition status.