Viral Hepatitis: Nutritional Considerations

The following nutrition considerations apply to prevention and treatment of viral hepatitis:

Hygiene and sanitation. Persons who travel internationally or who are in areas of the United States where contamination occurs should be aware of an increased risk for hepatitis A. Uncooked food, water, and ice can increase the risk for hepatitis A transmission. Drinking bottled water, making sure food is prepared hygienically, and careful washing of hands and dishes can help prevent virus spread.¹

Shellfish risk. Shellfish are often harvested from wastewater–polluted areas of the sea, and can concentrate the microbial pathogens in the seawater. An estimated 4 million cases of infectious hepatitis A and E occur each year globally as a result of consumption of raw or partially cooked filter–feeding shellfish/mollusks taken from polluted coastal waters.²

Alcohol abstinence. In persons with hepatitis C, alcohol appears to have undesirable effects on immune function, viral replication, and hepatic regeneration, while contributing to increased hepatic iron content and negating the effects of drug (ie, interferon) treatment. Alcohol and the hepatitis C virus also act in an additive and possibly synergistic fashion to promote the development and progression of liver damage.³ A review of studies indicates significantly worse outcomes for alcohol users who have hepatitis C.⁴

High–antioxidant diet. An imbalance between diet–derived and endogenously produced antioxidants and the generation of oxidants triggered by viral infection causes oxidative stress in patients with viral hepatitis; this process results in liver damage that ranges from random apoptosis to sporadic or massive cell necrosis.⁵ Limited preliminary evidence indicates that certain antioxidants may improve the effectiveness of antiviral treatments, but clinical trials have not yet established their benefit.

Iron–restricted diet. Iron–induced oxidative stress may contribute to the pathogenesis of chronic hepatitis C,⁶ and iron depletion by phlebotomy consistently reduces serum aminotransferases.⁷ The benefit of effecting a change in iron status has not yet been proven to affect disease outcome. Nevertheless, the American Liver Foundation suggests that chronic hepatitis C patients with an elevated serum iron level or cirrhosis avoid iron–containing supplements and restrict intake of high–iron foods (eg, meats, liver, and iron–fortified foods).⁸

Orders

See Basic Diet Orders.

What to Tell the Family

Viral hepatitis may be relatively mild and self–limiting, or it may become chronic, depending on the virus involved and success of treatment. In cases of hepatitis A, family members may protect themselves by avoiding direct contact with the affected member and by practicing safe hygiene. In patients with chronic hepatitis B or the more common hepatitis C, the family can help keep the patient well–nourished, which should strengthen the effectiveness of antiviral treatment.