الفهرس 
Chronic liver diseaseOnly 14 pages are availabe for public view
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Abstract
Health education is very important in improving patient’s knowledge and practice in many diseases. Dietary counseling is the application of the principals of health education to change nutritional behavior to manage disease or to improve overall health.
The principals of dietary counseling were applied to modify the dietary habits in patients with chronic diseases such as coronary heart disease, diabetes mellitus, hypertension, renal diseases, anorexia nervosa, and obesity, while little is known about application of principals of dietary counseling in the field of chronic liver diseases.
This study was conducted at the out-patient clinic of National Research Center, in-patient department and out-patient clinic of Dr. Yassin Abdel Ghaffar Charity Center to provide nutritional counseling for a group of patients with ascites due to chronic liver disease and to evaluate the effect of dietary counseling in the studied population clinically (through improvement of ascites and lower limb edema); biochemically (through change in the 24 hour urinary Na excretion) and through anthropometric measurements (weight, height, BMI, TSFT, MAC and waist circumference).
The studied population included a total of 50 adult ascitic patients aged between 18-65 years old. They were patients with chronic liver disease due to hepatitis B and/or C virus with or without history of infestation with schistosomiasis. Patients were randomly allocated into two groups; (group I and group II), both groups included 25 patients, of both sexes, cross-matched as regard age, sex and degree of ascites. The study was performed during the period from the beginning of January 2009 till the end of July 2009. Studied patients were followed up over four months.
All the included patients were subjected to complete history taking, thorough clinical examination, laboratory investigations including (serum transaminases, albumin, total and direct bilirubin, prothrombin time. serum creatinine, urea, Na and K, and 24- hour urinary sodium excretion) as well as anthropometric measurements.
24 hours recall sheet, questionnaire of Knowledge, attitude and practice of all patients were evaluated regarding the sodium restricted diet.
Patients in Group I were subjected to sessions of dietary counseling concerning salt restriction in diet and its importance in improving ascites and edema, besides the usual management of ascites. The counseling included food lists about what kind of food should be avoided, what could be eaten, the amount of sodium present in commonly used food items and food menu. As salt restriction is the initial treatment, patients were advised that salt shouldn’t be used at the table or when cooking. Foods containing sodium were restricted or avoided and these included anything containing baking powder or baking soda as biscuits and cakes, all canned foods, salted foods as well as soft drinks. Patients in Group II were subjected to the usual management of ascites only without dietary counseling.
Both groups were followed up to 2 times at two months interval and were subjected to examination of the degree of ascites, lower limb edema, body weight measurement, measurement of waist circumference as well as twenty four hour Recall Sheet.
In the last visit: both groups were subjected to routine laboratory investigations, 24- hour urinary sodium excretion, 24 hour recall sheet, knowledge, attitude and practice questionnaire, examination of degree of ascites, examination of lower limb edema and anthropometric measurements: (weight, height, BMI, TSFT, MAC and waist circumference). Also, treatment given to the patient was reported.
The mean age of the studied patients was 52.92±6.3 years. Males represented 62%, while the females were 38% in both groups. As regards the etiology, 90% of patients had HCV, while only 10% had HBV.
The mean duration of disease since diagnosis was 10.2 ±5.5 years. Regarding Child-Pugh classification in this study, 68% of group I were Child B, 32% were Child C and none was Child A.
Regarding SFT; 32% of group I were malnourished.
Dietary counseling was significantly associated with improvement in the degree of ascites over the follow up period. This improvement was accompanied by significant improvement in lower limb edema, decrease in intervention by abdominal paracentesis and albumin infusion and a decrease in the dose of diuretics.
The amount of Na excreted in urine/day was increased significantly after dietary counseling in group I.
Improvement in ascites and lower limb edema was high in patients that had an increase in 24-hour urinary sodium excretion.
The median recall sheet score was lower in improved patients than non improved patients as regards ascites and lower limb edema. It was also lower in patients with increased 24 hour urinary Na excretion. Thus, patient’s commitment to salt restricted diet can help in their improvement.
Since sodium intake is related to the preference for salty taste and the use of salt and salty spices, questions addressing to such behaviors may be useful for estimation of sodium intake. The amount of sodium intake varies among people with different food habits and different taste preference.
Knowledge, attitude, and practice of all studied patients were evaluated regarding the sodium restricted diet before and after dietary counseling.
Knowledge, attitude, and practice (KAP) regarding the sodium restricted diet showed improvement in group I after dietary counseling; being represented by higher score obtained by the patients.
Improved patients in group I regarding ascites and lower limb edema had a lower salt intake (represented by lower recall sheet score) than non improved patients.