Hepatitis C: Nutrition Care 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: <www.healthcanada.ca/hepc>.

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 <www.dietitians.ca/resources/HepatitisC_Guidelines.htm>.

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

Executive Summary

Practice Essentials

Introduction
     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
     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

Chapter 2: Healthy Lifestyle Overview
     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 3: Nutrition Intervention in Hepatitis C
     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

Chapter 4: Assessment of Nutritional Status
     Factors to Consider in Clinical Nutrition Evaluation
     Counselling Guidelines and Recommendations

Chapter 5: Dealing with Symptoms and Treatment
Side Effects
     Common Symptoms and Treatment Side Effects Associated
     with Hepatitis C
     Strategies for Coping with Symptoms and Treatment Side Effects

Chapter 6: Complementary and Alternative Therapies
     The Naturopathic Approach
     Vitamin/Mineral Supplements
     Herbal Products

Chapter 7: Nutritionally At-Risk Groups
     Concomitant Medical Conditions
     At-Risk Population or Lifestyle Groups

Chapter 8: Skills for Healthy Eating
     Ability to Plan, Shop and Cook
     Nutrition Labelling
     Food Safety

References and Resources
     References by Chapter
     Resources - Organizations and General Useful Resources
     Resources - by Chapter

Glossary of Terms and Acronyms

Appendices
     Appendix A: Healthy Eating Checklist for Persons with Hepatitis C
     Appendix B: Canada's Food Guide Principles
     Appendix C: Summary of Physical Activity Considerations
     Appendix D: Quick Protein Check
     Appendix E: Guidelines for Food Selection with Sodium Restriction
     Appendix F: Managing Common Discomforts and Treatment Side                            Effects
     Appendix G: Healthy Eating - Planning Tips
     Appendix H: Low-Cost Nutritious Choices
     Appendix I: Standard Nutrition Facts Label
     Appendix J: Tips for Safe Food Handling

Acknowledgements

Many people have contributed to the development of these guidelines and deserve recognition for their time, effort and dedication.

Dietitians of Canada sincerely thanks the members of the national advisory committee for their expert advice and guidance. We also thank the organizations involved in the project, as well as the expert reviewers who provided valuable guidance on the technical and practical aspects of the guidelines.

Production of the guidelines would not have been possible without the insights of those who participated in the key informant interviews for the needs assessment. We are also grateful to the participants in the focus groups conducted to test and refine the patient education material.

National Advisory Committee

Renée C. Crompton, M.Sc., RD
Regional Nutritionist - Ontario Region
First Nations and Inuit Health Branch
Health Canada

Mary Giudici, RDN
Vancouver Island Health Authority
Royal Jubilee Hospital
Victoria, BC

Lynn Greenblatt
Community Acquired Infections Division
Health Canada

Kelly Kaita, MD, FRCP(C)
Director, Viral Hepatitis Investigative Unit
University of Manitoba
Canadian Association for the Study of the Liver

Timothy J. McClemont
Executive Director
Hepatitis C Society of Canada

Billie Potkonjak
National Director of Health Promotion and Patient Services
Canadian Liver Foundation

Jeff Rice
Coordinator of Regional Resources and Hepatitis C Programs
Canadian Hemophilia Society

Vera Simon, RN, M.Sc.N
President
Canadian Association of Hepatology Nurses

Jayne Thirsk, Ph.D., RD
Professional Development and Support
Dietitians of Canada

Lori Hards, RD
Dietitian/Nutritionist
Southern Alberta Clinic
Calgary, AB

Janet Madill, Ph.D.(C), RD
Transplant Dietitian, Research Practice Leader
University Health Network, Toronto General
Toronto, ON

Tania Soutar, B.Sc., RD
Clinical Dietitian
Regina Qu'Appelle Health Region
Regina, SK

Special thanks go to Mary Giudici for sharing her patient education tools, and to the additional expert reviewers: Diana Johansen, B.Sc., RD, Clinical Dietitian, Oak Tree Clinic, Children's and Women's Health Centre of British Columbia, and Adjunct Professor, Department of Family Practice, University of British Columbia; and Sian Hoe Cheong, RD, Supervisor, Food Services, Medicine Hat Regional Hospital, Palliser Health Region.

Project Management

Susan Morgan, M.Ed., RD
Project Manager

Jeane Ennis
Consultant/Project Associate

 
Expert Reviewers-Dietitians of Canada

Pauline Brazeau-Gravelle, RD
Perinatology Clinical Dietitian
Ottawa Hospital, General Campus
Ottawa, ON

Alison Cummins, RD
Clinical Dietitian-Medicine Program
Health Sciences Centre
Winnipeg, MB

Marylynn Cutten, P.Dt.
Dietitian, Food & Nutrition Services
Capital District Health Authority
Queen Elizabeth II Health Sciences Centre
Halifax, NS

Sheryl Conrad, RD
Consultant/Writer

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