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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