Role of diet in control of ascites

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Role of diet in control of ascites
Presented by Rabab Maamoun
Salama
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• The first step in the management of cirrhotic
  patients having ascites is sodium restriction.
• The amount of fluid retained in the body depends
  on the balance between sodium injested in the
  diet and sodium excreted in urine.
• If Na excretion in urine is greater than intake
  , ascites and or Oedema will decrease.

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• In patients with mild Na retention , reduction
  of Na content in the diet to 40-60 mmol / day
  (1-1.5 g of salt) without any therapeutic
  intervention will result in negative Na balance
  and loss of ascites.
• In patients with moderate or severe Na
  retention , more severe restriction of Na to 20
  mmol/ day is indicated , however such intense Na
  restriction is difficult to accomplish and may
  impair nutritional status.
• Failure to adhere to a low Na diet is the usual
  reason for ascites to be termed Resistant or
  Refractory.

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General Remarks for diet control in ascites

• I) Cereal and Cereal products
• Bread
• Avoid French bread , and white bread as they have
  high sodium content. Each one contains nearly 530
  mg Na.
• ¾ of Balady bread 90 g contains 125 mg Na. So
  the patient can eat per day ¼ balady bread each
  meal.

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• Rice
• 1/2 cup of boiled rice 65 g contains nearly
  7.15mg of Na.
• Rice can be boiled or cooked with unsalted butter
  oil (low Na content every 100g 5 mg Na) or
  with corn oil or olive oil (no Na content at all
  ).
• Macaroni
• 3/4 cup of macaroni 60 g contains 4.8mg of Na
  can be eaten boiled with a small piece of
  unsalted butter.
• Wheat flour
• One cup 100g contains 22 mg Na.
• Wheat
• One cup of wheat 142 g contains 14.2 mg Na.

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• II)Legumes
• Broad Beans
• One cup of cooked unsalted broad beans 200 g
  contains 70 mg Na.
• Germinated broad beans
• One cup of boiled unsalted germinated broad beans
  200 g contains 28 mg of Na.
• Lentils
• ½ cup of boiled lentils 100g contains 30 mg
  Na.
• Cow pea
• ½ cup of cooked cow pea 100g contains 20 mg
  Na.
• Lentils , peeled
• ½ cup of boiled peeled lentils 72.5 g contains
  30 mg Na.

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• III) Starchy roots and Tubers
• Potatoes
• White potato has a low Na content . Every 100 g
  contains 8 mg Na.
• One cup of fried potatoes 75 g contains 6 mg
  Na.
• Sweet potatoes
• One cup of boiled and minced sweet potatoes 125
  g contains 28 . 75 mg Na.
• Colcasia tuber One cup of Colcasia 200 g
• ½ of it colcasia and ½ of it chard swiss contains
  nearly 198 mg Na

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• IV) Vegetables
• Most of vegetables are of low to average sodium
  content ranging from 7 100 mg / 100 g.
• Examples of vegetables with low to average sodium
  content
• Cucumber (medium size 80 g 4 mg Na).
• Tomato (small size 70 g 7 mg Na).
• Lettuce (6 leafs 70 g 7 mg Na).
• Egg plant Radish white artichokes Squash
  Cauliflower Spinach.
• Examples of vegetables with gt 100 mg Na content
  / 100 g
• Chard swiss 164mg.
• Jews Mallow 180 mg .
• Water cress 116 mg.

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• V) Eggs
• Hens eggs one small egg 32 g contains 50 mg
  Na.
• Egg white Every 100 g contains 172 mg Na.
• Egg yolk Every 100 g contains 44 mg Na.
• VI) Milk and its products
• ½ cup of milk 99 g contains 50-60 mg Na.
• One cup of yoghurt 70 g contains 35 mg Na.
• ½ cup of Cheese skim milk 80 g contains 36 mg
  Na.
• Avoid Cow milk powder Cheese Camembert
  processed cheese- Salted cheese and Roquefort
  cheese.

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• VII) Meat and Poultry
• 1 peice of cooked meat 30 g contains nearly
  30.9 mg of Na.
• 1 slice of liver 50 g contains 40 mg Na.
• ¼ of cooked chicken 30 g contains 23.1 mg of
  Na.
• Avoid Canned corned beef (880 mg Na/ 100g).
• Dried meat (5200 mg Na/ 100g).
• Sausaged meat and salami .

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• VIII) Fish and Sea foods
• One small Mullet fried 125 g contains 120 mg
  Na.
• One small Mullet roasted 125 g contains 125 mg
  Na.
• Avoid salted fish , and salted sardine.
• IX) Fruits
• All fruits of medium size as apple , apricots ,
  Banana , dates , grapes , lemon, Guava , pears,
  orange , mandarin , water melon and strawberry
  ,are of low Na content . Dried fruits as raisins
  , figs contain 30 mg Na/100 g.

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• X) Nuts
• All nuts as Almonds , peanuts , hazelnuts and
  coconuts are of low Na content in the range of
  7-15 mgNa/100 g.
• XI) Condiments
• Avoid Mustard (240 mg/100g).
• Clove and Cumin should be used in small amounts .
• Clove (300 mg/100g).
• Cumin ( 145 mg/100g).
• Rest of condiments are of low Na content.

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• The ascitic patient can drink coffee , tea , ½
  glass of Seven up (14 mg / 100g).
• He can also eat
• Jam (2 tb spoon ) 40 g contains 5.6 mg of Na.
• 1 piece of Halawah Tehiniah 40 g contains 2 mg
  Na.
• Molasses (3 tb spoon) 20 g contains 8.2 mg Na.
• Honey (2 tb spoon) 20 g contains 1.2 mg Na.
• All patients should be individualized , weighted
  , clinically assessed and then menu according to
  the condition of nutrition and the amount of
  ascites is prescribed.

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Thank you