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1、临床研究营养与肝胆胰疾病课件 主页目录-Home营养与肝胆胰疾病Hepatopancreatobiliary Disease and Nutrition? LIVER is the largest organ in the body. It is found high in the right upper abdomen, behind the ribs. There are two lobes: a big one on the right and a small left one. Blood runs through the liver every two minutes主页目录-Hom
2、e第一节 肝 炎? 肝脏与胆囊、胰腺在营养物质的消化、吸收、排泄、生物转化以及代谢中发挥重要的作用。?Together with gallbladder and pancreas, they play significant roles in the digestion, absorption, excretion, bioconversion, metabolism of nutrients.定义Definition肝炎 各种原因引起的,以肝实质细胞变性坏死为主要病变的肝功能损害 Hepatitis implies injury to the liver characterized by t
3、he presence of inflammatory cells in the tissue of the organ.主要病症Symptoms乏力、食欲减退、厌油腻、肝区不适、腹胀等 The main symptoms include hypodynamia, loss of appetite, nausea or vomiting,abdominal discomfort or distension分类 Categorizations根据病程长短分急性肝炎(病程不超过半年)和慢性肝炎(病程在半年以上)肝炎以病毒性肝炎(viral hepatitis)最常见,也包括由于酒精滥用、药物使用不
4、当、环境毒物以及遗传引起的肝炎 Acute hepatitis half a year; chronic hepatitis half a yearHepatitis is caused mostly by viruses, but other factors like alcohol, drugs, toxins and heredity may also lead to hepatitis 病毒性肝炎是法定乙类传染病,传染性较强、传播途径复杂、流行面广泛、发病率高局部乙型、丙型和丁型病毒性肝炎患者可演变成慢性,并可开展为肝硬化和原发性肝细胞癌Viral hepatitis is one o
5、f the Class B notifiable infectious diseases and easily infected, with a high prevalence? Hepatitis A, C and D may develop into liver cirrhosis or primary liver cell cancer一、肝炎与营养的关系 Hepatitis & Diet/Nutrition? 过度节食,减肥,营养不良,脂肪和能量摄入过剩肥胖,机体的抵抗力下降,过量饮酒损害肝脏功能水质和食物受到有害的重金属(镉、铜、汞等)、化合物(苯、酚等)、农药(有机磷等)污染后可引
6、起中毒性肝炎Overeat, on diet, malnutrition, excessive intake of fat and energy, decline in immune functionAnd water/food contaminated with heavy metals Cd, Cu, Hg, compounds benzene, phenol or pesticide organophosphorus may cause hepatitis 碳水化合物代谢障碍 Disorder of Carbohydrate Metabolism? 肝糖原合成减少,加上病人进食少而处于饥
7、饿状态,易出现低血糖肝脏将乳酸转变为糖原的功能减弱,易引起乳酸在体内蓄积,四肢酸痛,重者可出现酸中毒 Deceased glycogen formation and diet intake easily lead to hypoglycemiaImpaired function of converting lactic acid to hepatin causes lactic acid accumulation, painful limbs and even acidosis 蛋白质代谢障碍Disorder of Protein Metabolism肝细胞合成蛋白质障碍,血浆白蛋白水平下降凝
8、血酶原和纤维蛋白原等多种凝血因子合成障碍,重症者可发生皮肤和粘膜出血不止鸟氨酸循环受影响,尿素合成能力下降,使血氨水平增高 Blocked protein synthesis in liver cells and decreased plasma albumin level Prothrombin, fibrinogen and other blood clotting factors synthesis obstructed; mucocutaneous hemorrhage Ornithine cycle interfered, declined urea formation and el
9、evated blood ammonia level 脂肪代谢障碍Disorder of Lipid Metabolism肝脏受损,各种脂肪转变为血浆中磷脂,胆固醇、胆固醇脂与脂蛋白的合成过程发生障碍,脂肪不能释放出肝脏以供人体组织利用脂肪就淤积于肝内而形成脂肪肝肝内结缔组织增生而导致肝硬化Damaged liver; lipids turn into plasma phospholipids; the composition of cholesterol/cholesterol ester and lipoprotein is impaired and lipid cannot be use
10、d by the body from the liverLipid accumulation leads to fatty liverHyperplasia of reticular tissues in liver causes cirrhosis 肝脏在脂质代谢中的作用Liver in the metabolism of lipids 维生素和矿物质代谢障碍 Disorder of Vitamin/Mineral Metabolism? 肝内有胡萝卜素酶95%的维生素A和大量维生素D贮存于肝内矿物质如铁和铜在肝内贮存亦甚多Carotenase in liver95% of vitamin
11、A and most vitamin D are stored in liverMinerals, like iron and copper, are abound in liver? 维生素B族在肝内形成辅酶参与新陈代谢;维生素C能促使肝糖原形成、保护肝内酶系统、增加肝细胞抵抗力及促进肝细胞再生B-complex vitamins become coenzymes and take part in metabolism in liver; vitamin C facilitates glycogen formation, protects the enzymes in liver, incr
12、eases the immune function of liver cells and promotes liver cells proliferation 二、营养防治 Nutrition Prevention/Treatment? 合理的膳食结构、少喝酒和清洁的饮用水可减少肝炎的发生 营养治疗的目的是防止加重肝脏的负担和损伤,同时给予充分营养以保护肝脏、促进肝脏细胞的再生和功能的恢复 Balanced diet, no alcohol and clean water may reduce the incidence of hepatitisThe goal of nutrition th
13、erapy is to decrease the burden and damage to liver, and meanwhile provide sufficient nutrition to protect and promote the regeneration and recover of liver cells1.急性期Acute Phase原那么是保证有足够的蛋白质、糖类、多种维生素和矿物质,适量的脂肪,即给予低脂肪、易消化、高维生素、高碳水化合物的清淡饮食 选用富有营养、易消化吸收的流质或半流质饮食,少量屡次用餐 Adequate protein, sugar, multi-v
14、itamins and minerals, moderate fat, i.e, low fat, high vitamin, high carbohydrate and easily absorbed-dietLiquid or semi-liquid diet that are nutritious and easily absorbed/digested; (20002500kcal)为宜;结合具体情况作相应的能量摄入调整 Appropriate energy intake Generally, adults needs 8.410.5 MJ 20002500kcal energy da
15、ily; adjust the volume accordingly. 足量优质蛋白 Adequate good protein蛋白质是肝细胞再生、肝功能恢复所需要的主要原料肝病时,易出现负氮平衡 Protein is the main material that the liver cells needed for cell proliferation and function-recoveryNegative nitrogen balance often occurs in liver diseases? 蛋白质的供给量应占总能量的15%,并以质优、量足、产氨少的蛋白质为主 每日供给适量的
16、动物性蛋白和蛋氨酸食物,如瘦肉、蛋、鱼、豆类及豆制品等 Protein should be the 15% of total energy; good protein, adequate amount, less ammonia productionProvide animal protein and methionine rich food everyday, like lean meat, egg, fish, soy or soy product? 食物选择应富含必需氨基酸,且种类齐全,特别要多供给鱼、虾、鸭、去皮鸡肉、牛奶、黄豆、玉米、小米、糯米、菜花、小红枣等含支链氨基酸多的食物少吃
17、带皮鸡肉、猪肉、牛肉、羊肉、兔肉等含芳香族氨基酸包括酪氨酸、苯丙氨酸、色氨酸多的食物 Essential amino acid rich food, various kinds, especially fish, shrimp, duck, skinless chicken, milk, soy, corn, millet, sticky rice, cauliflower, red date and other branched amino acid rich foodChicken with skin, pork, beef, mutton, rabbit and other aromat
18、ic amino acid like tyrosine, phenylalanine, tryptophan rich food should be avoided.适量的碳水化合物Moderate Carbohydrate 肝病时易出现低血糖和乳酸堆积 碳水化合物节约蛋白质,增加肝糖原储藏,维持肝微粒体酶的活性,增强肝细胞对毒素的抵抗力每日供给量占总能量的60%70%为宜,主要从米、面、谷类食物中摄取? Hypoglycemia and lactic acid accumulation often happen during liver diseasesCarbohydrate can sa
19、ve protein, increase the glycogen content, maintain hepatomicrosome enzyme activity, and increase the resistance to toxinsCarbohydrate should provide 6070% of the total energy, mainly from rice, flour and other grains不过分限制脂类Dont restrict fat每天供给5060g脂肪,脂肪供给量可占总热量的20%25% 宜采用易消化的植物油限制胆固醇高的食物,如猪油、动物内脏、
20、蛋黄、乌贼鱼、贝类等,减轻肝脏的负担,改善胆固醇的代谢障碍5060 g fat everyday, 2025% of the total energyPlant oil that are easily digestedRestrict high cholesterol food, like lard, animal viscera, egg yolk, cuttlefish and seashell, to relieve the burden of liver, improve cholesterol metabolism补充充足维生素 Adequate Vitamins维生素对肝细胞的解毒
21、、再生和提高免疫力等方面有特殊意义;一些抗氧化营养素如维生素E、A、C等有保护肝脏免受损伤的作用 Vitamins have special meanings for the detoxification, regeneration, immunity functions of liver cells; some antioxidants, like vitamin E, A and C can prevent the liver from oxidative damage? 选食含B 较多的全麦、花生、豆芽和新鲜蔬1菜、水果外,必要时增服合成制剂 富含维生素A的食物,主要为胡萝卜、深绿色菜叶
22、、牛奶、蛋黄和肝脏 肝炎病人维生素C的需要量增加,而存量减少,主要来源为新鲜蔬菜 Eat more whole grains rich vitamin B , peanut, 1bean sprout and fresh vegetables & fruits; take supplements when necessaryFood rich in vitamin A includes carrot, dark green vegetables, milk, yolk and liverThe amount of vitamin C should be increased in liver d
23、iseases patients, with mainly resources from fresh vegetables丰富的膳食纤维和水分 Enough fiber and water培养良好的饮食习惯 少食多餐,每日45餐,定时定量,食物应清淡、可口、易消化,原料必须新鲜,严禁暴饮暴食;戒酒? Regular diet eat less but more often, 45 meals per day, at fixed time and volume; the food should contain less fat, easily digested, fresh; no engorg
24、ement and alcohol第二节 脂肪肝 Fatty Liver 脂肪肝系一种多病因引起肝细胞内脂质蓄积过多的病理状态 脂肪肝的发病率在我国明显上升,据不完全统计脂肪肝的发病率在10%左右 Fatty liver is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis The incidence of fatty liver, which in China is approximately 10%,
25、is increasing obviously 一、脂肪肝与营养的关系 Fatty Liver and Nutrition“酒精性脂肪肝 酒精对肝细胞有较强的直接毒害作用,可使转运到肝脏的脂肪增加,肝内脂肪的分解代谢降低,运出减少,脂肪堆积于肝脏Alcoholic Fatty Liver alcohol does strong and direct harm to liver cells, increases the fat content in liver, decreases the metabolism and transport of fat and causes fat accumu
26、lation? 营养不良性脂肪肝 过度节食、长时间饥饿、神经性厌食、肠道病变引起营养素吸收不良、能量供给缺乏、蛋白质供给低下都会导致脂肪发动增加;磷脂合成受影响,脂蛋白生成缺乏。大量游离脂肪释放到血液中,进入肝脏,超过脂蛋白转运能力而沉积于肝内MalnutritionOver slimming, longtime hunger, anorexia nervosa, intestinal tract diseases limit the absorption of nutrients, supply of energy and protein, which all cause higher fa
27、t mobilization, less phospholipids and lipoprotein formationLarge amount of lipid is released to blood and goes to liver, and finally exceed the lipoprotein capability and accumulates in liver? 营养过剩性脂肪肝 偏食荤菜、甜食,摄入过多的脂肪和碳水化合物,在引起高血脂的同时,还使肝内脂肪代谢紊乱,造成肝内脂肪蓄积Hyperalimentary fatty liver-preference for ani
28、mal food, sweets, and over-intake of fat and carbohydrate cause hyperlipemia, disorder of lipid metabolism in liver and eventually fat accumulation in liver二、营养防治 Nutritional Therapy1.调整饮食结构,保持营养均衡2.主食不要过于精细,注意粗细粮搭配3.每日进食一定量的蔬菜和水果,经常食用豆制品4.动物性食品以鱼类、禽类、兔肉为主,适量食用牛、羊肉,少吃猪肉,尤其是肥肉、猪大肠1. Keep a balanced d
29、iet and nutrition2. Eat more whole grain food3. Eat vegetables and fruits everyday, and soy products regularly4. More fish, poultry, rabbit, moderate beef and mutton, less pork, no fat and pork intestine? 5.建立合理的膳食制度,均衡地安排三餐的饮食,少吃零食6.饥饱适当,切忌暴饮暴食,不偏食、挑食7.饮酒要适量,不要酗酒 5. Keep a regular diet and eat less snacks6. No engorgement, no monophagia and picky in food7. Moderate if drink wines? 营养治疗的目的 消除或减轻肝脏脂肪沉积,阻止脂肪肝开展和恶化;改善肝功能,保证机体营养需要,防止并发症Goals of nutritional therapyeliminate or alleviate liver fat accumulation, improve liver functions, provide adequate nutrients, and prevent complications