Dietary alterations due to perceptions in acute viral hepatitis lead to sub-optimal calorie intake and increased length of hospitalization E. Sathiaraj, 1 M. Chutke, 1 S. Mahurkar, 2 P. Nagaraja Rao 3 and D. Nageshwar Reddy 3 1 Department of Clinical Nutrition, Asian Institute of Gastroenterology, Hyderabad, India; 2 Institute of Basic Sciences and Translational Research: Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India; and 3 Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India Received March 2009; accepted for publication June 2009 SUMMARY. Although there are no dietary restrictions rec- ommended in acute viral hepatitis (AVH), there is an altered food intake, probably because of perceptions and traditional nutritional practices, leading to sub-optimal intake and poorer clinical outcome. Therefore, we aimed to determine nutri- tional intake of AVH patients before and after disease onset and to investigate if optimal intake following nutrition education shortened the length of hospitalization (LOH). Seventy-five patients with AVH were interviewed for foods consumed and avoided because of perceptions during illness. Nutrition education was given to all patients with meal plan. In-patients were monitored for their nutritional intake until discharge. All patients were followed up after 2 weeks to assess compliance to the plan. There was a statistically significant decrease in mean calorie and protein intake in AVH patients during illness [1314 kcal (standard deviation, SD 291) and 27.5 g (SD 8.84)] when compared with that before onset of the disease [1873 kcal (SD 246) and 51.5 g (SD 8.03); P < 0.0001]. Mean LOH in patients consuming a high calorie diet [6.28 days (SD 2.91)] was significantly lower than those consuming low calories [8.36 days (SD 2.59), P = 0.024]. Two-week follow up revealed that 70% of patients modified their diet to a balanced normal diet as per the given plan. Our study showed that AVH patients consumed sub- optimal calories because of perceptions and traditional nutri- tional practices. Nutrition education played a major role in achieving overall nutritional goals and in decreasing the LOH. Keywords: acute viral hepatitis, diet, jaundice, length of hospitalization, nutrition education. INTRODUCTION Acute viral hepatitis (AVH), a common disease in all parts of the world, is caused by infection with one of the hepatotropic viruses such as hepatitis A, hepatitis B and hepatitis E [1,2]. Jaundice is a common presentation which follows a pre- icteric period of 5–10 days, deepens for 1–2 weeks and then levels off and decreases. Convalescence requires 3 weeks to 3 months and optimal care during this time is essential [3]. The mainstay of treatment for AVH is supportive care, as most cases are self-limited. General measures in all types of viral hepatitis include bed-rest if the patient is very symptomatic, a high calorie diet, avoidance of hepatotoxic medications and abstinence from alcohol [4]. Optimal nutrition provides the foundation for recovery of injured liver cells and overall regain of strength, which is a major aspect of basic care [5]. There are no specific dietary restrictions recommended in AVH. Fever and infection increase the nutrient requirements and a well-balanced diet is recommended during the illness. Despite the fact that low fat diets were associated with prolonged and complicated illness known almost for 20 years [6], such diets are still prevalent. There is an alteration in the food intake because of perceptions driven by traditional beliefs which could lead to sub-optimal nutrient intake and poorer clinical outcome. There are no reports to systematically prove that dietary restriction because of perceptions contributes to undernutrition and delays recovery. Therefore, our aim was to study the calorie and protein intake of patients with AVH before and after the onset of jaundice, and to understand the dietary patterns adopted by them based on their perceptions. We also wanted to investigate if optimal nutritional intake leads to faster recovery using length of hospitalization (LOH) as a surrogate Abbreviations: AVH, acute viral hepatitis; LOH, length of hospital- ization; SD, standard deviation; BMI, body mass index Correspondence: Ms. Esther Sathiaraj, Department of Clinical Nutrition, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, India. E-mail: esther.sathiaraj@gmail.com Journal of Viral Hepatitis, 2010, 17, 367–371 doi:10.1111/j.1365-2893.2009.01184.x Ó 2009 Blackwell Publishing Ltd