Intensive nutritional therapy beneficial to decompensated cirrhosis patients with sarcopenia

In patients with decompensated cirrhosis and sarcopenia, dietitian-supervised intensive nutritional therapy yields greater improvements in skeletal muscle mass, strength, and physical performance compared with routine physician-led guideline-based dietary advice, as shown in a study.

The single-centre, open-label study included 180 patients with decompensated cirrhosis and sarcopenia. These patients were randomly assigned to undergo dietitian-supervised intensive nutritional therapy or physician-led guideline-based dietary advice for 6 months. Patients in the intensive nutritional therapy had a targeted energy intake of 35–40 kcal/kg/day and protein intake of 1.2–1.5 g/kg/day through structured dietitian supervision.

Change in skeletal muscle index over 6 months of intervention was the primary outcome. Secondary outcomes included handgrip strength, gait velocity, nutritional status, liver disease severity, and clinical outcomes.

Over 6 months, skeletal muscle index increased significantly more in the intensive nutritional therapy group than in the dietary advice group (between-group difference, 2.50 cm²/m², 95 percent confidence interval [CI], 1.30–3.70).

Compared with dietary advice, intensive nutritional therapy was also associated with significantly greater improvements in handgrip strength (between-group differences, 7.5 kg in men and 4.8 kg in women; p<0.001) and gait velocity (between-group difference, 0.23 m/s; p<0.001).

Patients who received intensive nutritional therapy vs dietary advice had an increase in serum albumin levels (between-group difference, 0.48 g/dL) and decrease in the Child-Turcotte-Pugh score (between-group difference, −1.30 points).

Overall multidomain response occurred in 68.9 percent of patients in the intensive nutritional therapy group vs 37.8 percent of those in the dietary advice group (relative risk, 1.82, 95 percent CI, 1.36–2.44). Dietitian-supervised therapy independently predicted skeletal muscle index response (odds ratio, 3.82, 95 percent CI, 1.80–8.10).

There were no significant differences observed in mortality, hospitalization, or other major clinical events.