Dietary protein intake and mortality among survivors of liver cirrhosis: a prospective cohort study

Abstract

Background Liver cirrhosis is a worldwide burden and is associated with poor clinical outcomes, including increased mortality. The beneficial effects of dietary modifications in reducing morbidity and mortality are inevitable. Aim The current study aimed to evaluate the potential association of dietary protein intake with the cirrhosis-related mortality. Methods In this cohort study, 121 ambulatory cirrhotic patients with at least 6 months of cirrhosis diagnosis were followed-up for 48 months. A 168-item validated food frequency questionnaire was used for dietary intake assessment. Total dietary protein was classified as dairy, vegetable and animal protein. We estimated crude and multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), applying Cox proportional hazard analyses. Results After full adjustment for confounders, analyses showed that total (HR = 0.38, 95% CI = 0.2–1.1, p trend = 0.045) and dairy (HR = 0.38, 95% CI = 0.13–1.1, p trend = 0.046) protein intake was associated with a 62% lower risk of cirrhosis-related mortality. While a higher intake of animal protein was associated with a 3.8-fold increase in the risk of mortality in patients (HR = 3.8, 95% CI = 1.7–8.2, p trend = 0.035). Higher intake of vegetable protein was inversely but not significantly associated with mortality risk. Conclusion A comprehensive evaluation of the associations of dietary protein intake with cirrhosis-related mortality indicated that a higher intakes of total and dairy protein and a lower intakes of animal protein are associated with a reduced risk of mortality in cirrhotic patients.

Dietary acid load and cirrhosis-related mortality: a prospective cohort study

“…The exact mechanisms by which DAL may influence cirrhosis and its complications are currently unclear. However, several factors may contribute to this association, such as insulin resistance (IR) 24 , hypertension (HTN) 25 , high consumption of red meat 26 , and low consumption of fruits and vegetables 27 . It has been demonstrated that high acid-load diets can cause chronic low-grade metabolic acidosis (MA), which is associated with metabolic abnormalities 22 .…”

“…In addition, reducing red meat consumption may slow the progression of NAFLD and fibrosis, as continued red meat consumption was linked to a higher risk of hepatic fibrosis 60 . Additionally, the study by Daftari et al 26 demonstrated that lower intakes of animal protein are associated with lower mortality risks in patients with cirrhosis. On the other hand, consuming potassium-rich foods, such as fruits and vegetables, may favor muscle preservation, while acidosis may impair protein synthesis, increase proteolysis, and enhance amino acid oxidation, leading to a greater loss of muscle mass 61 .…”

“…These metabolic abnormalities, especially insulin resistance (IR) 24 , dysglycemia 19 , high blood pressure (HTN) 25 and metabolic syndrome 21 , are considered risk factors for liver diseases such as cirrhosis. On the other hand, high consumption of red meat and low consumption of fruits and vegetables are characteristics of a diet with a high acid load, each of which alone can contribute to the development and progression of cirrhosis 26 , 27 .…”

The Association between Diet–Exercise Patterns and Cirrhosis: A Cross-Sectional Study from NHANES 2017-March 2020

“…Liver cirrhosis is the terminal stage of most chronic liver diseases (CLDs), having the highest incidence and mortality among liver-related diseases, which has an inferior prognosis [ 1 , 2 , 3 ]. In 2019, LC was associated with 2.4% of global deaths, and cirrhosis deaths are predicted to increase over the next decade, with the rate gradually increasing in some countries [ 4 , 5 ].…”

“…It eventually leads to liver regeneration and fibrogenesis, enhances collagen and extracellular matrix deposition, and gradually progresses to cirrhosis [ 6 , 10 ]. Cirrhosis gives rise to numerous systemic complications, including ascites, malnutrition, sarcopenia and various others [ 3 , 5 , 11 ]. Malnutrition is a prominent characteristic and a significant complication of cirrhosis.…”