Intensive Nutrition Therapy Reduces Frailty and Sarcopenia in Decompensated Cirrhosis

A dietician-supported program using home-based intensive nutrition therapy improved frailty in patients with decompensated cirrhosis.

A dietitian-guided, home-based nutritional program improved frailty and sarcopenia in patients with decompensated liver cirrhosis compared with standard medical care, according to study findings published in the Journal of Gastroenterology and Hepatology.

Researchers conducted a single-center, open-label, randomized clinical trial in a tertiary care hospital. The researchers screened patients with decompensated cirrhosis for frailty and sarcopenia at the hospital’s outpatient liver clinic from May 2019 to December 2019.

At total of 100 patients with cirrhosis were randomly assigned to 2 groups. The control group received standard medical therapy for nutrition recommendations to manage cirrhosis, while the treatment group received both standard medical therapy and a dietitian-monitored, home-based, high-calorie, protein-rich, low-sodium diet. Follow-ups occurred once a week for the first month and then once a month for 6 months, with dietary intake recorded at months 1, 3, and 6.

Assessments for frailty included handgrip strength, chair stand, and balance tests, all of which are used for the Liver Frailty Index (LFI). Researchers used computed tomography (CT) scans of the abdomen performed by trained radiologists to assess for sarcopenia based on cut-off values for men (50cm2/m2) and women (39cm2/m2) per the skeletal muscle index (SMI). Additional testing included laboratory tests and 3 different scoring systems for liver disease severity. The patients underwent these assessments at baseline and after 6 months.

These findings support the key role of food as medicine in the management of cirrhosis.

After 6 months, frailty decreased more in the home-based nutrition group than the control group (LFI score differences: 0.8 vs 0.4; P <.001) Sarcopenia also decreased more in the subgroup of men in the treatment group compared with the control group (6.36 vs 0.80; P =.02).

During the 6-month follow-up, patients in the intervention group experienced less hospitalizations (38% vs 58%; P =.04). Liver disease severity significantly decreased (P <.05), while survival increased (P <.05) in the patients (64%) who adhered to the nutritional program target goals at 6 months.

“These findings support the key role of food as medicine in the management of cirrhosis,” the study authors noted.

Study limitations include reduced generalizability due to the predominance of men with cirrhosis caused by alcohol and the exclusion of patients with scores higher than 10 on the Child Turcotte Pugh (CTP) scale, the relatively short follow-up duration of 6 months, the modest sample size, the single-center and open-label design, and cut-offs for frailty and sarcopenia based on North American consensus definitions, which might be different in exclusively Indian cohorts.

References:

Meena BL, Taneja S, Tandon R, et al. Home-based intensive nutrition therapy improves frailty and sarcopenia in patients with decompensated cirrhosis: A randomized clinical trial. J Gastroenterol Hepatol. Published online October 21, 2022. doi:10.1111/jgh.16035