Elsabaawy Maha, Ragab Mohammed, Naguib Madiha, Kamal Eman, Al-Khalifa Maymona, Gamil Khaled, Elfayoumy Marwa
Hepatology and Gastroenterology Department, National Liver Institute Minufiya University, Shebeen Elkoom, Egypt.
Anesthesia and Intensive Care Nutrition Department, National Liver Institute Menoufia University, Shebeen Elkoom, Egypt.
BMC Gastroenterol. 2025 Jul 15;25(1):521. doi: 10.1186/s12876-025-03830-1.
Salt restriction is a cornerstone in managing ascites in cirrhotic patients; however, its impact on nutritional status, sarcopenia, and mortality remains unclear.
To evaluate the effects of a salt-restricted diet (SRD) on ascites control, body composition, sarcopenia development, and patient survival in cirrhotic patients with decompensated liver disease.
This prospective study included 102 patients with grade III ascites, categorized into two groups based on dietary adherence: Salt-Restricted Diet (SRD), (n = 46) and Salt-Unrestricted Diet (SUD) (n = 56). Sodium intake was assessed using the Dietary Sodium Restriction Questionnaire (DSRQ) and spot urine Na/K ratio. Nutritional status, sarcopenia, ascites control, and six-month mortality were evaluated.
The SRD group showed better ascites control, with fewer paracentesis sessions per month (1.57 ± 0.65 vs. 4.07 ± 1.43, p < 0.001). Sarcopenia was more prevalent in the SRD group (p < 0.001), with lower SMI (4.88 ± 7.13 vs. 16.7 ± 544.8, p < 0.001) and TR PMM (19.03 ± 3.68 vs. 71.92 ± 191.9, p < 0.001). Higher nutritional risk was significantly associated with SRD (p = 0.001). Mortality was significantly higher in the SRD group (67.4%) compared to the SUD group (35.7%), p = 0.001. Multivariate analysis identified sarcopenia (OR = 2.684, p = 0.006) and SRD (OR = 1.65, p < 0.001) as independent predictors of mortality.
While effective in ascites control, sodium restriction may compromise nutritional status, heighten sarcopenia risk, and increase mortality, highlighting the need for a more individualized dietary approach.
限盐是肝硬化患者腹水管理的基石；然而，其对营养状况、肌肉减少症和死亡率的影响仍不明确。
评估限盐饮食（SRD）对失代偿期肝病肝硬化患者腹水控制、身体成分、肌肉减少症发展及患者生存的影响。
这项前瞻性研究纳入了102例Ⅲ级腹水患者，根据饮食依从性分为两组：限盐饮食（SRD）组（n = 46）和不限盐饮食（SUD）组（n = 56）。使用饮食钠限制问卷（DSRQ）和即时尿钠/钾比值评估钠摄入量。评估营养状况、肌肉减少症、腹水控制情况及6个月死亡率。
SRD组腹水控制更好，每月腹腔穿刺次数更少（1.57±0.65对4.07±1.43，p<0.001）。肌肉减少症在SRD组更普遍（p<0.001），骨骼肌指数（SMI）更低（4.88±7.13对16.7±544.8，p<0.001），四肢骨骼肌质量（TR PMM）更低（19.03±3.68对71.92±191.9，p<0.001）。更高的营养风险与SRD显著相关（p = 0.001）。SRD组死亡率（67.4%）显著高于SUD组（35.7%），p = 0.001。多变量分析确定肌肉减少症（OR = 2.684，p = 0.006）和SRD（OR = 1.65，p<0.001）是死亡率的独立预测因素。
虽然限盐在腹水控制方面有效，但可能会损害营养状况，增加肌肉减少症风险并提高死亡率，这凸显了需要采用更个体化的饮食方法。
