Impacts of salt restriction on nutritional status, sarcopenia, and mortality of cirrhotic patients with ascites

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.