Carbohydrate consumption and cirrhosis-related mortality: a prospective cohort study

Liver cirrhosis is a chronic liver disease that is often associated with poor prognosis. An important part of the treatment of patients with cirrhosis is related to nutrition. Although carbohydrates constitute the main component of the diet, limited data is available regarding the association of carbohydrate intake with cirrhosis. This study aimed to investigate the relationship between different types of carbohydrates and the risk of mortality in patients with cirrhosis.

The current study was conducted as a prospective cohort with a follow-up length of 4 years, on 166 newly diagnosed outpatient cirrhosis patients. Evaluation of dietary intake was conducted using a valid 168-item food frequency questionnaire. Carbohydrate intake was classified into total, sugar, glucose, galactose, fructose, sucrose, lactose and maltose. Cox proportional hazards regression models were used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

The comparison of dietary intakes indicated a higher intake of calories and protein and a lower intake of fat and carbohydrates in the survivors. After fully adjustment for confounders, significant associations were observed between different types of carbohydrates and cirrhosis-related mortality: sugar (HR = 4.9, CI 95%: 1.5-11.2, P = 0.014), glucose (HR = 3.4, CI 95%: 1.2-10, P = 0.030), fructose (HR = 1.6, CI 95%: 1.02-3, P = 0.043), sucrose (HR = 2.2, CI 95%: 1.2-4, P = 0.024) and lactose (HR = 0.65, CI 95%: 0.3-0.92, P = 0.044). No significant association was found for galactose and maltose.

Mortality in cirrhosis is positively associated with total dietary intake of carbohydrates in addition to sugar, glucose, fructose, sucrose, and negatively associated with dietary intake of lactose. A low carbohydrate diet may help the prognosis of cirrhotic patients.