Association between dietary fatty acids and all-cause mortality in patients with cirrhosis: A cohort study

Liver cirrhosis imposes a substantial global burden, with complications driving high mortality. Diet is pivotal in managing liver disease progression and cirrhosis-related death. This study investigated associations between total fat intake, specific dietary fatty acid subclasses and all-cause mortality in cirrhotic patients. In this prospective cohort study, 121 ambulatory patients with recently diagnosed cirrhosis (≤6 months) were enrolled. Baseline dietary intake was evaluated via a validated 168-item semi-quantitative food frequency questionnaire. Participants were categorized into tertiles by total fat and fatty acid subclasses: saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA), omega-3 and omega-6 fatty acids. Cox proportional hazards models computed hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted sequentially for age, sex, energy intake, BMI, smoking, alcohol use, cirrhosis aetiology, MELD score and Child-Pugh class. During the 60-month follow-up, 50 deaths (41.3%) occurred. In fully adjusted models, highest versus lowest tertiles of total fat intake (HR = 6.69; 95% CI: 1.37-13.34; P-trend = 0.017), SFA intake (HR = 8.2; 95% CI: 1.33-20.53; P-trend = 0.014) and PUFA-6 intake (HR = 5.24; 95% CI: 1.1-26.44; P-trend = 0.014) were independently associated with significantly elevated mortality risk. No significant associations were observed for MUFA, total PUFA or PUFA-3 intake. Kaplan-Meier analyses confirmed significantly reduced 5-year survival with higher total fat (log-rank P = 0.003) and SFA intake (log-rank P < 0.001). In this exploratory prospective cohort study, higher intakes of total fat, saturated fatty acids and omega-6 polyunsaturated fatty acids were associated with increased all-cause mortality among patients with cirrhosis. These preliminary findings are hypothesis-generating and require confirmation in larger, adequately powered prospective studies.