J Gastroenterol Hepatol. 2022 Oct 21. doi: 10.1111/jgh.16035. Online ahead of print.
ABSTRACT
BACKGROUND & AIMS: The majority of patients with decompensated cirrhosis suffer from malnutrition, a potentially modifiable contributor to frailty and sarcopenia. The present study investigated the impact of a six-month dietician-supported home-based intensive nutrition therapy (HINT) intervention on objective frailty and sarcopenia metrics in patients with decompensated cirrhosis.
METHODS: One hundred adult patients with decompensated cirrhosis, frailty, and sarcopenia at baseline were randomized 1:1 to receive standard medical therapy (SMT) plus HINT (intervention) versus SMT (control) alone. The primary outcome was an improvement in frailty as measured by the Liver Frailty Index (LFI). Secondary outcome measures included sarcopenia metrics, liver disease severity scores, hospitalization and death.
RESULTS: The LFI improved more in the intervention arm as compared to controls (0.8 versus 0.4;p<0.001). Baseline and end-of-study Skeletal Muscle Index (SMI) was available in a subset of thirty two male patients, with greater improvements seen in the intervention arm compared to controls(6.36 versus 0.80;p=0.02). Patients in the intervention arm had less hospitalizations over the 6-month follow-up(19(38%) vs. 29(58%)(p=0.04)). On subgroup analysis, in the 64% of patients who were adherent to calorie and protein intake targets at six months, significant improvement was seen in liver disease severity scores and survival (p<0.05).
CONCLUSION: In patients with decompensated cirrhosis, frailty and sarcopenia, a 6-month dietitian supported home-based intensive outpatient nutrition therapy was associated with statistically and clinically relevant improvement in frailty. The subgroup of adherent patients showed improvement in their liver disease scores and reduction in mortality. These findings support the key role of food as medicine in the management of cirrhosis.
PMID:36268614 | DOI:10.1111/jgh.16035
