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

Abstract Background Salt restriction is a cornerstone in managing ascites in cirrhotic patients; however, its impact on nutritional status, sarcopenia, and mortality remains unclear. Aim To evaluate the effects of a salt-restricted diet (SRD) on ascites control, body composition, sarcopenia developm...

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Main Authors: Maha Elsabaawy, Mohammed Ragab, Madiha Naguib, Eman Kamal, Maymona Al-Khalifa, Khaled Gamil, Marwa Elfayoumy
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Gastroenterology
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Online Access:https://doi.org/10.1186/s12876-025-03830-1
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Summary:Abstract Background Salt restriction is a cornerstone in managing ascites in cirrhotic patients; however, its impact on nutritional status, sarcopenia, and mortality remains unclear. Aim 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. Methods 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. Results 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. Conclusion 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.
ISSN:1471-230X