Home-based intensive nutrition therapy improves frailty and sarcopenia in patients with decompensated cirrhosis: a randomized clinical trial
Abstract
BACKGROUND AND AIM: 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 6-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 with controls (0.8 vs 0.4; P < 0.001). Baseline and end-of-study skeletal muscle index (SMI) was available in a subset of 32 male patients, with greater improvements seen in the intervention arm compared with controls (6.36 vs 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 6 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.
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In an RCT among individuals with decompensated cirrhosis, a 6-month dietitian-supported home-based intensive high-calorie, protein-rich nutrition therapy was associated with improvement in frailty, sarcopenia and, among treatment-adherent individuals, liver disease scores and survival.
“In an RCT among individuals with decompensated cirrhosis, a 6-month dietitian-supported home-based intensive high-calorie, protein-rich nutrition therapy was associated with improvement in frailty, sarcopenia and, among treatment-adherent individuals, liver disease scores and survival.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [454]
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- Authors
- Meena, B. L., Taneja, S., Tandon, P., Sahni, N., Soundararajan, R., Gorsi, U., De, A., Verma, N., Premkumar, M., Duseja, A., Dhiman, R. K., & Singh, V.
- Affiliations
- Post Graduate Institute of Medical Education and Research (IN)
- University of Alberta (CA)
- Corresponding author
- Taneja, Sunil
- ORCID
- Venue
- Journal of Gastroenterology and Hepatology
- Publisher
- Wiley
- Published
- 2022-11-09
- Volume
- 38
- Issue
- 2
- Pages
- 210-218
- ISSN
- 0815-9319 (ISSN-L)
- 1440-1746
- OpenAlex
- W4306976899
- Cited by
- 36
- References
- 36
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 10 · 2023: 6
- FWCI
- 3.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- decompensated cirrhosis, frailty, sarcopenia, malnutrition, Liver Frailty Index, skeletal muscle index, dietary adherence, protein intake, hospitalization, survival, food as medicine
- MeSH terms
- Frailty, Adult, Humans, Liver Cirrhosis, Liver Diseases, Male, Nutrition Therapy, Sarcopenia
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