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

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.