Higher animal protein intake increases mortality risk in cirrhosis by nearly fourfold
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Key takeaways:
- Total and dairy protein intake was associated with a 62% lower risk for cirrhosis-related mortality.
- A higher intake of vegetable protein was “inversely but non-significantly” associated with risk for mortality.
Higher intake of total and dairy protein and lower animal protein consumption correlated with a reduced risk for mortality among patients with cirrhosis, according to data published in BMC Gastroenterology.
“Dietary therapy plays a major role in reversing the progression of liver cirrhosis, and nutritional evaluation aims to reduce morbidity and mortality by exploring modifiable nutritional risk factors,” Ghazal Daftari, MD, of Tehran University of Medical Sciences, and colleagues wrote. “Protein energy malnutrition is directly related to survival in cirrhosis and its prevalence varies from relatively 60% in decompensated and 20% in compensated cirrhotic patients.”
They continued: “However, little is known about dietary protein intake and cirrhosis-related mortality.”
In a prospective cohort study, Daftari and colleagues evaluated data from 121 ambulatory patients (mean age, 54.8 years; 68% men) who had been diagnosed with cirrhosis for at least 6 months and were monitored for 48 months. Patients completed a 168-item validated food-frequency questionnaire via in-person interviews with trained dietitians. Over 3,955 person-months of follow-up, 43 deaths (47% due to liver failure) were reported.
Study results showed total protein (HR = 0.38; 95% CI, 0.2-1.1) and dairy protein intake (HR = 0.38; 95% CI, 0.13-1.1) was associated with a 62% lower risk for cirrhosis-related mortality, while higher intake of animal protein correlated with a 3.8-fold increased risk for mortality (HR = 3.8; 95% CI, 1.7-8.2).
Higher animal protein intake also was significantly associated with an increased risk for mortality among patients with more severe disease severity, defined as a MELD score of at least 11 (HR = 1.9; 95% CI, 0.7-3.9).
Researchers also noted that higher intake of vegetable protein was “inversely but non-significantly” associated with mortality risk.
“We found a significant reverse association between total and dairy protein intake and a significant direct association between animal protein intakes with cirrhosis-related mortality,” Daftari and colleagues concluded. “Further studies are recommended to evaluate effectiveness and appropriate amount of total, dairy, vegetable and animal protein in cirrhotic patients.”
Perspective
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Jamile’ Wakim-Fleming, MD, FACG, FAASLD
It is well-known that dietary proteins are indispensable to human health; they possess tissue-building function and regulate various metabolic pathways, as well as satiety and immune system activity.
People with cirrhosis have decreased synthesis of protein and need dietary supplementation. They lose muscle mass and function and have protein-calorie malnutrition of various degrees associated with poor health outcomes. Society guidelines on clinical nutrition and metabolism recommend daily total protein intake of 1.2 to 1.5 g/kg body weight for patients with cirrhosis.
However, little is known about total protein intake and mortality in cirrhosis, as not all proteins are equal and not all calories are equal. For example, it is clearly known that animal proteins are complete proteins, as they contain the nine essential amino acids, but they also contain fats, which may have deleterious metabolic effects. Conversely, a high intake of dairy proteins has consistently shown a beneficial effect on glucose, insulin metabolism and musculoskeletal health.
Vegetable-based proteins have higher concentration of magnesium, potassium and antioxidant phytonutrients that positively affect overall health. Dairy and vegetable-based proteins are rich in branched-chain amino acids, which are important in detoxifying ammonia and improving the immune system in people with cirrhosis.
Results of this study are significant, especially if they can be replicated in large prospective trials. The impact on the health and outcome of patients with cirrhosis may be of great significance, especially for patients with advanced cirrhosis whose only hope for survival is liver transplantation.
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