Dietary Approaches to Stop Hypertension (DASH) and mortality risk among patients with liver cirrhosis: a prospective cohort study.

BACKGROUND AND PURPOSE: The relationship between dietary patterns and cirrhosis is undeniable. The present study aimed to investigate the association between the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of mortality in patients with cirrhosis prospectively. METHODS: In this cohort study, 121 cirrhotic patients were enrolled and followed up annually for four years. Nutritional status and dietary intakes were assessed initially, and the DASH score was calculated accordingly. Crude and multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazard analyses. RESULTS: DASH components including fruits, vegetables, legumes, nuts and seeds, and low-fat dairy products were significantly associated with lower mortality risk in cirrhotic patients. Also, a higher DASH score was significantly associated with a reduction in the risk of mortality in patients with cirrhosis, so that after adjusting for all confounders, the risk of mortality in the upper tertile was 89% lower than the first tertile (HR = 0.11, 95% CI: 0.03-0.42, P trend < 0.001). The 4-year survival rate among patients across tertiles of DASH was 32%, 37%, and 46%, respectively (P = 0.005). CONCLUSION: It can be concluded that a higher DASH diet score may be associated with a reduced risk of mortality in cirrhotic patients. However, larger studies are needed to confirm the findings and determine their potential mechanisms.

The association of dietary inflammatory indices and mortality in patients with cirrhosis: a cohort based study.

Dietary intake has an undeniable role in the development and progression as well as the prevention and treatment of cirrhosis. This study was conducted with the aim of investigating the association between dietary inflammatory indices and total mortality in patients with cirrhosis. A total of 166 outpatients with cirrhosis who were diagnosed within the last 6 months were followed up for 48 months in this cohort study. A 168-question valid food frequency questionnaire was used to evaluate dietary intake. Accordingly, the dietary inflammatory index (DII), empirical dietary inflammatory pattern (EDIP) and dietary inflammatory score (DIS) were calculated. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through cox proportional hazards regression models for an association of cirrhosis mortality and three dietary inflammatory indices. After full adjustment for confounders, the results showed that mortality risk increased significantly with increasing dietary inflammatory indices. Compared to the first tertile, the risk of mortality due to cirrhosis was associated with 4.8 times increase in the third tertile of DII (HR = 4.8, 95% CI = 1.1-19.8, p trend = 0.029), 3.3 times in the third tertile of EDIP (HR = 3.3, 95% CI = 1.3-8, p trend = 0.004), and 2.2 times increased in the third tertile of DIS (HR = 2.2, 95% CI = 1-4.7, p trend = 0.032). The results of the present study indicated a significant association between dietary inflammatory indices and total mortality among patients with cirrhosis. Additional research is necessary to confirm our findings.

Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis.

BACKGROUND: Despite the robust evidence demonstrating positive effects from creatine supplementation (primarily when associated with resistance training) on measures of body composition, there is a lack of a comprehensive evaluation regarding the influence of creatine protocol parameters (including dose and form) on body mass and estimates of fat-free and fat mass. METHODS: Randomized controlled trials (RCTs) evaluating the effect of creatine supplementation on body composition were included. Electronic databases, including PubMed, Web of Science, and Scopus were searched up to July 2023. Heterogeneity tests were performed. Random effect models were assessed based on the heterogeneity tests, and pooled data were examined to determine the weighted mean difference (WMD) with a 95% confidence interval (CI). RESULTS: From 4831 initial records, a total of 143 studies met the inclusion criteria. Creatine supplementation increased body mass (WMD: 0.86 kg; 95% CI: 0.76 to 0.96, I2 = 0%) and fat-free mass (WMD: 0.82 kg; 95% CI: 0.57 to 1.06, I2 = 0%) while reducing body fat percentage (WMD: -0.28 %; 95% CI: -0.47 to -0.09; I2 = 0%). Studies that incorporated a maintenance dose of creatine or performed resistance training in conjunction with supplementation had greater effects on body composition. CONCLUSION: Creatine supplementation has a small effect on body mass and estimates of fat-free mass and body fat percentage. These findings were more robust when combined with resistance training.

Effects of Hesperidin Supplementation on Cardiometabolic Markers: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

CONTEXT: Hesperidin is a naturally occurring bioactive compound that may influence cardiometabolic markers, but the existing evidence is inconclusive. OBJECTIVE: This study aims to further investigate the effects of hesperidin supplementation on cardiometabolic markers in adults. DATA SOURCES: A comprehensive search was conducted up to August 2023, utilizing relevant key words in databases such as PubMed, Scopus, Embase, and the Cochrane Central Register of Controlled Trials, focusing on randomized controlled trials (RCTs). DATA EXTRACTION: RCTs that examined the impact of hesperidin on fasting blood sugar (FBS), insulin, quantitative insulin-sensitivity check index (QUICKI), homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), systolic blood pressure (SBP), diastolic blood pressure (DBP), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) were selected independently by 2 authors. The GRADE assessment was used to ascertain the certainty of the evidence. Results were pooled using a random-effects model as weighted mean differences and 95% CIs. DATA ANALYSIS: The results of this study demonstrate that hesperidin supplementation had a significant impact on reducing FBS, TG, TC, LDL-C, SBP, and TNF-α. However, there was no significant effect observed on insulin, HOMA-IR, QUICKI, HDL-C, DBP, and hs-CRP. The study's subgroup analyses also revealed that interventions lasting more than 12 weeks were effective in reducing FBS, TG, TC, and LDL-C. Moreover, hesperidin dosage exceeding 500 mg/day showed significance in reducing FBS, TC, and LDL-C levels. CONCLUSION: In conclusion, this research suggests that hesperidin can be consumed as an effective dietary approach to enhance cardiometabolic markers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022325775.

Dietary acid load and cirrhosis-related mortality: a prospective cohort study.

As a global health concern, cirrhosis contributes significantly to morbidity and mortality. This prospective cohort study aimed to investigate the association between dietary acid load (DAL) and cirrhosis-related mortality. Present study was conducted on 121 patients with newly diagnosed cirrhosis who were followed up for 48 months. Anthropometric measures, nutritional status and dietary intakes were assessed and DAL was estimated based on potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores. Crude and multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazard analyses. Participants in the high PRAL and NEAP scores had significantly higher intakes of grains and lower intakes of fruits and vegetables. Also, the intake of dairy products and legumes, nuts and seeds decreased significantly with increasing NEAP score. After adjustment of all the confounders, the risk of mortality in the second and third tertiles of PRAL was 5.9 times and 10.97 higher than those in the first tertile, respectively (P trend: 0.006). Similarly, comparing the risk of mortality in the second and third tertiles with the first tertile of NEAP showed a 4.46-fold and 12.3-fold increased risk, respectively (P trend: 0.010). Our findings suggested that DAL was significantly associated with cirrhosis-related mortality and highlight the need for further research to understand the underlying mechanisms and establish optimal DAL levels in cirrhotic patients.

Keeping an eye on the nutrition: The importance of nutrition management on cardiometabolic risk factors in cirrhotic patients.

Chronic liver diseases, especially cirrhosis, are associated with significant morbidity and mortality. Besides predisposing to chronic liver disease per se, diabetes, hypertension, and dyslipidemia worsen the prognosis of patients with cirrhosis induced by other causes. There is no standard of care in the management of these factors in patients with cirrhosis. Also, in particular, it is not known whether nutritional interventions in the modification of cardiometabolic factors can improve the course of cirrhosis or not. This narrative review aimed to investigate the clinical significance of diabetes, hypertension, and dyslipidemia and appropriate nutritional interventions in cirrhotic patients. A comprehensive literature search of the published data was performed in regard to the association of cirrhosis with cardiometabolic factors and the management of cirrhosis and its complications. There is limited evidence on the association of cirrhosis with cardiometabolic risk factors. Cirrhotic cardiometabolic abnormalities are associated with an increased risk of complications, such that the coexistence of diabetes, hypertension, and dyslipidemia increases the risk of clinical decompensation in cirrhosis. Dietary management of cirrhotic patients with risk factors such as diabetes, hypertension, or dyslipidemia does not seem to be considerably different from non-cirrhotic patients.

Zinc Supplementation in Individuals with Prediabetes and type 2 Diabetes: a GRADE-Assessed Systematic Review and Dose-Response Meta-analysis.

Zinc supplementation has therapeutic effects on cardiovascular disease (CVD) risk factors, including dyslipidemia, hyperglycemia, and inflammation as the main contributors to CVD pathogenesis. Since CVD is a major cause of mortality among people with type 2 diabetes mellitus (T2DM), this study aimed to overview the potential effects of zinc supplementation on CVD risk factors in T2DM patients. To determine appropriate randomized clinical trials (RCTs) investigating the effects of zinc supplementation on CVD risk factors, electronic sources including PubMed, Web of Science, and Scopus were systematically searched until January 2023. The heterogeneity of trials was checked using the I2 statistic. According to the heterogeneity tests, random-effects models were estimated, and pooled data were defined as the weighted mean difference (WMD) with a 95% confidence interval (CI). Of the 4004 initial records, 23 studies that met inclusion criteria were analyzed in this meta-analysis. The pooled findings indicated the significant lowering effects of zinc supplementation on triglycerides (TG), total cholesterol (TC), fasting blood glucose (FBG), hemoglobin A1C (HbA1C), and C-reactive protein (CRP), while high-density cholesterol (HDL) concentrations showed an elevation after zinc supplementation. In addition to statistical significance, the effect of zinc supplementation on most of the variables was clinically significant; however, the quality of evidence in the included studies is regarded as low or very low for most variables. Our study demonstrated that zinc supplementation has beneficial effects on glycemic control markers, lipid profile, and CRP levels as a classic marker of inflammation in T2DM. Due to the high degree of heterogeneity between studies and the low rate of quality in them, further well-designed studies are necessitated to strengthen our findings.

Dietary protein intake and mortality among survivors of liver cirrhosis: a prospective cohort study.

BACKGROUND: Liver cirrhosis is a worldwide burden and is associated with poor clinical outcomes, including increased mortality. The beneficial effects of dietary modifications in reducing morbidity and mortality are inevitable. AIM: The current study aimed to evaluate the potential association of dietary protein intake with the cirrhosis-related mortality. METHODS: In this cohort study, 121 ambulatory cirrhotic patients with at least 6 months of cirrhosis diagnosis were followed-up for 48 months. A 168-item validated food frequency questionnaire was used for dietary intake assessment. Total dietary protein was classified as dairy, vegetable and animal protein. We estimated crude and multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), applying Cox proportional hazard analyses. RESULTS: After full adjustment for confounders, analyses showed that total (HR = 0.38, 95% CI = 0.2-1.1, p trend = 0.045) and dairy (HR = 0.38, 95% CI = 0.13-1.1, p trend = 0.046) protein intake was associated with a 62% lower risk of cirrhosis-related mortality. While a higher intake of animal protein was associated with a 3.8-fold increase in the risk of mortality in patients (HR = 3.8, 95% CI = 1.7-8.2, p trend = 0.035). Higher intake of vegetable protein was inversely but not significantly associated with mortality risk. CONCLUSION: A comprehensive evaluation of the associations of dietary protein intake with cirrhosis-related mortality indicated that a higher intakes of total and dairy protein and a lower intakes of animal protein are associated with a reduced risk of mortality in cirrhotic patients.

Dietary fiber intake and mortality among survivors of liver cirrhosis: A prospective cohort study.

Background: Liver cirrhosis is associated with significant nutritional risks and poor survival rates. Little is known about the impact of dietary factors on metabolic complications and mortality from cirrhosis. Aim: The present study investigated the potential associations between dietary fibers and the risk of cirrhosis-related mortality. Methods: In this prospective study, 121 ambulatory cirrhotic patients with more than six months of cirrhosis diagnosis were followed-up for 4 years. Dietary intakes were assessed using a 168-item semi-quantitative validated food frequency questionnaire. Crude and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through cox proportional hazards regression models. Results: Comparing the highest versus the lowest tertile, soluble and insoluble fiber intake was associated with 62% (HR = 0.38, 95% CI = 0.045-3.5, p trend = 0.047) and 73% (HR = 0.27, 95% CI = 0.06-1.2, p trend = 0.021) lower mortality risk, respectively, after full adjustment for potential confounders. Higher intakes of total fiber were inversely but non-significantly associated with mortality risk. Conclusion: Comprehensive assessment of dietary fiber intake associations with cirrhosis-related mortality showed that higher intakes of soluble and insoluble fiber were significantly associated with reduced mortality risk.

Diet-dependent acid load and the risk of breast cancer: A case-control study.

BACKGROUND & AIMS: Dietary acid load causes metabolic acidosis, which leads to inflammation and cell change, both of which are related to cancer development. Even though a high acid load has been associated with an increased risk of breast cancer (BC), epidemiologic evidence correlating diet-dependent acid load and cancer risk, particularly for BC, is still lacking. As a result, we intend to investigate its potential role. METHODS: The potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores were calculated in this case-control study using the dietary intake of individuals as determined by a verified FFQ. Logistic regression was used to calculate odds ratios (ORs), which were adjusted for probable confounders. RESULTS: Using multivariate logistic regression models, the odds ratios (OR) of BC according to quartiles of PRAL and NEAP scores revealed that neither PRAL (P-trend = 0.53) nor NEAP (P-trend = 0.19) scores were significantly associated with BC risk. Multiple logistic regressions remained non-significant after controlling for covariates, indicating no significant relationships between PRAL (P-trend = 0.96) and NEAP (trend = 0.45) scores and the odds of BC. CONCLUSION: According to the findings of our study, there is no relation between DAL and the risk of BC in Iranian women.

Malnutrition and its association with the mortality in liver cirrhosis; a prospective nutritional assessment in two referral centers in Iran.

INTRODUCTION: Liver cirrhosis is a chronic condition caused by different conditions including viral infection, alcoholism, and autoimmune disorders. Malnutrition is one of the complications of liver cirrhosis that is associated with poor outcomes. This study aimed to determine the association of malnutrition with mortality in liver cirrhosis patients. METHODS: This prospective cross-sectional study was conducted on liver cirrhosis patients who were referred to two referral centers for liver disease in Tehran, Iran. Patients' information including demographics (age, gender, etiology of cirrhosis, alcohol and smoking history) in addition to triceps skinfold (TSF), mid-arm circumference (MAC), Child-Pugh score and Model for End-Stage Liver Disease (MELD) score were recorded in all patients. Patients were classified into A, B, and C categories based on the Subjective Global Assessment (SGA) questionnaire. RESULTS: Among 121 participants (68.6%) were males and the mean age was 54.78. Viral infections were the most common etiology and 65 patients (56.2%) were in the classification A of Child-Pugh Score. TSF (P = 0.001) and MAC (P = 0.003) were significantly lower in SGA class C. The survival rate in SGA class C was significantly lower than other groups (P < 0.001; log-rank test). The risk of mortality in patients with SGA class A and B was 85% (HR value: 0.15; 95% CI: 0.02-0.87; P = 0.03) and 76% (HR value: 0.24; 95% CI: 0.06-0.83; P = 0.02) lower than those with SGA class C. CONCLUSION: Anthropometric and SGA measure are two easy and accessible methods for assessing malnutrition and mortality in liver cirrhosis patients.

Salt consumption and mortality risk in cirrhotic patients: results from a cohort study.

Since conducting a long-term randomised clinical trial is not logical and feasible to find the optimum dosage of salt intake in patients with cirrhosis, cohort studies are the best design to assess the long-term effects of dietary salt on the survival of cirrhotic patients. This cohort study aimed to evaluate the association between dietary intake of salt and mortality risk in cirrhotic patients. The present study was designed as a cohort in three referral hospitals in Iran in 2018. One hundred and twenty-one patients aged between 20 and 70 years with established cirrhosis were recruited. Dietary intakes, demographic data and disease severity were evaluated at the baseline. Participants were followed up annually. Crude survival was greater in patients with low-to-moderate salt consumption rather than in those with high consumption, and in non-consumers [34⋅26 (95 % CI 33⋅04, 35⋅49) v. 30⋅41 (95 % CI 27⋅13, 33⋅69) v. 32⋅72 (95 % CI 30⋅63, 34⋅80), P = 0⋅028; log-rank test]. Using the Cox proportional hazard model, it was shown that the risk of mortality in the high-salt consumption category was approximately 126 % higher than that of the reference category (non-consumers) [HR value 2⋅26, (95 % CI 0⋅91, 5⋅63)], while this risk for the low-to-moderate consumption group was about 28 % lower than the reference category [HR value 0⋅72, (95 % CI 0⋅26, 1⋅99), P-trend = 0⋅04]. In conclusion, a high daily dietary intake of salt might increase the rate of mortality and moderate salt restriction (instead of elimination of salt) decreases the risk of death.

Probiotics and synbiotics supplementation improve glycemic control parameters in subjects with prediabetes and type 2 diabetes mellitus: A GRADE-assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials.

Probiotics and synbiotics have been proposed to exhibit an important role in glucose homeostasis and maintain the balance of the gut microbiota. However, clinical trials have shown mixed findings. Therefore, we conducted a systematic review and meta-analysis of all eligible randomized controlled trials (RCTs) examining the effects of probiotics and synbiotics intake on glycemic outcomes among individuals with prediabetes and type 2 diabetes mellitus (T2DM). The PubMed/Medline, Scopus, ISI Web of Science, and Cochrane library were searched up to March 2022 for published RCTs exploring the effectiveness of probiotics and synbiotics compared to control on glycemic outcomes. The random-effects model was applied in order to the estimation of 95 % confidence interval (CI) and the weighted mean difference (WMD) for each endpoint. Meta-analysis of forty-six RCTs (3067 participants) showed that probiotics and synbiotics supplementation significantly reduced fasting plasma glucose (FPG) (weighted mean difference (WMD): - 11.18 mg/dl, 95 % CI: - 13.60, - 8.75, p ˂0.001), fasting insulin serum level (WMD: -1.23 µIU/ml, 95 % CI: -1.76, -0.71, p ˂0.001), hemoglobin A1c (HbA1c) (WMD: -0.35 %, 95 % CI: -0.44, -0.26, p˂0.001), and homeostatic model assessment of insulin resistance (HOMA-IR) (WMD: -0.87, 95 % CI: -1.09, -0.65, p˂0.001). Additionally, probiotics and synbiotics intake resulted in an increase in values of quantitative insulin-sensitivity check index (QUICKI) (WMD: 0.01, 95 % CI: 0.00, 0.01, p˂0.001). However, probiotics and synbiotics consumption did not change glucose values following oral glucose tolerance test (OGTT). Our findings suggest that probiotic and synbiotic intake has favorable effects on glycemic profile in patients with prediabetes and T2DM.

Food groups intake of cirrhotic patients, comparison with the nutritional status and disease stage.

AIM: The aim of this study was to determine the relation between different food groups intake, nutritional status of cirrhotic patient and the stage of the disease. BACKGROUND: Protein-energy malnutrition (PEM) is a common problem in cirrhotic patients. Food intake assessment is highly important in the investigation regarding the health-disease process. METHODS: In this cross-sectional study, sixty eight ambulatory cirrhotic patients, with a mean age of 54 years, were included. In order to assess the stage of the disease and malnutrition status, Child-Pugh score and Subjective Global Assessment index were used respectively. Dietary intakes were assessed using a 168-item semi-quantitative validated food frequency questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were computed, using logistic regression models. RESULTS: After adjustment for confounders, we found significant inverse relations between intakes of nuts (OR=0.140, CI=0.031-0.625) and olive (OR=0.212, CI=0.049-0.917) with severity of disease and boiled potatoes (OR=0.154, CI=0.040-0.592) and legumes (OR=0.090, CI=0.020-0.406) with malnutrition status. Inversely, solid fats (OR=3.324, CI=1.080-10.238) and mayonnaise (OR=5.215, CI=1.203-22.612) were positively associated with disease severity and malnutrition, respectively. CONCLUSION: These findings suggest that selection of healthy foods was negatively associated with severity of hepatic cirrhosis whereas unhealthy food groups had a positive relation with disease severity and malnutrition.

Dietary protein sources and disease severity, malnutrition and anthropometric measurements in cirrhotic patients.

AIM: To evaluate the association between dietary protein sources with disease severity, malnutrition and anthropometric measurements in cirrhotic patients. BACKGROUND: Although the beneficial effects of protein and some amino-acids have been shown previously, no study has evaluated the effects of different dietary sources of proteins in patients with hepatic cirrhosis. METHODS: In this cross-sectional study, dietary intakes of patients with hepatic cirrhosis were assessed using a valid and reliable food frequency questionnaire. The association between different dietary sources of proteins and nutritional status, anthropometric measurements, and disease severity were evaluated. RESULTS: Muscle strength (MS) increased significantly in highest tertile of dairy and vegetable protein sources compared with the lowest one (p=0.045). Dietary dairy and vegetable protein intakes had a positive significant correlation with body weight, MS, visceral fat percentage (VFP), and triceps skin-fold thickness (TST), and negative significant correlation with malnutrition stage. CONCLUSION: Our results indicate that consumption of proteins from dairy and vegetable sources is associated with improvement in nutritional and anthropometric status of patients with hepatic cirrhosis. Further prospective studies are needed to confirm these results.