Do Nutritional Interventions Improve the Outcomes of Patients with Cirrhosis and Ascites: a Systematic Review of Randomized Trials

Purpose of Review Ascites is a common, morbid complication of cirrhosis. Nutritional interventions such as sodium restriction and high-protein diet are considered standard of care. However, their evidence base is limited. We performed a systematic review of randomized trials of nutritional interventions for ascites. Recent Findings Increasing consumption of calories and protein alone was ineffective. Studies reached contradictory conclusions regarding sodium restriction in patients taking combination diuretics. Intravenous amino acid infusion alone did not improve outcomes, and peripheral parenteral nutrition did not improve outcomes alone but reduced mortality in conjunction with branched chain amino acid evening snack. Summary Patients may benefit from sodium restriction and a protein-rich evening snack. Future trials should prioritize standardizing nutritional targets and tailoring interventions to the specific needs of patients including the socioeconomic factors impacting adherence.