Outpatient Intensive Nutrition Therapy Improves Survival and Frailty in Males With Alcohol-related ACLF - Randomized Controlled Trial.

Sahaj Rathi, Nancy Sahni, Madhumita Premkumar, Arka De, Pratibha Garg, Nipun Verma, Sunil Taneja, Ajay Duseja, Harish Bhujade, Patal Giri, B K Padhi, Tanka Karki

Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2025;23(7):1164-1173.e2

PMID: 39461460

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND & AIMS

Improvement in the nutritional status of patients with acute-on-chronic liver failure (ACLF) may lead to reduction in morbidity and mortality. This study assessed the impact of dietician-supported outpatient intensive nutrition therapy (OINT) on survival and frailty in patients with alcohol-related ACLF METHODS: Seventy patients with alcohol-related ACLF (Asia Pacific Association for the Study of the Liver [APASL] criteria) and frailty were randomized 1:1 to receive standard medical therapy (SMT) plus OINT (intervention) vs SMT (control) alone. The primary outcome was an improvement in survival at 3 months. Secondary outcome measures included improvement in frailty, prognostic scores, and hospitalization.

RESULTS

There was a significant improvement in overall survival in the OINT group as compared with the SMT group after 3 months of follow up (91.4% [standard error (SE), 4.7%] vs 57.1% [SE, 8.4%]; P < .00). On Cox regression model, inclusion in the intervention arm, baseline skeletal muscle index (SMI), and APASL ACLF Research Consortium (AARC score) were independent predictors of survival (P < .05). The liver frailty index (LFI) score also significantly improved in the OINT as compared with SMT (Δ-0.93; 95% confidence interval, -0.71 to 1.13 vs Δ -0.33; 95% confidence interval, -0.44 to 0.72; P < .00). The disease severity including MELD, MELD-Na, and AARC score showed a significant improvement in the OINT group as compared with the SMT group (P < .05). The patients in OINT group had lesser number of hospitalizations 6 (17%) vs 16 (45.7%) (P = .01) as compared with the SMT group.

CONCLUSION

Outpatient intensive nutrition therapy significantly improves survival, frailty, and disease severity with a reduction in number of hospitalizations and supports the key role of nutrition in treatment of patients with alcohol-related ACLF.

CLINICAL TRIAL REGISTRY NUMBER

ctri.nic.in/ CTRI/2022/01/039735.

Address: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: [email protected].; Department of Dietetics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.; Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.; Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

DOI: 10.1016/j.cgh.2024.09.021

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MeSH Terms: Humans, Male, Middle Aged, Frailty, Acute-On-Chronic Liver Failure, Treatment Outcome, Nutrition Therapy, Adult, Outpatients, Aged, Survival Analysis, Ambulatory Care