{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T15:02:26Z","timestamp":1790262146531,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sarcopenia is highly prevalent in decompensated cirrhosis and independently predicts adverse outcomes. Although nutritional therapy is guideline\u2010recommended, evidence comparing specialist dietitian\u2010supervised nutritional care with routine physician\u2010delivered dietary advice remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To compare the efficacy of dietitian\u2010supervised intensive nutritional therapy with physician\u2010led guideline\u2010based dietary advice for improving skeletal muscle mass, strength and physical performance in patients with decompensated cirrhosis and sarcopenia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single\u2010centre, open\u2010label, randomised controlled trial, 180 patients with decompensated cirrhosis and sarcopenia were randomised (1:1) to dietitian\u2010supervised intensive nutritional therapy or physician\u2010led guideline\u2010based dietary advice for 6\u2009months. The intervention targeted energy intake of 35\u201340\u2009kcal\/kg\/day and protein intake of 1.2\u20131.5\u2009g\/kg\/day through structured dietitian supervision. The primary outcome was change in skeletal muscle index (SMI); secondary outcomes included handgrip strength (HGS), gait velocity, nutritional status, liver disease severity and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Dietitian\u2010supervised therapy produced significantly greater improvements than physician\u2010led care in SMI (between\u2010group difference +2.50\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      ; 95% CI 1.30\u20133.70), HGS (men: +7.5\u2009kg, 95% CI 5.39\u20139.61; women: +4.8\u2009kg, 95% CI 3.12\u20136.48) and gait velocity (+0.23\u2009m\/s; 95% CI 0.13\u20130.33) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Serum albumin increased (+0.48\u2009g\/dL between groups) and CTP score improved (\u22121.30 points), whereas MELD score remained unchanged. Overall multidomain response occurred in 68.9% versus 37.8% of participants (RR 1.82, 95% CI 1.36\u20132.44; number needed to treat 3.2). Dietitian\u2010supervised therapy independently predicted SMI response (OR 3.82; 95% CI 1.80\u20138.10). No significant differences were observed in mortality, hospitalisation or other major clinical events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with decompensated cirrhosis and sarcopenia, dietitian\u2010supervised intensive nutritional therapy produced greater improvements in skeletal muscle mass, strength and physical performance than routine physician\u2010led guideline\u2010based dietary advice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      CTRI number (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.ctri.nic.in\">www.ctri.nic.in<\/jats:ext-link>\n                      ): CTRI\/2023\/12\/060881\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70938","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:21:20Z","timestamp":1787728880000},"page":"1058-1070","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Trial: Intensive Supervised Nutritional Therapy Versus Guideline\u2010Based Nutritional Advice for Sarcopenia in Decompensated Cirrhosis\u2014A Randomised Controlled Trial"],"prefix":"10.1111","volume":"64","author":[{"given":"Gireesh Kumar","family":"Dhaked","sequence":"first","affiliation":[{"name":"Department of Gastroenterology SMS Medical College and Hospitals  Jaipur India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhat Narain","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology ESIC Medical College and Hospital  Jaipur 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