{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:31:30Z","timestamp":1790631090146,"version":"4.1.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Minufiya University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Salt restriction is a cornerstone in managing ascites in cirrhotic patients; however, its impact on nutritional status, sarcopenia, and mortality remains unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Aim<\/jats:title>\n            <jats:p>To evaluate the effects of a salt-restricted diet (SRD) on ascites control, body composition, sarcopenia development, and patient survival in cirrhotic patients with decompensated liver disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This prospective study included 102 patients with grade III ascites, categorized into two groups based on dietary adherence: Salt-Restricted Diet (SRD), (<jats:italic>n<\/jats:italic>\u2009= 46) and Salt-Unrestricted Diet (SUD) (<jats:italic>n<\/jats:italic>\u2009= 56). Sodium intake was assessed using the Dietary Sodium Restriction Questionnaire (DSRQ) and spot urine Na\/K ratio. Nutritional status, sarcopenia, ascites control, and six-month mortality were evaluated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The SRD group showed better ascites control, with fewer paracentesis sessions per month (1.57 \u00b1\u20090.65 vs. 4.07 \u00b1\u20091.43, <jats:italic>p<\/jats:italic>\u2009&lt; 0.001). Sarcopenia was more prevalent in the SRD group (<jats:italic>p<\/jats:italic>\u2009&lt; 0.001), with lower SMI (4.88 \u00b1\u20097.13 vs. 16.7 \u00b1\u2009544.8, <jats:italic>p<\/jats:italic>\u2009&lt; 0.001) and TR PMM (19.03 \u00b1\u20093.68 vs. 71.92 \u00b1\u2009191.9, <jats:italic>p<\/jats:italic>\u2009&lt; 0.001). Higher nutritional risk was significantly associated with SRD (<jats:italic>p<\/jats:italic>\u2009= 0.001). Mortality was significantly higher in the SRD group (67.4%) compared to the SUD group (35.7%), <jats:italic>p<\/jats:italic>\u2009= 0.001. Multivariate analysis identified sarcopenia (OR =\u20092.684, <jats:italic>p<\/jats:italic>\u2009= 0.006) and SRD (OR =\u20091.65, <jats:italic>p<\/jats:italic>\u2009&lt; 0.001) as independent predictors of mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>While effective in ascites control, sodium restriction may compromise nutritional status, heighten sarcopenia risk, and increase mortality, highlighting the need for a more individualized dietary approach.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12876-025-03830-1","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T10:42:26Z","timestamp":1752576146000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impacts of salt restriction on nutritional status, sarcopenia, and mortality of cirrhotic patients with ascites"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3110-1547","authenticated-orcid":false,"given":"Maha","family":"Elsabaawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Ragab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madiha","family":"Naguib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Kamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maymona","family":"Al-Khalifa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Gamil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa","family":"Elfayoumy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"3830_CR1","doi-asserted-by":"crossref","unstructured":"Aithal GP, Palaniyappan N, China L, et al. Guidelines on the management of ascites in cirrhosis Gut. 2021;70:9\u201329.","DOI":"10.1136\/gutjnl-2020-321790"},{"key":"3830_CR2","doi-asserted-by":"publisher","first-page":"55","DOI":"10.2147\/HMER.S136578","volume":"10","author":"H Fukui","year":"2018","unstructured":"Fukui H, Kawaratani H, Kaji K, Takaya H, Yoshiji H. Management of refractory cirrhotic ascites: challenges and solutions. Hepat Med. 2018;10:55\u201371.","journal-title":"Hepat Med"},{"key":"3830_CR3","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.jhep.2010.05.004","volume":"53","author":"European Association for the Study of the Liver","year":"2010","unstructured":"European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397\u2013417. https:\/\/doi.org\/10.1016\/j.jhep.2010.05.004.","journal-title":"J Hepatol"},{"key":"3830_CR4","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1002\/hep.31884","volume":"74","author":"SW Biggins","year":"2021","unstructured":"Biggins SW, Angeli P, Garcia-Tsao G, Gin\u00e8s P, Ling SC, Nadim MK, Wong F, Kim WR. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the american association for the study of liver diseases. Hepatology. 2021;74:1014\u201348. https:\/\/doi.org\/10.1002\/hep.31884.","journal-title":"Hepatology"},{"key":"3830_CR5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1136\/gutjnl-2020-321790","volume":"70","author":"GP Aithal","year":"2021","unstructured":"Aithal GP, Palaniyappan N, China L, H\u00e4rm\u00e4l\u00e4 S, Macken L, Ryan JM, Wilkes EA, Moore K, Leithead JA, Hayes PC, O\u2019Brien AJ, Verma S. Guidelines on the management of ascites in cirrhosis. Gut. 2021;70:9\u201329. https:\/\/doi.org\/10.1136\/gutjnl-2020-321790.","journal-title":"Gut"},{"key":"3830_CR6","first-page":"65","volume":"5","author":"S Eghtesad","year":"2013","unstructured":"Eghtesad S, Poustchi H, Malekzadeh R. Malnutrition in liver cirrhosis:the influence of protein and sodium. Middle East J Dig Dis. 2013;5:65\u201375.","journal-title":"Middle East J Dig Dis"},{"key":"3830_CR7","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s13643-016-0250-4","volume":"5","author":"B Walbaum","year":"2016","unstructured":"Walbaum B, Valda ML, Rada G. Sodium restriction in patients with cirrhotic ascites: a protocol for a systematic review. Syst Rev. 2016;5:78.","journal-title":"Syst Rev"},{"key":"3830_CR8","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1136\/gut.19.6.549","volume":"19","author":"TB Reynolds","year":"1978","unstructured":"Reynolds TB, Lieberman FL, Goodman AR. Advantages of treatment of ascites without sodium restriction and without complete removal of excess fluid. Gut. 1978;19:549\u201353.","journal-title":"Gut"},{"key":"3830_CR9","doi-asserted-by":"publisher","first-page":"687s","DOI":"10.1093\/ajcn\/65.2.687S","volume":"65","author":"CD Morris","year":"1997","unstructured":"Morris CD. Effect of dietary sodium restriction on overall nutrient intake. Am J Clin Nutr. 1997;65:687s\u2013s691.","journal-title":"Am J Clin Nutr"},{"key":"3830_CR10","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.cgh.2011.08.016","volume":"10","author":"K Cheung","year":"2012","unstructured":"Cheung K, Lee SS, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol. 2012;10:117\u201325.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"3830_CR11","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1002\/hep.510230516","volume":"23","author":"M Merli","year":"1996","unstructured":"Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi). Hepatology. 1996;23:1041\u20136.","journal-title":"Hepatology"},{"key":"3830_CR12","doi-asserted-by":"publisher","first-page":"109","DOI":"10.4103\/JMU.JMU_91_21","volume":"30","author":"CC Onwuka","year":"2022","unstructured":"Onwuka CC, Famurewa OC, Adekanle O, Ayoola OO, Adegbehingbe OO. Hepatic function predictive value of hepatic venous waveform versus portal vein velocity in liver cirrhosis. J Med Ultrasound. 2022;30:109\u201315.","journal-title":"J Med Ultrasound"},{"key":"3830_CR13","doi-asserted-by":"publisher","first-page":"16","DOI":"10.3350\/cmh.2022.0104","volume":"29","author":"F Wong","year":"2023","unstructured":"Wong F. Management of refractory ascites. Clin Mol Hepatol. 2023;29:16\u201332.","journal-title":"Clin Mol Hepatol"},{"key":"3830_CR14","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1038\/ejcn.2016.238","volume":"71","author":"MP Rodrigues","year":"2017","unstructured":"Rodrigues MP, Rabelo-Silva E, Fuchs FD, Fuchs SC, Moreira LB. Validity and reliability of the dietary sodium restriction questionnaire in patients with hypertension. Eur J Clin Nutr. 2017;71:552\u20134.","journal-title":"Eur J Clin Nutr"},{"key":"3830_CR15","first-page":"164","volume":"23","author":"V Arroyo","year":"1996","unstructured":"Arroyo V, Gin\u00e8s P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Int Ascites Club Hepatol. 1996;23:164\u201376.","journal-title":"Int Ascites Club Hepatol"},{"key":"3830_CR16","doi-asserted-by":"publisher","unstructured":"Ackermans LLGC, Rabou J, Basrai M, et al. Screening, diagnosis and monitoring of sarcopenia: When to use which tool?. Clin Nutr ESPEN. 2022;48:36\u201344. https:\/\/doi.org\/10.1016\/j.clnesp.2022.01.027.","DOI":"10.1016\/j.clnesp.2022.01.027"},{"key":"3830_CR17","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1007\/s10620-015-4015-z","volume":"61","author":"SM Borhofen","year":"2016","unstructured":"Borhofen SM, Gerner C, Lehmann J, Fimmers R, G\u00f6rtzen J, Hey B, et al. The royal free hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci. 2016;61:1735\u201343.","journal-title":"Dig Dis Sci"},{"issue":"10","key":"3830_CR18","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.4254\/wjh.v15.i10.1084.PMID:37970619;PMCID:PMC10642432","volume":"15","author":"R Kumar","year":"2023","unstructured":"Kumar R, Marrapu S. Dietary salt in liver cirrhosis: with a pinch of salt! World J Hepatol. 2023;15(10):1084\u201390. https:\/\/doi.org\/10.4254\/wjh.v15.i10.1084.PMID:37970619;PMCID:PMC10642432.","journal-title":"World J Hepatol"},{"key":"3830_CR19","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1111\/j.1440-1746.2011.07043.x","volume":"27","author":"P Sorrentino","year":"2012","unstructured":"Sorrentino P, Castaldo G, Tarantino L, et al. Preservation of nutritional-status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis. J Gastroenterol Hepatol. 2012;27:813\u201322.","journal-title":"J Gastroenterol Hepatol"},{"key":"3830_CR20","first-page":"1013","volume":"26","author":"CT Soulsby","year":"1997","unstructured":"Soulsby CT, Madden AM, Morgan MY. The effect of dietary sodium restriction on energy and protein intake in patients with cirrhosis. Hepatology. 1997;26:1013.","journal-title":"Hepatology"},{"key":"3830_CR21","doi-asserted-by":"publisher","first-page":"355","DOI":"10.5009\/gnl.2012.6.3.355","volume":"6","author":"XB Gu","year":"2012","unstructured":"Gu XB, Yang XJ, Zhu HY, Xu BY. Effect of a diet with unrestricted sodium on ascites in patients with hepatic cirrhosis. Gut Liv. 2012;6:355\u201361.","journal-title":"Gut Liv"},{"key":"3830_CR22","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1111\/liv.12583","volume":"35","author":"F Morando","year":"2015","unstructured":"Morando F, Rosi S, Gola E, Nardi M, Piano S, Fasolato S, et al. Adherence to a moderate sodium restriction diet in outpatients with cirrhosis and ascites: a real-life cross-sectional study. Liver Int. 2015;35:1508\u201315.","journal-title":"Liver Int"},{"key":"3830_CR23","doi-asserted-by":"publisher","first-page":"8061","DOI":"10.3748\/wjg.v20.i25.8061","volume":"20","author":"AJ Montano-Loza","year":"2014","unstructured":"Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol. 2014;20:8061\u201371.","journal-title":"World J Gastroenterol"},{"issue":"1","key":"3830_CR24","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1002\/jcsm.12095","volume":"8","author":"M Kalafateli","year":"2017","unstructured":"Kalafateli M, Mantzoukis K, Choi Yau Y, Mohammad AO, Arora S, Rodrigues S, de Vos M, Papadimitriou K, Thorburn D, O\u2019Beirne J, Patch D, Pinzani M, Morgan MY, Agarwal B, Yu D, Burroughs AK, Tsochatzis EA. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the Model for End-stage Liver Disease score. J Cachexia Sarcopenia Muscle. 2017;8(1):113\u201321. https:\/\/doi.org\/10.1002\/jcsm.12095. Epub 2016 Feb 1. PMID: 27239424; PMCID: PMC4864202.","journal-title":"J Cachexia Sarcopenia Muscle."},{"issue":"1","key":"3830_CR25","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.jceh.2022.06.005","volume":"13","author":"ER Warner Ii","year":"2023","unstructured":"Warner Ii ER, Satapathy SK. Sarcopenia in the cirrhotic patient: current knowledge and future directions. J Clin Exp Hepatol. 2023;13(1):162\u201377. https:\/\/doi.org\/10.1016\/j.jceh.2022.06.005. Epub 2022 Jun 27. PMID: 36647414; PMCID: PMC9840086.","journal-title":"J Clin Exp Hepatol."},{"key":"3830_CR26","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1111\/j.1600-0676.1993.tb00624.x","volume":"13","author":"M Bernardi","year":"1993","unstructured":"Bernardi M, Laffi G, Salvagnini M, et al. Efficacy and safety of the stepped care medical treatment of ascites in liver cirrhosis: a randomized controlled clinical trial comparing two diets with different sodium content. Liver. 1993;13:156\u201362.","journal-title":"Liver"},{"key":"3830_CR27","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1136\/gutjnl-2020-321790","volume":"70","author":"GP Aithal","year":"2021","unstructured":"Aithal GP, Palaniyappan N, China L, et al. Guidelines on the management of ascites in cirrhosis. Gut. 2021;70:9\u201329.","journal-title":"Gut"},{"key":"3830_CR28","unstructured":"Brinkman JE, Dorius B, Sharma S. Physiology, Body Fluids. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Available from: \nhttps:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482447\/. Updated 2023 Jan 27."},{"issue":"4","key":"3830_CR29","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1016\/j.rgmxen.2018.10.004","volume":"83","author":"O Ruiz-Marg\u00e1in","year":"2018","unstructured":"Ruiz-Marg\u00e1in O, M\u00e9ndez-Guerrero BM, Rom\u00e1n-Calleja S, Gonz\u00e1lez-Rodr\u00edguez G, Fern\u00e1ndez-del-Rivero PA, Rodr\u00edguez-C\u00f3rdova A, Torre RU. Mac\u00edas-Rodr\u00edguez, Dietary management and supplementation with branched-chain amino acids in cirrhosis of the liver. Rev Gastroenterol M\u00e9xico (English Edition). 2018;83(4):424\u201333.","journal-title":"Rev Gastroenterol M\u00e9xico (English Edition)"},{"key":"3830_CR30","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.1017\/jns.2022.69","volume":"11","author":"F Pashayee-Khamene","year":"2022","unstructured":"Pashayee-Khamene F, Hajimohammadebrahim-Ketabforoush M, Saber-Firoozi M, Hatami B, Naseri K, Karimi S, et al. Salt consumption and mortality risk in cirrhotic patients: results from a cohort study. J Nutr Sci. 2022;11:e99.","journal-title":"J Nutr Sci."}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-03830-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-025-03830-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-03830-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T10:45:56Z","timestamp":1757241956000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-025-03830-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3830"],"URL":"https:\/\/doi.org\/10.1186\/s12876-025-03830-1","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"assertion":[{"value":"21 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the principles of the Declaration of Helsinki. This study was approved by the Ethics Committee of the National Liver Institute, Menoufia University (NLI IRB 00003413 FWA 0000227).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"521"}}