The effect of a diet based on vegetable and dairy protein on biochemical and functional indicators of sarcopenia in patients with liver cirrhosis: a randomized controlled trial

Mahdiyeh Taghizadeh; Banafshe Khalese-Ranjbar; Amirreza Ostevari; Mohammad Taher; Amir Ali Sohrabpour; Mir Saeed Yekaninejad; Mohammad Javad Hosseinzadeh-Attar; Somayyeh Asghari

doi:10.1186/s12937-025-01272-9

The effect of a diet based on vegetable and dairy protein on biochemical and functional indicators of sarcopenia in patients with liver cirrhosis: a randomized controlled trial

Nutr J. 2025 Dec 13. doi: 10.1186/s12937-025-01272-9. Online ahead of print.

Authors

Mahdiyeh Taghizadeh¹, Banafshe Khalese-Ranjbar¹, Amirreza Ostevari², Mohammad Taher^{3

4}, Amir Ali Sohrabpour⁵, Mir Saeed Yekaninejad⁶, Mohammad Javad Hosseinzadeh-Attar¹, Somayyeh Asghari⁷

Affiliations

¹ Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No#44, Hojjatdoust St., Naderi St., Keshavarz Blvd, Tehran, 141556117, Iran.
² Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Gastroenterology & Hepatology, Tehran University of Medical Sciences, Imam Khomeini Hospital complex, Tehran, Iran.
⁴ Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Tehran Gastroenterology and Hepatology Centre (Masoud Clinic), Tehran, Iran.
⁶ Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
⁷ Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No#44, Hojjatdoust St., Naderi St., Keshavarz Blvd, Tehran, 141556117, Iran. asghari.nut@gmail.com.

PMID: 41388544
DOI: 10.1186/s12937-025-01272-9

Abstract

Background: Sarcopenia, a prevalent complication of cirrhosis, is strongly linked to adverse clinical outcomes including hepatic encephalopathy and increased mortality which underscoring the urgent need for effective prevention and treatment strategies. This study investigates the effects of a diet based on vegetable and dairy protein on sarcopenia-related parameters in patients with cirrhosis.

Methods: This randomized, controlled clinical trial was carried out on 42 patients with cirrhosis aged 30 to 60 years. Patients were randomly assigned to either the diet based on vegetable and dairy protein (n = 21) or the standard omnivorous isocaloric and isonitrogenous diet (n = 21). Fasting blood samples, anthropometric measurements, handgrip strength, five times sit to stand (5STS) test, four meters gate speed (4MGS) as well as dietary intake and physical activity data were collected for all patients at the baseline and after 12 weeks of the intervention.

Results: Following 12 weeks of intervention, functional indicators of sarcopenia including handgrip strength, 4MGS, and the 5STS improved in vegetable and dairy protein-based diet group; however, no significant differences were found between the intervention and control groups (P > 0.05). Blood ammonia and myostatin levels remained stable in the vegetable and dairy protein-based diet group, whereas these biomarkers significantly increased in the standard diet group (P = 0.03). Moreover, a significant between-group difference was observed in blood ammonia levels (P = 0.02). Anthropometric indices including weight, BMI, mid-arm circumference (MAC), triceps skinfold (TSF), and mid-arm muscle circumference (MAMC) did not show significant differences between two groups (P > 0.05).

Conclusions: In conclusion, a vegetable and dairy protein-based diet effectively inhibited significant elevations in ammonia levels compared to the standard diet in persons with liver cirrhosis; however, anthropometric parameters and muscle function did not differ between two groups.

Keywords: Ammonia; Animal protein; Liver cirrhosis; Myostatin; Plant and dairy protein; Sarcopenia.