The effect of a plant- and dairy-based protein diet on serum levels of inflammatory and oxidative stress biomarkers in patients with liver cirrhosis: a randomized controlled trial

1. In a group of individuals with liver cirrhosis, a 12-week diet rich in plant and dairy proteins was associated with improved liver disease severity, even though inflammatory markers and oxidative stress levels did not significantly change. 

Evidence Rating Level: 1 (Excellent) 

Cirrhosis is the final stage of all chronic liver disease, marked by liver scarring, nodular regeneration, and dysfunction. It can range from compensated (mild) to decompensated (severe) and often leads to complications such as sarcopenia (muscle breakdown) through disruption of energy metabolism, and a higher risk of mortality. This occurs due to inflammation through increased amounts of tumour necrosis factor alpha (TNF-α), interleukin 1 (IL-1), and interleukin 6 (IL-6), along with increased oxidative stress. Combined, these promote muscle loss and liver cell damage through the production of reactive oxygen species (ROS). As such, prioritizing nutrition is essential to prevent complications, with current guidelines recommending high-protein, high-calorie diets. Emerging evidence suggests that plant and dairy proteins may reduce inflammation more effectively compared to standard diets; however, human studies are limited. To address this knowledge gap, this randomized controlled trial was designed to evaluate the effects of a plant- and dairy-based diet on inflammation and oxidative stress markers in patients with liver cirrhosis. A total of 46 participants were included, with 23 assigned to a plant- and dairy-based diet, and 23 assigned to a standard isocaloric diet. At baseline, both groups had similar body measurements. Throughout the study, only the intervention group experienced a significant decrease in body weight; however, the difference was borderline significant after adjusting for baseline values and fiber intake. There were no significant changes in body mass index (BMI), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), or skinfold thickness in the area of the triceps muscle (TSF) (p>0.05). Baseline serum levels of high-sensitive C-reactive protein (hs-CRP), TNF-α, IL-6, total oxidant status (TOS), and total antioxidant capacity (TAC) were similar between the two groups and did not significantly change during the study (p>0.05). This study found that a diet rich in plant and dairy proteins significantly decreased the Model for End-Stage Liver Disease (MELD) score (p<0.05).

Click here to read this study in BMC Gastroenterology

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