title: Adherence to a moderate sodium restriction diet in outpatients with cirrhosis and ascites: a real-life cross-sectional study.
abstract: OBJECTIVE
  A moderate sodium restriction diet should be indicated in patients with cirrhosis and ascites. Nevertheless, there is a lack of specific investigation on its correct application. To evaluate the adherence of patients with cirrhosis and ascites to a moderately low-salt diet and the impact on intake of total calories and serum sodium concentration.
  
  
  METHODS
  A total of 120 outpatients with cirrhosis and ascites were interviewed with a pre-established questionnaire. A quantitative assessment of nutrient and salt intake was performed.
  
  
  RESULTS
  A moderately low-salt diet was followed by 37 patients (Group A). Of the 83 patients who did not follow the diet (Group B), 54 thought that they were following it. The mean daily sodium intake was 79.5 ± 5.5 mmol/day (Group A) and 205.9 ± 14.1 mmol/day (Group B), P < 0.0001. The adherence to diet was related to the severity of cirrhosis, and was higher among candidates for liver transplantation and in patients followed through the Care Management Program. Patients of Group A had reduced the mean daily calorie intake by 20% compared with Group B patients (P < 0.0005), while there was no difference on the occurrence of hyponatraemia.
  
  
  CONCLUSIONS
  This study shows a poor adherence of patients with cirrhosis and ascites to a moderate dietary sodium restriction. Adherence to a diet seems to increase with the worsening of liver disease, probably because of the reduction of alternative therapeutic options. In addition, a deficiency in the educational process can lead the patient to follow a sodium-reduced diet by means of dangerous tools, such as reducing the overall daily food intake.
authors.affiliation: Department of Medicine, DIMED, University of Padova, Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.forename: Silvia
authors.initials: S
authors.lastname: Rosi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gola
authors.forename: Mariateresa
authors.initials: M
authors.lastname: Nardi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Stanco
authors.forename: Marta
authors.initials: M
authors.lastname: Cavallin
authors.forename: Antonietta
authors.initials: A
authors.lastname: Romano
authors.forename: Antonietta
authors.initials: A
authors.lastname: Sticca
authors.forename: Lorenza
authors.initials: L
authors.lastname: Caregaro
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D001201:Ascites / Q000178:diet therapy*; D003430:Cross-Sectional Studies; D004039:Diet, Sodium-Restricted; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D010349:Patient Compliance / Q000706:statistics & numerical data*; D064167:Recommended Dietary Allowances
keywords: ascites; calories; cirrhosis; diet; hyponatraemia; nutrition; restriction; salt; sodium; sodium balance