Association of dietary amino acid composition with mortality risk in cirrhosis: a prospective cohort study

The role of dietary amino acid composition in cirrhosis prognosis is incompletely understood. We evaluated associations between dietary intake of branched-chain (BCAAs), aromatic (AAAs), and sulfur-containing amino acids (SAAs) and mortality risk in cirrhosis. In this prospective cohort study, 166 ambulatory cirrhosis patients were enrolled and followed for up to 60 months; 121 with complete dietary and covariate data were retained for analysis. Dietary amino acid intake was assessed via a validated food frequency questionnaire, expressed as absolute (g/day) and relative (g/g protein) intake. Mortality associations were examined using Cox proportional hazards models. Among 121 participants, 50 deaths occurred. Higher absolute SAA intake was significantly associated with mortality, while BCAA and AAA intakes were not. Relative to total protein, higher BCAA intake was associated with significantly lower mortality risk (HR T3vsT1 = 0.25, 95% CI: 0.06–0.97; p-trend = 0.046), while higher SAA intake was associated with increased mortality (HR T3vsT1 = 3.10, 95% CI: 1.09–8.60; p-trend = 0.027). AAA intake showed no significant association after full adjustment. Dietary amino acid composition may influence survival in cirrhosis. A higher BCAA-to-protein ratio may be beneficial, while higher SAA intake may worsen outcomes, highlighting the importance of amino acid quality.