Association between dietary fatty acids and all‐cause mortality in patients with cirrhosis: A cohort study

Abstract Liver cirrhosis imposes a substantial global burden, with complications driving high mortality. Diet is pivotal in managing liver disease progression and cirrhosis‐related death. This study investigated associations between total fat intake, specific dietary fatty acid subclasses and all‐cause mortality in cirrhotic patients. In this prospective cohort study, 121 ambulatory patients with recently diagnosed cirrhosis (≤6 months) were enrolled. Baseline dietary intake was evaluated via a validated 168‐item semi‐quantitative food frequency questionnaire. Participants were categorized into tertiles by total fat and fatty acid subclasses: saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA), omega‐3 and omega‐6 fatty acids. Cox proportional hazards models computed hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted sequentially for age, sex, energy intake, BMI, smoking, alcohol use, cirrhosis aetiology, MELD score and Child–Pugh class. During the 60‐month follow‐up, 50 deaths (41.3%) occurred. In fully adjusted models, highest versus lowest tertiles of total fat intake (HR = 6.69; 95% CI: 1.37–13.34; P ‐trend = 0.017), SFA intake (HR = 8.2; 95% CI: 1.33–20.53; P ‐trend = 0.014) and PUFA‐6 intake (HR = 5.24; 95% CI: 1.1–26.44; P ‐trend = 0.014) were independently associated with significantly elevated mortality risk. No significant associations were observed for MUFA, total PUFA or PUFA‐3 intake. Kaplan–Meier analyses confirmed significantly reduced 5‐year survival with higher total fat (log‐rank P = 0.003) and SFA intake (log‐rank P < 0.001). In this exploratory prospective cohort study, higher intakes of total fat, saturated fatty acids and omega‐6 polyunsaturated fatty acids were associated with increased all‐cause mortality among patients with cirrhosis. These preliminary findings are hypothesis‐generating and require confirmation in larger, adequately powered prospective studies.