Opinion Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2023; 15(10): 1084-1090
Published online Oct 27, 2023. doi: 10.4254/wjh.v15.i10.1084
Dietary salt in liver cirrhosis: With a pinch of salt!
Ramesh Kumar, Sudheer Marrapu
Ramesh Kumar, Sudheer Marrapu, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
Author contributions: Kumar R designed the manuscript, collected data, and wrote the manuscript; Marrapu S collected data, and wrote the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MD, Additional Professor, Department of Gastroenterology, All India Institute of Medical Sciences, 4th Floor, IPD Block-C, Patna 801507, India. docrameshkr@gmail.com
Received: July 12, 2023
Peer-review started: July 12, 2023
First decision: September 11, 2023
Revised: September 21, 2023
Accepted: October 8, 2023
Article in press: October 8, 2023
Published online: October 27, 2023

Patients with liver cirrhosis are advised to limit their sodium consumption to control excessive fluid accumulation. Salt is the most common form in which sodium is consumed daily. Consequently, various recommendations urge patients to limit salt intake. However, there is a lack of consistency regarding salt restriction across the guidelines. Moreover, there is conflicting evidence regarding the efficacy of salt restriction in the treatment of ascites. Numerous studies have shown that there is no difference in ascites control between patients with restriction of salt intake and those without restriction. Moreover, patients with cirrhosis may have several negative effects from consuming too little salt, although there are no recommendations on the lower limit of salt intake. Sodium is necessary to maintain the extracellular fluid volume; hence, excessive salt restriction can result in volume contraction, which could negatively impact kidney function in a cirrhotic patient. Salt restriction in cirrhotic patients can also compromise nutrient intake, which can have a negative impact on the overall outcome. There is insufficient evidence to recommend restricted salt intake for all patients with cirrhosis, including those with severe hyponatremia. The existing guidelines on salt restriction do not consider the salt sensitivity of patients; their nutritional state, volume status and sodium storage sites; and the risk of hypochloremia. This opinion article aims to critically analyze the existing literature with regard to salt recommendations for patients with liver cirrhosis and identify potential knowledge gaps that call for further research.

Keywords: Salt, Cirrhosis, Sodium, Hyponatremia, Ascites, Malnutrition

Core Tip: There are still many inconsistencies in the guidelines regarding salt recommendations for patients with liver cirrhosis. Although controlling ascites is the core tenet of salt restriction, there is insufficient data to back up this assertion. Moreover, the guidelines have no recommendations for minimum salt intake, even though too little salt consumption may have a variety of negative effects on patients with liver cirrhosis. To achieve optimal salt consumption in these patients, several factors need to be considered. This article discusses several important aspects of salt consumption in patients with cirrhosis.