Dietary Self-management in Heart Failure: High Tech or High Touch?

Abstract

Dietary management of heart failure (HF) has largely been focused on sodium and fluid restrictions. Although safety and efficacy of these interventions in HF remain unclear, a daily sodium intake between 2000 and 3000 mg/day appears to be safe in these patients. Ongoing clinical research will inform on the safety and efficacy of a more restrictive sodium intake to less than 1500 mg/day. Data shows that routine fluid restriction in HF regardless of symptoms may be unnecessary; however, in patients with signs of congestion, fluid restriction to 2.0 L/day may be advisable. Recently, more attention has been paid to other nutritional aspects of HF beyond sodium and fluid intake, although there is still little evidence available to guide nutritional management of HF. Assuring that patients meet daily requirements for key micronutrients, such as calcium, magnesium, potassium, folate, vitamin E, vitamin D, zinc, and thiamine, is essential in order to prevent deficiencies. More appropriate macronutrient composition of the diet is still to be determined; however, a diet containing 50-55% carbohydrates, 25-30% fat, and 15-20% protein seems acceptable for patients with HF with or without non-end-stage renal disease. Additionally, increased protein intake may be considered in malnourished/cachectic patients. Consulting a registered dietitian is especially helpful for patients with recent HF exacerbations or for patients with multiple comorbidities who may need to follow several dietary restrictions and may benefit of individualized dietary counseling in order to ensure appropriate intake of energy, protein, and micronutrients. Today, there are still several knowledge gaps in guiding the dietary management of HF. In this article, we review current recommendations for the dietary management of HF and the evidence supporting this practice.

High salt induced hypertension leads to cognitive defect

“…Sodium is an essential nutrient and the primary cation in the extracellular fluid [ 22 , 23 ]. Previous study has shown that rats with high salt diet has higher sodium levels in the interstitial space [ 21 ].…”

Evidence related to sodium restriction in patients with heart failure

“…It is considered pertinent to analyze that water restriction associated with sodium restriction may have influenced the findings. Limiting fluid intake to 1.5-2 L/day is advised only in severe Patients with HF with signs of congestion or hyponatremia (29) . Moreover, the benefits of this recommendation are controversial due to hemodynamic changes and progressive cardiac remodeling in chronic HF.…”

Problems Experienced in the Second and Third Months After Discharge From a Heart Failure-Related Hospitalization

“…Yet, data are unclear as to the safety and efficacy of restricting fluids, with some evidence indicating routine restriction may be unwarranted unless IHF have pulmonary congestion or decompensated HF. 13,14 Comorbidities emerged as a new problem in managing HF treatment and symptoms. For example, different glucose-lowering agents affect HF outcomes, 15,16 while pulmonary disease, diabetes mellitus, and obesity tend to increase morbidity and mortality risk in both IHF with a preserved or reduced ejection fraction.…”