Micronutrients and their supplementation in chronic cardiac failure. An update beyond theoretical perspectives

Abstract

Physicians' use of micronutrients to improve symptoms or outcomes in chronic illness has until recently been guided by limited data on the actions of individual agents in vitro or in animal studies. However several recently published clinical trials have provided information about which groups of patients are likely to benefit from which combination of micronutrients. Patients with chronic cardiac failure (CCF), particularly elderly individuals, have several reasons to be deficient in micronutrients including reduced intake, impaired gastrointestinal absorption and increased losses on the background of increased utilisation due for example to increased oxidative stress. Studies of nutritional supplementation in CCF patients have usually concentrated on specific agents. However given that many micronutrients have synergistic influences upon metabolic processes this strategy might merely lead to a shifting of a limiting step. Rather, a strategy of increasing the availability of multiple agents at once might be more logical. The aim of this article is to briefly review the experimental rationale for each of the micronutrients of potential benefit in chronic heart failure and examine the current clinical trial evidence supporting their use.

The Dietary Quality of Persons with Heart Failure in NHANES 1999–2006

“…[2][3][4][5][6][7][8]11,12 This analysis demonstrates that the dietary quality of U.S. adults living in the community with heart failure is poor. It is likely the poor dietary patterns observed in the population began many years before diagnosis of heart failure, and in fact contributed to the development of heart failure.…”

“…9 Additional nutrients promoted by the DASH diet, which documented associations with impact on heart failure outcomes, were also assessed. [2][3][4][5][6][7][8] The DASH diet promotes a high quality diet that includes consumption of fruits, vegetables, whole grains, low-fat and fat-free dairy products, lean meats, poultry and fish, and sparse intake of fats, oils, sweets, and added sugars. 13,17 Nutrients included in the DASH diet are potassium, calcium, magnesium, fiber, saturated fat, protein and cholesterol.…”

“…[2][3][4][5][6][7][8] The American College of Cardiology/American Heart Association (ACC/AHA) joint guidelines recommend restricted sodium intake for patients with symptomatic, non-end-stage heart failure. 9 These guidelines also endorse adherence to dietary guidelines for common underlying and comorbid conditions in chronic heart failure, including coronary heart disease, hypertension, hypercholesterolemia, and diabetes.…”

“…The results of several recent studies have suggested that nutrients consistent with Dietary Approaches to Stop Hypertension (DASH) eating plan influence heart failure progression and associated outcomes. [2][3][4][5][6][7][8] Additionally, omega-3 fish oil intake has been associated with a beneficial effect on heart failure outcomes. 10 Despite the influence of dietary factors in determining disease outcomes in patients with heart failure, there is little understanding of the current dietary quality of persons with heart failure.…”

“…9 The secondary purpose is to describe the overall dietary quality of persons with heart failure, based on additional nutrients documented as being beneficial to non-endstage heart failure and its underlying conditions. [2][3][4][5][6][7][8]12 These include nutrients listed in the DASH recommendations: potassium, calcium, magnesium, fiber, saturated fat, protein and cholesterol, 13 as well as omega-3 fish oil. 10 …”