Nutritional Assessment and Dietary Interventions in Older Patients with Heart Failure

Abstract

Purpose of Review Older patients with heart failure (HF) are challenging to manage due to the high prevalence of frailty, polypharmacy, cognitive impairment, and other geriatric conditions. Malnutrition and poor dietary habits are also common and strongly predict adverse outcomes in older patients with HF. Current dietary recommendations for HF primarily advise reducing sodium intake, but randomized studies suggest that excess restriction can lead to adverse outcomes. The optimal dietary pattern, caloric intake, advice for weight management, and strategies for self-care in this population have not been determined. Recent Findings Screening tools for malnutrition, including the Geriatric Nutritional Risk Index and Mini Nutritional Assessment, can be used to assess nutritional risk and predict mortality, hospitalization, and functional decline in older patients with HF. The ideal dietary pattern for patients with HF has not been determined, though epidemiologic and observational cohort studies suggest that the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean dietary patterns are reasonable to recommend to many patients. Recent dietary intervention studies highlight the importance of individualized nutritional counseling interventions, maintaining adequate nutritional intake during sodium restriction, and the potential for caloric restriction to improve outcomes in some patients. Summary Nutritional status and dietary intake are prognostically important and potentially modifiable in older patients with HF. Ongoing interventional and translational studies may help define the ideal sodium intake, dietary regimen, and recommendations for weight loss, but more research is needed in this important domain.

Functional status mediates the association of nutritional status with depressive symptoms in patients with heart failure

“…Based on these findings, it is essential to assess nutritional status and provide nutritional support in patients with HF, which might contribute to curbing the development of depressive symptoms. At present, consistent guidelines and recommendations for nutritional support are limited in patients with HF (Lee, Tam, Cascino, & Hummel, 2018). A previous review indicated that individualized nutritional interventions could be beneficial (Lee et al., 2018).…”

“…At present, consistent guidelines and recommendations for nutritional support are limited in patients with HF (Lee, Tam, Cascino, & Hummel, 2018). A previous review indicated that individualized nutritional interventions could be beneficial (Lee et al., 2018). A randomized controlled trial demonstrated that providing high‐quality diets according to the patients' nutritional needs, reducing barriers related to intake and providing nutritional supplements if needed, could significantly improve the prognosis of malnourished patients with HF (Bonilla‐Palomas et al., 2016).…”