Nutritional Strategy in the Management of Heart Failure in Adults

Abstract

The incidence of congestive heart failure (CHF) is increasing in Westernized countries, and patients with CHF experience poor quality of life (functional impairment, high hospitalization rate and high mortality). Malnutrition occurring during the course of CHF is referred to as cardiac cachexia and is associated with higher mortality independent of the severity of CHF. Cardiac cachexia involving a loss of more than 10% of lean body mass can clinically be defined as a bodyweight loss of 7.5% of previous dry bodyweight in a period longer than 6 months. The energy requirements of patients with CHF, whether cachectic or not, are not noticeably modified since the increase in resting energy expenditure is compensated by a decrease in physical activity energy expenditure. Malnutrition in CHF has been ascribed to neurohormonal alterations, i.e. anabolic/catabolic imbalance and increased cytokine release. Anorexia may occur, particularly during acute decompensation of CHF. Function is impaired in CHF, because of exertional dyspnea and changes in skeletal muscle. Decreased exercise endurance seems to be related to decreased mitochondrial oxidative capacities and atrophy of type 1 fibers, which are attributed to alteration in muscle perfusion and are partially reversible by training. Malnutrition could also impair muscle function, because of decreased muscle mass and strength associated with decreased glycolytic capacities and atrophy of type 2a and 2b fibres. With respect to the putative mechanisms of cardiac cachexia, anabolic therapy (hormones or nutrients) and anticytokine therapy have been proposed, but trials are scarce and often inconclusive. In surgical patients with CHF, perioperative (pre- and postoperative) nutritional support has been shown to be effective in reducing the mortality rate. Long term nutritional supplementation trials in patients with CHF and cachexia are thus required to establish recommendations for the nutritional management of patients with CHF.

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

“…Magnesium intake may temper the increased arrhythmic risk and vasoconstriction experienced by many heart failure patients. 6,31 Magnesium deficiency can lead to increased sodium retention, decreased potassium uptake, and affect essential intracellular calcium concentrations, all of which further complicate the management of heart failure.…”

Anthropometric variables and physical activity as predictors of cardiac cachexia

“…It has been suggested as a probable mechanism for the development of cardiac cachexia an imbalance between the energy intake and the nutrition requirements due to: an inadequate intake (anorexia), intestinal malabsorption or an elevated basal metabolic rate [13].…”

Cambios en la composición corporal por impedancia bioeléctrica y su asociación con el deterioro de la capacidad funcional en pacientes con insufi ciencia cardiaca crónica estable

“…Furthermore, depletion of the body protein reserves causes a greater increase in the extracellular water volume, so it is difficult to assess free fat mass (22). Therefore, without assessing the fluid variation, treatment with diuretics cannot be indicated without reincorporating the intravascular space.…”