What are the outcomes of dietary interventions in Heart Failure with preserved Ejection Fraction? A systematic review and meta-analysis

Abstract

Aim To determine the efficacy of dietary interventions in Heart Failure with preserved Ejection Fraction (HFpEF). Method and results Key word searches were performed in five bibliographic databases to identify randomised or controlled studies of dietary interventions conducted in HFpEF or mixed heart failure (HF) samples published in the English language. Studies were appraised for bias and synthesised into seven categories based on similarity of the intervention or targeted population. The quality of the body of evidence was assessed via the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. Twenty-five unique interventions were identified; seventeen were considered for meta-analysis. Most studies were judged to be at high risk of bias. There was moderate quality evidence that caloric restriction led to clinically meaningful improvements in blood pressure and body weight. There was moderate quality evidence carbohydrate restriction resulted in meaningful reductions in blood pressure. There was very low quality evidence protein supplementation improved blood pressure and body weight and moderate quality evidence for clinically meaningful improvements in function. Conclusions Whilst some types of dietary interventions appeared to deliver clinically meaningful change in critical outcomes; the study heterogeneity and overall quality of the evidence makes it difficult to make firm recommendations. Greater transparency when reporting nutritional composition of interventions would enhance ability to pool studies.

Beyond Weight Loss: the Emerging Role of Incretin-Based Treatments in Cardiometabolic HFpEF

“…This is not trivial, as GLP1-RAs are not the only available strategy to achieve a significant weight loss. In fact, losing weight through caloric restriction and/or aerobic exercise might be a more affordable strategy in the long term, significantly improving exercise capacity and/or quality of life in patients with obesity and HFpEF [39 ▪ ,40]. Consistently, supervised exercise training (SET) is a valuable intervention in these patients [41 ▪▪ ].…”

Guía mexicana de práctica clínica para el diagnóstico y el tratamiento de la insuficiencia cardiaca

“…La restricción de sodio mostró un cambio modesto en la HRQoL en 5 estudios que la evaluaron (DME 0.02, IC95% -0.22; 0.26) equivalente a 0.36 puntos en el score KCCQ y con muy baja calidad de la evidencia. Respecto a la disminución de las cifras de presión arterial, tampoco se encontró una diferencia estadísticamente significativa (DME -1.38, IC95% -11.04; 8.28) con la evidencia evaluada como con muy alto riesgo de sesgo, inconsistencia y heterogeneidad importante 59 .…”