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Nutritional management of heart failure
Keisuke Kida1, Isao Miyajima2, Norio Suzuki3
1Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan.
Journal of Cardiology
|November 12, 2022
Summary
Nutritional strategies for heart failure must shift from weight loss to preventing undernutrition, considering the "obesity paradox." Personalized interventions, focusing on the heart-gut axis and individual values, are crucial for better outcomes.
Area of Science:
- Cardiovascular Medicine
- Nutritional Science
- Gerontology
Background:
- Current cardiovascular nutrition focuses on secondary prevention of lifestyle diseases like hypertension and diabetes, often recommending weight loss.
- Symptomatic heart failure (Stage C/D) patients often experience poor nutrition, sarcopenia, and cardiac cachexia, leading to a poor prognosis, termed the "obesity paradox."
- Existing nutritional guidelines, such as uniform salt restriction, may not be suitable for all heart failure patients.
Purpose of the Study:
- To advocate for a paradigm shift in heart failure nutritional management, moving from weight loss to preventing undernutrition.
- To highlight the importance of personalized nutritional interventions, considering individual patient needs and values.
- To introduce the concept of "heart nutrition" for comprehensive nutritional care in heart failure.
Main Methods:
- Review of existing literature on nutrition in cardiovascular disease and heart failure.
- Discussion of the "obesity paradox" and its implications for heart failure patients.
- Exploration of the role of the heart-gut axis and behavioral change models in nutritional management.
Main Results:
- Undernutrition and cardiac cachexia are associated with poor prognosis in advanced heart failure.
- A uniform approach to salt restriction may need re-evaluation in favor of individualized strategies.
- Early nutritional intervention (within 48 hours) in acute heart failure is recommended.
Conclusions:
- A new approach, "heart nutrition," is proposed for managing heart failure patients, emphasizing weight maintenance and personalized care.
- Nutritional management in heart failure requires a shift towards preventing weight loss and addressing undernutrition.
- Further research is needed to establish evidence-based guidelines for nutritional management in heart failure.
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