Advertisement

Nutritional management of heart failure

Published:November 25, 2022DOI:https://doi.org/10.1016/j.jjcc.2022.11.001

      Highlights

      • In symptomatic heart failure, it is known that underweight is associated with poor prognosis and called “Obesity paradox”.
      • In the elderly, the salt restriction may lead to loss of appetite and reduced food intake, and the degree of priority of intervention for undernutrition must be determined and salt restriction may need to be lifted to determine the moderation.
      • In the CCU for acute heart failure, nutritional intervention is required earlier, within 48 hours of admission, and the key points are the selection of access route, timing of intervention, and monitoring of side effects.
      • The importance of the digestive tract should also be recognized in heart failure from oral flail to intestinal edema, constipation, and the intestinal bacteria called the Heart-Gut axis.

      Abstract

      Nutrition in the cardiovascular field to date has focused on improving lifestyle-related diseases such as hypertension and diabetes from the viewpoint of secondary prevention. For these conditions, “nutrition for weight loss” is recommended, and nutritional guidance that restricts calories is provided. On the other hand, in symptomatic Stage C and D heart failure, it is known that underweight patients who manifest poor nutrition, sarcopenia, and cardiac cachexia have a poor prognosis. This is referred to as the “Obesity paradox”. In order to “avoid weight loss” in patients with heart failure, a paradigm shift to nutritional management to prevent weight loss is needed. Rather than prescribing uniform recommendation for salt reduction of 6 g/day or less, awareness of the behavior change stage model is attracting attention. In this setting, the value of salt restriction will need to be determined to determine the priority level of intervention for undernutrition versus the need to prevent congestive signs and symptoms.
      In the Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) for acute heart failure, nutritional intervention should be considered within 48 h of admission. Key points are selection of access route, timing of intervention, and monitoring of side effects. In nutritional management at home and in end-of-life care, food is a reflection of an individual's values, as well as a source of joy and encouragement. The importance of digestive tract should also be recognized in heart failure from oral flail to intestinal edema, constipation, and the intestinal bacteria called the heart-gut axis.
      Finally, we would like to propose a new term “heart nutrition” for nutritional management in patients with heart failure in this review. Compared to the evidence for exercise therapy in heart failure, studies assessing nutritional management remain scarce and there is a need for research in this area in the future.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Anker S.D.
        • Ponikowski P.
        • Varney S.
        • Chua T.P.
        • Clark A.L.
        • Webb-Peploe K.M.
        • et al.
        Wasting as independent risk factor for mortality in chronic heart failure.
        Lancet. 1997; 349: 1050-1053
        • Evans W.J.
        • Morley J.E.
        • Argilés J.
        • Bales C.
        • Baracos V.
        • Guttridge D.
        • et al.
        Cachexia: a new definition.
        Clin Nutr. 2008; 27: 793-799
        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • Butler J.
        • Casey Jr., D.E.
        • Drazner M.H.
        • et al.
        2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines.
        J Am Coll Cardiol. 2013; 62: e147-e239
        • Vest A.R.
        • Chan M.
        • Deswal A.
        • Givertz M.M.
        • Lekavich C.
        • Lennie T.
        • et al.
        Nutrition, obesity, and cachexia in patients with heart failure: a consensus statement from the Heart Failure Society of America scientific statements committee.
        J Card Fail. 2019; 25: 380-400
        • Hamaguchi S.
        • Tsuchihashi-Makaya M.
        • Kinugawa S.
        • Goto D.
        • Yokota T.
        • Goto K.
        • et al.
        Body mass index is an independent predictor of long-term outcomes in patients hospitalized with heart failure in Japan.
        Circ J. 2010; 74: 2605-2611
        • Nochioka K.
        • Shiba N.
        • Kohno H.
        • Miura M.
        • Shimokawa H.
        Both high and low body mass indexes are prognostic risks in japanese patients with chronic heart failure: implications from the CHART study.
        J Card Fail. 2010; 16: 880-887
        • Yamamoto K.
        • Tsuchihashi-Makaya M.
        • Kinugasa Y.
        • Iida Y.
        • Kamiya K.
        • Kihara Y.
        • et al.
        Japanese heart failure society 2018 scientific statement on nutritional assessment and Management in Heart Failure Patients.
        Circ J. 2020; 84: 1408-1444
        • Makita S.
        • Yasu T.
        • Akashi Y.
        • Adachi H.
        • Izawa H.
        • Ishihara S.
        • et al.
        JCS/JACR 2021 guideline on rehabilitation in patients with cardiovascular disease.
        Circ J. 2022; (in press)
        • Lloyd-Jones D.M.
        • Allen N.B.
        • Anderson C.A.M.
        • Black T.
        • Brewer L.C.
        • Foraker R.E.
        • et al.
        Life's essential 8: updating and enhancing the American Heart Association's construct of cardiovascular health: a presidential advisory from the American Heart Association.
        Circulation. 2022; 146: e18-e43
        • Tsutsui H.
        • Isobe M.
        • Ito H.
        • Ito H.
        • Okumura K.
        • Ono M.
        • et al.
        JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure - digest version.
        Circ J. 2019; 83: 2084-2184
        • Tsutsui H.
        • Ide T.
        • Ito H.
        • Kihara Y.
        • Kinugawa K.
        • Kinugawa S.
        • et al.
        JCS/JHFS 2021 guideline focused update on diagnosis and treatment of acute and chronic heart failure.
        Circ J. 2021; 85: 2252-2291
        • Evans D.C.
        • Corkins M.R.
        • Malone A.
        • Miller S.
        • Mogensen K.M.
        • Guenter P.
        • et al.
        The use of visceral proteins as nutrition markers: an ASPEN position paper.
        Nutr Clin Pract. 2021; 36: 22-28
        • Nagano A.
        • Nishioka S.
        • Wakabayashi H.
        Rehabilitation nutrition for iatrogenic sarcopenia and sarcopenic dysphagia.
        J Nutr Health Aging. 2019; 23: 256-265
        • Nakajima T.
        • Murata M.
        • Nitta S.
        • Shitara T.
        • Kazama H.
        • Satoh Y.
        • et al.
        Sodium restriction counseling reduces cardiac events in patients with heart failure.
        Circ J. 2021; 85: 1555-1562
        • Sekizuka H.
        • Kida K.
        Behavior change and prognosis in patients with heart failure - salt reduction guidance and readiness for heart failure treatment.
        Circ J. 2021; 85: 1563-1564
        • Arrigo M.
        • Jessup M.
        • Mullens W.
        • Reza N.
        • Shah A.M.
        • Sliwa K.
        • et al.
        Acute heart failure.
        Nat Rev Dis Primers. 2020; 6: 16
        • Kinugasa Y.
        • Nakayama N.
        • Sugihara S.
        • Mizuta E.
        • Nakamura K.
        • Kamitani H.
        • et al.
        Polypharmacy and taste disorders in heart failure patients.
        Eur J Prev Cardiol. 2020; 27: 110-111
        • Yoshihisa A.
        • Abe S.
        • Kiko T.
        • Kimishima Y.
        • Sato Y.
        • Watanabe S.
        • et al.
        Association of serum zinc level with prognosis in patients with heart failure.
        J Card Fail. 2018; 24: 375-383
        • Ezekowitz J.A.
        • Colin-Ramirez E.
        • Ross H.
        • Escobedo J.
        • Macdonald P.
        • Troughton R.
        • et al.
        Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial.
        Lancet. 2022; 399: 1391-1400
        • Singer P.
        • Blaser A.R.
        • Berger M.M.
        • Alhazzani W.
        • Calder P.C.
        • Casaer M.P.
        • et al.
        ESPEN guideline on clinical nutrition in the intensive care unit.
        Clin Nutr. 2019; 38: 48-79
        • Thibault R.
        • Pichard C.
        • Wernerman J.
        • Bendjelid K.
        Cardiogenic shock and nutrition: safe?.
        Intensive Care Med. 2011; 37: 35-45
        • Heidegger C.P.
        • Berger M.M.
        • Graf S.
        • Zingg W.
        • Darmon P.
        • Costanza M.C.
        • et al.
        Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial.
        Lancet. 2013; 381: 385-393
        • Berger M.M.
        • Pantet O.
        • Jacquelin-Ravel N.
        • Charrière M.
        • Schmidt S.
        • Becce F.
        • et al.
        Supplemental parenteral nutrition improves immunity with unchanged carbohydrate and protein metabolism in critically ill patients: the SPN2 randomized tracer study.
        Clin Nutr. 2019; 38: 2408-2416
        • Friedli N.
        • Stanga Z.
        • Culkin A.
        • Crook M.
        • Laviano A.
        • Sobotka L.
        • et al.
        Management and prevention of refeeding syndrome in medical inpatients: an evidence-based and consensus-supported algorithm.
        Nutrition. 2018; 47: 13-20
        • Ziegler T.R.
        L-glutamine-enriched parenteral nutrition in catabolic patients.
        Clin Nutr. 1993; 12: 65-66
        • Shiraishi Y.
        • Kohsaka S.
        • Sato N.
        • Takano T.
        • Kitai T.
        • Yoshikawa T.
        • et al.
        9-year trend in the management of acute heart failure in Japan: a report from the National Consortium of acute heart failure registries.
        J Am Heart Assoc. 2018; 7e008687
        • Andreae C.
        • van der Wal M.H.L.
        • van Veldhuisen D.J.
        • Yang B.
        • Strömberg A.
        • Jaarsma T.
        Changes in appetite during the heart failure trajectory and association with fatigue, depressive symptoms, and quality of life.
        J Cardiovasc Nurs. 2021; 36: 539-545
        • Kelley A.S.
        • Morrison R.S.
        Palliative care for the seriously ill.
        N Engl J Med. 2015; 373: 747-755
        • Kida K.
        • Doi S.
        • Suzuki N.
        Palliative care in patients with advanced heart failure.
        Heart Fail Clin. 2020; 16: 243 -54
        • Tanaka T.
        • Takahashi K.
        • Hirano H.
        • Kikutani T.
        • Watanabe Y.
        • Ohara Y.
        • et al.
        Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly.
        J Gerontol A Biol Sci Med Sci. 2018; 73: 1661-1667
        • Matsuo H.
        • Yoshimura Y.
        • Fujita S.
        • Maeno Y.
        Incidence of dysphagia and its association with functional recovery and 1-year mortality in hospitalized older patients with heart failure: a prospective cohort study.
        JPEN J Parenter Enteral Nutr. 2021; 45: 372-380
        • Sandek A.
        • Swidsinski A.
        • Schroedl W.
        • Watson A.
        • Valentova M.
        • Herrmann R.
        • et al.
        Intestinal blood flow in patients with chronic heart failure: a link with bacterial growth, gastrointestinal symptoms, and cachexia.
        J Am Coll Cardiol. 2014; 64: 1092-1102
        • Sandek A.
        • Bauditz J.
        • Swidsinski A.
        • Buhner S.
        • Weber-Eibel J.
        • von Haehling S.
        • et al.
        Altered intestinal function in patients with chronic heart failure.
        J Am Coll Cardiol. 2007; 50: 1561-1569
        • Forkosh E.
        • Ilan Y.
        The heart-gut axis: new target for atherosclerosis and congestive heart failure therapy.
        Open Heart. 2019; 6e000993
        • Anker S.D.
        • Egerer K.R.
        • Volk H.D.
        • Kox W.J.
        • Poole-Wilson P.A.
        • Coats A.J.
        Elevated soluble CD14 receptors and altered cytokines in chronic heart failure.
        Am J Cardiol. 1997; 79: 1426-1430
        • Niebauer J.
        • Volk H.D.
        • Kemp M.
        • Dominguez M.
        • Schumann R.R.
        • Rauchhaus M.
        • et al.
        Endotoxin and immune activation in chronic heart failure: a prospective cohort study.
        Lancet. 1999; 353: 1838-1842
        • Sandek A.
        • Bjarnason I.
        • Volk H.D.
        • Crane R.
        • Meddings J.B.
        • Niebauer J.
        • et al.
        Studies on bacterial endotoxin and intestinal absorption function in patients with chronic heart failure.
        Int J Cardiol. 2012; 157: 80-85
        • Pasini E.
        • Aquilani R.
        • Testa C.
        • Baiardi P.
        • Angioletti S.
        • Boschi F.
        • et al.
        Pathogenic gut flora in patients with chronic heart failure.
        JACC Heart Fail. 2016; 4: 220-227
        • Valentova M.
        • von Haehling S.
        • Bauditz J.
        • Doehner W.
        • Ebner N.
        • Bekfani T.
        • et al.
        Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure.
        Eur Heart J. 2016; 37: 1684-1691
        • Katsimichas T.
        • Ohtani T.
        • Motooka D.
        • Tsukamoto Y.
        • Kioka H.
        • Nakamoto K.
        • et al.
        Non-ischemic heart failure with reduced ejection fraction is associated with altered intestinal microbiota.
        Circ J. 2018; 82: 1640-1650
        • Song Y.
        • Liu Y.
        • Qi B.
        • Cui X.
        • Dong X.
        • Wang Y.
        • et al.
        Association of small intestinal bacterial overgrowth with heart failure and its prediction for short-term outcomes.
        J Am Heart Assoc. 2021; 10e015292
        • Tousoulis D.
        • Guzik T.
        • Padro T.
        • Duncker D.J.
        • De Luca G.
        • Eringa E.
        Mechanisms, therapeutic implications, and methodological challenges of gut microbiota and cardiovascular diseases: a position paper by the ESC Working Group on Coronary Pathophysiology and Microcirculation.
        Cardiovasc Res. 2022; cvac057
        • Ishiyama Y.
        • Hoshide S.
        • Mizuno H.
        • Kario K.
        Constipation-induced pressor effects as triggers for cardiovascular events.
        J Clin Hypertens (Greenwich). 2019; 21: 421-425
        • Sundbøll J.
        • Szépligeti S.K.
        • Adelborg K.
        • Szentkúti P.
        • Gregersen H.
        • Sørensen H.T.
        Constipation and risk of cardiovascular diseases: a danish population-based matched cohort study.
        BMJ Open. 2020; 10e037080
        • Bonilla-Palomas J.L.
        • Gámez-López A.L.
        • Castillo-Domínguez J.C.
        • Moreno-Conde M.
        • López Ibáñez M.C.
        • Alhambra Expósito R.
        • et al.
        Nutritional intervention in malnourished hospitalized patients with heart failure.
        Arch Med Res. 2016; 47: 535-540
        • Rozentryt P.
        • von Haehling S.
        • Lainscak M.
        • Nowak J.U.
        • Kalantar-Zadeh K.
        • Polonski L.
        • et al.
        The effects of a high-caloric protein-rich oral nutritional supplement in patients with chronic heart failure and cachexia on quality of life, body composition, and inflammation markers: a randomized, double-blind pilot study.
        J Cachexia Sarcopenia Muscle. 2010; 1: 35-42
        • Hersberger L.
        • Dietz A.
        • Bürgler H.
        • Bargetzi A.
        • Bargetzi L.
        • Kägi-Braun N.
        • et al.
        Individualized nutritional support for hospitalized patients with chronic heart failure.
        J Am Coll Cardiol. 2021; 77: 2307-2319
        • Kaegi-Braun N.
        • Tribolet P.
        • Gomes F.
        • Fehr R.
        • Baechli V.
        • Geiser M.
        • et al.
        Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: secondary analysis of a prospective randomized trial.
        Clin Nutr. 2021; 40: 812-819
        • Tsuchihashi M.
        • Tsutsui H.
        • Kodama K.
        • Kasagi F.
        • Takeshita A.
        Clinical characteristics and prognosis of hospitalized patients with congestive heart failure--a study in Fukuoka, Japan.
        Jpn Circ J. 2000; 64: 953-959