Macro- and micronutrients in African-Americans with heart failure

Abstract

An emerging body of evidence suggests secondary hyperparathyroidism (SHPT) may be an important covariant of congestive heart failure (CHF), especially in African-Americans (AA) where hypovitaminosis D is prevalent given that melanin, a natural sunscreen, mandates prolonged exposure of skin to sunlight and where a housebound lifestyle imposed by symptomatic CHF limits outdoor activities and hence sunlight exposure. In addition to the role of hypovitaminosis D in contributing to SHPT is the increased urinary and fecal losses of macronutrients Ca(2+) and Mg(2+) associated with the aldosteronism of CHF and their heightened urinary losses with furosemide treatment of CHF. Thus, a precarious Ca(2+) balance seen with reduced serum 25(OH)D is further compromised when AA develop CHF with circulating RAAS activation and are then treated with a loop diuretic. SHPT accounts for a paradoxical Ca(2+) overloading of diverse tissues and the induction of oxidative stress at these sites which spills over to the systemic circulation. In addition to SHPT, hypozincemia and hyposelenemia have been found in AA with compensated and decompensated heart failure and where an insufficiency of these micronutrients may have its origins in inadequate dietary intake, altered rates of absorption or excretion and/or tissue redistribution, and treatment with an ACE inhibitor or AT(1) receptor antagonist. Zn and Se deficiencies, which compromise the activity of several endogenous antioxidant defenses, could prove contributory to the severity of heart failure and its progressive nature. These findings call into question the need for nutriceutical treatment of heart failure and which is complementary to today's pharmaceuticals, especially in AA.

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

“…[2][3][4][5][6][7][8]11,12 This analysis demonstrates that the dietary quality of U.S. adults living in the community with heart failure is poor. It is likely the poor dietary patterns observed in the population began many years before diagnosis of heart failure, and in fact contributed to the development of heart failure.…”

“…9 Additional nutrients promoted by the DASH diet, which documented associations with impact on heart failure outcomes, were also assessed. [2][3][4][5][6][7][8] The DASH diet promotes a high quality diet that includes consumption of fruits, vegetables, whole grains, low-fat and fat-free dairy products, lean meats, poultry and fish, and sparse intake of fats, oils, sweets, and added sugars. 13,17 Nutrients included in the DASH diet are potassium, calcium, magnesium, fiber, saturated fat, protein and cholesterol.…”

“…[2][3][4][5][6][7][8] The American College of Cardiology/American Heart Association (ACC/AHA) joint guidelines recommend restricted sodium intake for patients with symptomatic, non-end-stage heart failure. 9 These guidelines also endorse adherence to dietary guidelines for common underlying and comorbid conditions in chronic heart failure, including coronary heart disease, hypertension, hypercholesterolemia, and diabetes.…”

“…The results of several recent studies have suggested that nutrients consistent with Dietary Approaches to Stop Hypertension (DASH) eating plan influence heart failure progression and associated outcomes. [2][3][4][5][6][7][8] Additionally, omega-3 fish oil intake has been associated with a beneficial effect on heart failure outcomes. 10 Despite the influence of dietary factors in determining disease outcomes in patients with heart failure, there is little understanding of the current dietary quality of persons with heart failure.…”

“…9 The secondary purpose is to describe the overall dietary quality of persons with heart failure, based on additional nutrients documented as being beneficial to non-endstage heart failure and its underlying conditions. [2][3][4][5][6][7][8]12 These include nutrients listed in the DASH recommendations: potassium, calcium, magnesium, fiber, saturated fat, protein and cholesterol, 13 as well as omega-3 fish oil. 10 …”