Nutrient Deficiencies in Heart Failure: A Micro Problem With Macro Effects?

Cascino, Thomas; Hummel, Scott L.

doi:10.1161/jaha.118.010447

Cited by 13 publications

(14 citation statements)

References 19 publications

(16 reference statements)

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“…Despite the presence of heterogeneity within the various subtypes of HF, current treatment options mainly target the activation and consequences of the renin–angiotensin–aldosterone system (RAAS), with success in decreasing mortality and morbidity in HF with reduced ejection fraction (HFrEF), but not HF with preserved ejection fraction (HFpEF) [ 2 ]. There is evolving evidence that several pathophysiological mechanisms are involved in the development and progression of HF, including oxidative stress [ 3 ], microvascular inflammation [ 4 ], mitochondrial dysfunction [ 5 ], suboptimal metabolism, and nutrient deficiencies [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Improper micronutrient intake is frequently observed in patients with HF, affecting 30–50% of this population [ 10 , 11 ]. Deficiencies in micronutrients, such as vitamin A, calcium, magnesium, selenium, iron, zinc, vitamin D, and iodine have been documented, without establishing a causative association between them and the onset of HF [ 6 ]. Of the various micronutrient deficiencies, only correcting iron deficiency by intravenous iron supplementation has found its way into the guidelines with beneficial effects on morbidity [ 12 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Selenium, Selenoproteins, and Heart Failure: Current Knowledge and Future Perspective

Al‐Mubarak

Meer

Bömer

2021

Curr Heart Fail Rep

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Purpose of Review (Mal-)nutrition of micronutrients, like selenium, has great impact on the human heart and improper micronutrient intake was observed in 30–50% of patients with heart failure. Low selenium levels have been reported in Europe and Asia and thought to be causal for Keshan disease. Selenium is an essential micronutrient that is needed for enzymatic activity of the 25 so-called selenoproteins, which have a broad range of activities. In this review, we aim to summarize the current evidence about selenium in heart failure and to provide insights about the potential mechanisms that can be modulated by selenoproteins. Recent Findings Suboptimal selenium levels (<100 μg/L) are prevalent in more than 70% of patients with heart failure and were associated with lower exercise capacity, lower quality of life, and worse prognosis. Small clinical trials assessing selenium supplementation in patients with HF showed improvement of clinical symptoms (NYHA class), left ventricular ejection fraction, and lipid profile, while governmental interventional programs in endemic areas have significantly decreased the incidence of Keshan disease. In addition, several selenoproteins are found impaired in suboptimal selenium conditions, potentially aggravating underlying mechanisms like oxidative stress, inflammation, and thyroid hormone insufficiency. Summary While the current evidence is not sufficient to advocate selenium supplementation in patients with heart failure, there is a clear need for high level evidence to show whether treatment with selenium has a place in the contemporary treatment of patients with HF to improve meaningful clinical endpoints. Graphical abstract

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selenium, Selenoproteins, and Heart Failure: Current Knowledge and Future Perspective

Al‐Mubarak

Meer

Bömer

2021

Curr Heart Fail Rep

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“…Various factors play a causative role in developing HF, including myocardial infarction, hypertension, diabetes, and valvular heart diseases [ 1 ]. Moreover, in the last decade micronutrient deficiencies have been implicated in the development and progression of HF [ 2 ]. An aberrant equilibrium of minerals and trace elements (for example, iron, iodine, and zinc) in patients’ circulation is closely associated with the development and progression of HF [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

A Clinical Tool to Predict Low Serum Selenium in Patients with Worsening Heart Failure

Al‐Mubarak

Beverborg

Anker³

et al. 2020

Nutrients

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Selenium is an essential micronutrient, and a low selenium concentration (<100 µg/L) is associated with a poorer quality of life and exercise capacity, and an impaired prognosis in patients with worsening heart failure. Measuring selenium concentrations routinely is laborious and costly, and although its clinical utility is yet to be proven, an easy implemented model to predict selenium status is desirable. A stepwise multivariable logistic regression analysis was performed using routinely measured clinical factors. Low selenium was independently predicted by: older age, lower serum albumin, higher N-terminal pro-B-type natriuretic peptide levels, worse kidney function, and the presence of orthopnea and iron deficiency. A 10-points risk-model was developed, and a score of ≥6 points identified >80% of patients with low selenium (sensitivity of 44%, specificity of 80%). Given that selenium and iron overlap in their physiological roles, we evaluated the shared determinants and prognostic associates. Both deficiencies shared similar clinical characteristics, including the model risk factors and, in addition, a low protein intake and high levels of C-reactive protein. Low selenium was associated with a similar or worse prognosis compared to iron deficiency. In conclusion, although it is difficult to exclude low selenium based on clinical characteristics alone, we provide a prediction tool which identifies heart failure patients at higher risk of having a low selenium status.

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“…Patients with heart failure have a low intake of several micronutrients, such as magnesium, vitamin D, and iron. These micronutrients are important cofactors for normal cardiac metabolism and deficiencies are often seen during progression of the disease [119,120]. The development of anorexia and malnutrition further contributes to the development of micronutrient deficiencies in patients with advanced heart failure [14].…”

Section: Discussionmentioning

confidence: 99%

The Use of Proton Pump Inhibitors May Increase Symptoms of Muscle Function Loss in Patients with Chronic Illnesses

Vinke

Wesselink

Orten-Luiten

et al. 2020

IJMS

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Long-term use of proton pump inhibitors (PPIs) is common in patients with muscle wasting-related chronic diseases. We explored the hypothesis that the use of PPIs may contribute to a reduction in muscle mass and function in these patients. Literature indicates that a PPI-induced reduction in acidity of the gastrointestinal tract can decrease the absorption of, amongst others, magnesium. Low levels of magnesium are associated with impaired muscle function. This unwanted side-effect of PPIs on muscle function has been described in different disease backgrounds. Furthermore, magnesium is necessary for activation of vitamin D. Low vitamin D and magnesium levels together can lead to increased inflammation involved in muscle wasting. In addition, PPI use has been described to alter the microbiota’s composition in the gut, which might lead to increased inflammation. However, PPIs are often provided together with nonsteroidal anti-inflammatory drugs (NSAIDs), which are anti-inflammatory. In the presence of obesity, additional mechanisms could further contribute to muscle alterations. In conclusion, use of PPIs has been reported to contribute to muscle function loss. Whether this will add to the risk factor for development of muscle function loss in patients with chronic disease needs further investigation.

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Nutrient Deficiencies in Heart Failure: A Micro Problem With Macro Effects?

Cited by 13 publications

References 19 publications

Selenium, Selenoproteins, and Heart Failure: Current Knowledge and Future Perspective

Selenium, Selenoproteins, and Heart Failure: Current Knowledge and Future Perspective

A Clinical Tool to Predict Low Serum Selenium in Patients with Worsening Heart Failure

The Use of Proton Pump Inhibitors May Increase Symptoms of Muscle Function Loss in Patients with Chronic Illnesses

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