Relevance of nutritional assessment and treatment to counteract cardiac cachexia and sarcopenia in chronic heart failure

Abstract

Chronic heart failure (CHF) is frequently associated with the involuntary loss of body weight and muscle wasting, which can determine the course of the disease and its prognosis. While there is no gold standard malnutrition screening tool for their detection in the CHF population, several bioelectrical and imaging methods have been used to assess body composition in these patients (such as Dual Energy X-Ray Absorptiometry and muscle ultrasound, among other techniques). In addition, numerous nutritional biomarkers have been found to be useful in the determination of the nutritional status. Nutritional considerations include the slow and progressive supply of nutrients, avoiding high volumes, which could ultimately lead to refeeding syndrome and worsen the clinical picture. If oral feeding is insufficient, hypercaloric and hyperproteic supplementation should be considered. b-Hydroxy-b-methylbutyrate and omega-3 polyunsaturated fatty acid administration prove to be beneficial in certain patients with CHF, and several interventional studies with micronutrient supplementation have also described their possible role in these subjects. Taking into account that CHF is sometimes associated with gastrointestinal dysfunction, parenteral nutritional support may be required in selected cases. In addition, potential therapeutic options regarding nutritional state and muscle wasting have also been tested in clinical studies. This review summarises the scientific evidence that demonstrates the necessity to carry out a careful nutritional evaluation and nutritional treatment to prevent or improve cardiac cachexia and sarcopenia in CHF, as well as improve its course.

Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure

“…Therefore, these distinct clinical entities frequently overlap and are recognized interchangeably by clinicians [28]. In the current understanding of cachexia and skeletal muscle wasting in HF, under-nutrition plays a central role [29].…”

Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology

“…Studies show that approximately 35% to 78% of HF patients suffer from malnutrition, which has also been independently associated with adverse outcomes [ 72 , 73 , 74 , 75 ]. The aetiology of malnutrition is complex and thought to be multifactorial where fatigue, dyspnoea, swallowing disturbances, nausea, anxiety, food monotony, reduced appetite and early satiety could play a role [ 76 , 77 , 78 ]. The advice to reduce dietary salt intake (albeit controversial [ 79 , 80 ]) could compromise the nutritional status of individual patients with HF [ 81 , 82 ].…”

Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services

“…Heart failure (HF) is a major public health problem that affects about 26 million people worldwide [ 1 , 2 ]. Despite advances in the treatment of HF, malnutrition is still a frequent and neglected condition, which affects between 30 and 70% of patients with the disease [ 1 , 3 , 4 ].…”

“…Heart failure (HF) is a major public health problem that affects about 26 million people worldwide [ 1 , 2 ]. Despite advances in the treatment of HF, malnutrition is still a frequent and neglected condition, which affects between 30 and 70% of patients with the disease [ 1 , 3 , 4 ]. This association occurs in a multifactorial and complex way, which can be a consequence of inadequate intake and absorption of nutrients or even of the systemic response to a decrease in cardiac function, which causes alterations in both anabolic and catabolic metabolism, from neurohormonal and inflammatory activation.…”

“…This association occurs in a multifactorial and complex way, which can be a consequence of inadequate intake and absorption of nutrients or even of the systemic response to a decrease in cardiac function, which causes alterations in both anabolic and catabolic metabolism, from neurohormonal and inflammatory activation. The therapeutic approaches conventionally adopted, such as polypharmacy and restrictive diet, in addition to the clinical picture of HF, favor malnutrition, either by reducing ingestion and/or nutrient absorption [ 1 ].…”