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

Abstract

The prevalence of cardiac cachexia in chronic heart failure is approximately 5% to 15% and 18-month mortality rates can reach 50%. Treatment with angiotensin-converting enzyme inhibitors and beta-blockers may confer some benefit but no proven therapy exists. We tested the effects of an oral nutritional supplement in cachectic patients with heart failure. This was a prospective, randomized, double-blind, placebo-controlled pilot study which randomized 29 patients to a high-caloric (600 kcal) high-protein (20 g) oral nutritional supplement or placebo for a duration of 6 weeks in addition to the patients’ usual food intake. At baseline, 6 weeks, and 18 weeks, we measured body weight, quality of life, body composition, heart function, laboratory parameters, and exercise performance. Edema-free body weight increased in 19 of 20 patients receiving intervention at 6 weeks and in 17 of 19 patients at 18 weeks with an average weight gain of 2.0 ± 1.7 kg (3.1 ± 2.4%, p = 0.0001) and 2.3 ± 3.1 kg (3.6 ± 4.7%, p = 0.007) at 6 and 18 weeks, respectively. Most of the weight gain was fat tissue with an absolute gain of 1.5 ± 1.7 kg (p = 0.003) and 1.6 ± 2.7 kg (p = 0.008). A significant improvement in quality of life and decrease in serum levels of tumor necrosis factor-α were observed (p < 0.05 for both). We demonstrated the feasibility of oral nutritional supplement in cachectic patients with heart failure and significant clinical benefit in terms of body size and body composition, laboratory parameters, and quality of life (www.clinicaltrials.gov identifier NCT00654719).

Muscle wasting in young patients with dilated cardiomyopathy

“…It has been shown that malnutrition and low protein intake can be responsible for muscle wasting in heart failure patients, particularly in those with sedentary life style and physical inactivity 26, 27, 28, 29. Although the albumin and protein level were within the normal limits in our study population, it cannot be easily concluded that the protein turnover is not disturbed in our study population.…”

Prognostic and Therapeutic Implications of Frailty in Older Adults with Heart Failure

“…A pilot randomized trial of 29 patients with severe HF and non-edema weight loss >7.5 % found that 20 g of protein supplementation per day had beneficial effects on body composition and Minnesota Living With Heart Failure Questionnaire scores [24]. The gradual age-related decline in muscle mass and strength known as sarcopenia should be differentiated from cardiac cachexia, as the latter is characterized by rapid loss of skeletal muscle mass and adipose tissue driven by inflammatory cytokines and typically resistant to nutritional interventions [25].…”

Highlights of the mechanistic and therapeutic cachexia and sarcopenia research 2010 to 2012 and their relevance for cardiology

“…Nutritional studies have been a cornerstone of therapeutic research in cachexia and sarcopenia. Rozentryt et al performed a clinical trial of nutritional intervention in cardiac cachexia [94]. A diet containing 600 kcal per day for 6 weeks (with relatively high fat content to reduce volume) increased weight during the treatment and the subsequent 12-week follow-up period (70% fat tissue, 30% muscle tissue) and had anti-inflammatory effects (reduction of TNF levels).…”