Dietary Sodium Intake and Outcomes: a Secondary Analysis From Sodium-HF.

OBJECTIVES: This post hoc analysis of SODIUM-HF (Study of Dietary Intervention under 100 mmol in Heart Failure) assessed the association between baseline dietary sodium intake and change at 6 months with a composite of cardiovascular (CV) hospitalizations, emergency department visits and all-cause death at 12 and 24 months. BACKGROUND: Dietary sodium restriction is common advice for patients with heart failure (HF). Randomized clinical trials have not shown a beneficial effect of dietary sodium restriction on clinical outcomes. METHODS: A multivariable Cox proportional hazard regression model was used to assess the association of dietary sodium intake measured at randomization with primary and secondary endpoints. RESULTS: The study included 792 participants. Baseline sodium intake was ≤ 1500 mg/day in 19.9% (n = 158), 1501-3000 mg/day in 56.5% (n = 448) and > 3000 mg/day in 23.4% (n = 186) of participants. The factors associated with higher baseline sodium intake were higher calorie consumption, higher body mass index and recruitment from Canada. Multivariable analyses showed no association between baseline sodium intake nor magnitude of 6-month change or 12- or 24-month outcomes. In a responder analysis, participants achieving a sodium intake < 1500 mg at 6 months showed an association with a decreased risk for the composite outcome (adjusted HR 0.52 [95% CI 0.25, 1.07] P = 0.08) and CV hospitalization (adjusted HR 0.51 [95% CI 0.24, 1.09] P = 0.08) at 12 months. CONCLUSION: There was no association between dietary sodium intake and clinical outcomes over 24 months in patients with HF. Responder analyses suggest the need for further investigation of the effects of sodium reduction in those who achieve the targeted dietary sodium-reduction level.

Evidence related to sodium restriction in patients with heart failure.

OBJECTIVES: to analyze the scientific production about sodium restriction in patients with heart failure. METHODS: integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. RESULTS: thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. CONCLUSIONS: based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

Cut-Point for Satisfactory Adherence of the Dietary Sodium Restriction Questionnaire for Patients with Heart Failure.

BACKGROUND: The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. OBJECTIVES: To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). METHODS: Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. RESULTS: A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. CONCLUSIONS: Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.

Cut-Point for Satisfactory Adherence of the Dietary Sodium Restriction Questionnaire for Patients with Heart Failure / Ponto de Corte para Adesão Satisfatória do Questionário de Restrição de Sódio na Dieta em Pacientes com Insuficiência Cardíaca

Abstract Background: The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. Objectives: To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). Methods: Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. Results: A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. Conclusions: Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.

Resumo Fundamento: A baixa ou a não adesão à redução de sódio na dieta foi identificada como um dos principais fatores causais da insuficiência cardíaca (IC). O Questionário de Restrição de Sódio na Dieta (QRSD) do inglês Dietary Sodium Restriction Questionnaire (DSRQ) identifica fatores que possam interferir na adesão a essa recomendação. No entanto, anda não existe um ponto de corte que estabelece adesão segundo o QRSD. Objetivos: Identificar o ponto de corte para adesão satisfatória ao QRSD, versão brasileira do DSRQ. Métodos: Estudo multicêntrico. Foram incluídos pacientes com IC em tratamento ambulatorial (compensados) e aqueles tratados em serviços de emergência por IC aguda (descompensados). Para a definição do ponto de corte, os escores do QRSD foram comparados entre os grupos. A curva ROC foi construída para cada subescala para determinar o melhor ponto de sensibilidade e especificidade em relação à adesão. Adotou-se um nível de significância de 5%. Resultados: Foram incluídos 206 pacientes compensados e 225 pacientes descompensados. Os pacientes compensados apresentaram escores que indicaram maior adesão em todas as subescalas (p < 0,05). Escores ≥ 40 pontos de um total de 45 para a subescala "atitude e norma subjetiva"; escores ≤ 8 de um total de 20 para a subescala "controle comportamental percebido"; e escores 3 de um total de 15 para "comportamento dependente" foram indicativos de adesão satisfatória. Conclusões: A avaliação de pacientes com IC atendidos no ambulatório ou na emergência permitiu a determinação dos pontos de corte para adesão satisfatória à restrição dietética de sódio. Países de culturas similares poderiam usar esse mesmo ponto de corte, bem como outros pesquisadores poderiam utilizá-lo como referência para outros estudos.

Nutrição em cães portadores de insuficiência cardíaca congestiva: revisão de literatura

A nutrição é extremamente importante em animais cardiopatas, pois pode tornar a progressão da doença mais lenta. Sua principal atuação é evitar que os animais apresentem caquexia. A insuficiência cardíaca causa uma incapacidade cardiovascular de manutenção da circulação sanguínea normal, onde o volume de sangue bombeado é insuficiente, causando alterações no débito cardíaco. A nutrição pode ser utilizada como adjuvante na terapia de animais cardiopatas, pois retardara progressão e minimiza os medicamentos necessários, melhorando a qualidade e expectativa de vida dos pacientes. O objetivo deste trabalho é abordar a insuficiência cardíaca congestiva (ICC) em cães e seus principais tratamentos nutricionais.

Nutrition is extremely important in heart disease animals as it can make disease progression slower. Its main action is to avoid that the animals present cachexia; Heart failure causes a cardiovascular inability to maintain normal blood circulation, in which the volume of blood pumped is insufficient, causing changes in cardiac output. Nutrition can be used as an adjuvant in the therapy of heart disease patients, because rather slows progression and minimizes the necessary medications, improving the quality and life expectancy of patients. The objective of this paper is to address congestive heart failure (CHF) in dogs and their main nutritional treatments.

Nutrição em cães portadores de insuficiência cardíaca congestiva: revisão de literatura

A nutrição é extremamente importante em animais cardiopatas, pois pode tornar a progressão da doença mais lenta. Sua principal atuação é evitar que os animais apresentem caquexia. A insuficiência cardíaca causa uma incapacidade cardiovascular de manutenção da circulação sanguínea normal, onde o volume de sangue bombeado é insuficiente, causando alterações no débito cardíaco. A nutrição pode ser utilizada como adjuvante na terapia de animais cardiopatas, pois retardara progressão e minimiza os medicamentos necessários, melhorando a qualidade e expectativa de vida dos pacientes. O objetivo deste trabalho é abordar a insuficiência cardíaca congestiva (ICC) em cães e seus principais tratamentos nutricionais.(AU)

Nutrition is extremely important in heart disease animals as it can make disease progression slower. Its main action is to avoid that the animals present cachexia; Heart failure causes a cardiovascular inability to maintain normal blood circulation, in which the volume of blood pumped is insufficient, causing changes in cardiac output. Nutrition can be used as an adjuvant in the therapy of heart disease patients, because rather slows progression and minimizes the necessary medications, improving the quality and life expectancy of patients. The objective of this paper is to address congestive heart failure (CHF) in dogs and their main nutritional treatments.(AU)

Dietary Patterns in Secondary Prevention of Heart Failure: A Systematic Review.

BACKGROUND: Diet is an important factor in secondary prevention of heart failure (HF) but there is still no consensus as to which dietary model should be adopted by this population. This systematic review aims to clarify the relationship between dietary patterns and secondary prevention in HF. METHODS: We searched the Medline, Embase and Cochrane databases for studies with different dietary patterns and outcomes of secondary prevention in HF. No limitation was used in the search. RESULTS: 1119 articles were identified, 12 met the inclusion criteria. Studies with Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Hyperproteic and Low-carb diets were found. The DASH pattern showed improvement in cardiac function, functional capacity, blood pressure, oxidative stress and mortality. The Mediterranean diet had a correlation with inflammation, quality of life and cardiac function but just on cross-sectional studies. Regarding the Hyperproteic and Low-carb diets only one study was found with each pattern and both were able to improve functional capacity in patients with HF. CONCLUSIONS: DASH pattern may have benefits in the secondary prevention of HF. The Mediterranean diet demonstrated positive correlation with factors of secondary prevention of HF but need more RCTs and cohort studies to confirm these effects. In addition, the Hyperproteic and Low-carb diets, despite the lack of studies, also demonstrated positive effects on the functional capacity in patients with HF.

Should sodium intake be restricted in chronic heart failure? / ¿Se debe restringir el consumo de sodio en la insuficiencia cardíaca crónica?

Sodium restriction has been recommended in chronic heart failure for decades. However, the evidence about the benefit of this measure is not clear, and it might even increase risks. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified three systematic reviews incorporating 13 studies addressing the question of this article, 10 were randomized trials. We extracted data, combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded sodium restriction might increase mortality and the risk of hospital admission in chronic heart failure, but the certainty of the evidence is low.

Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial.

IMPORTANCE: The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear. OBJECTIVE: To compare the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodium-restricted (maximum dietary intake, 800 mg/d) diet (intervention group [IG]) vs a diet with no such restrictions (control group [CG]) on weight loss and clinical stability during a 3-day period in patients hospitalized with ADHF. DESIGN: Randomized, parallel-group clinical trial with blinded outcome assessments. SETTING: Emergency room, wards, and intensive care unit. PARTICIPANTS: Adult inpatients with ADHF, systolic dysfunction, and a length of stay of 36 hours or less. INTERVENTION: Fluid restriction (maximum fluid intake, 800 mL/d) and additional sodium restriction (maximum dietary intake, 800 mg/d) were carried out until the seventh hospital day or, in patients whose length of stay was less than 7 days, until discharge. The CG received a standard hospital diet, with liberal fluid and sodium intake. MAIN OUTCOMES AND MEASURES: Weight loss and clinical stability at 3-day assessment, daily perception of thirst, and readmissions within 30 days. RESULTS: Seventy-five patients were enrolled (IG, 38; CG, 37). Most were male; ischemic heart disease was the predominant cause of heart failure (17 patients [23%]), and the mean (SD) left ventricular ejection fraction was 26% (8.7%). The groups were homogeneous in terms of baseline characteristics. Weight loss was similar in both groups (between-group difference in variation of 0.25 kg [95% CI, -1.95 to 2.45]; P = .82) as well as change in clinical congestion score (between-group difference in variation of 0.59 points [95% CI, -2.21 to 1.03]; P = .47) at 3 days. Thirst was significantly worse in the IG (5.1 [2.9]) than the CG (3.44 [2.0]) at the end of the study period (between-group difference, 1.66 points; time × group interaction; P = .01). There were no significant between-group differences in the readmission rate at 30 days (IG, 11 patients [29%]; CG, 7 patients [19%]; P = .41). CONCLUSIONS AND RELEVANCE: Aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at 3 days and is associated with a significant increase in perceived thirst. We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01133236.

Nutritional orientation, knowledge and quality of diet in heart failure: randomized clinical trial.

BACKGROUND: Non-pharmacological measures are recommended for heart failure patients. However, most studies evaluate low sodium diet, while little is known about the effects of interventions to improve adherence and knowledge of patients about diet content. OBJECTIVE: To evaluate if a global nutritional orientation could affect nutritional knowledge, adherence to food guidelines, anthropometrics and quality of life in heart failure patients. METHODS: Forty six patients were randomized to intervention or control group. Both groups received usual care with medical and nursing staff; the intervention group received additional nutritional guidance about diet and its relationship with disease, sources of nutrients, and reduction of dietary sodium and fats. Enforcement of the nutritional guidance was performed after 4 weeks. Both groups were evaluated at baseline, and after 6 weeks and 6 months. Evaluations included anthropometric parameters, sodium excretion in 24-hour urine, dietary recall, nutrition knowledge and quality of life questionnaires. RESULTS: Mean age of included patients was 58 ± 10 years and 70% were male. After 6 months of follow-up, the nutritional knowledge of intervention group increased compared to control (p < 0.05). Caloric, fat and sodium intake decreased in the intervention group compared to control (p < 0.05). No significant differences were seen in quality of life or anthropometric parameters. CONCLUSIONS: Nutritional orientation was effective to modify 1) knowledge about food and nutrition, and 2) quality of diet in outpatients with heart failure. Further studies are necessary to evaluate the benefits on quality of life and prognosis.

Adaptação transcultural para o Brasil do Dietary Sodium Restriction Questionnaire (Questionário Restritivo da Dieta de Sódio) (DSRQ) / Cross-cultural adaptation into Brazilian portuguese of the Dietary Sodium Restriction Questionnaire (DSRQ) / Adaptación transcultural para Brasil del dietary sodium restriction questionnaire (Cuestionario Restrictivo de la Dieta de Sodio) (DSRQ)

FUNDAMENTO: A restrição de sódio é uma medida não farmacológica frequentemente orientada aos pacientes com Insuficiência Cardíaca (IC). No entanto, a adesão é de baixa prevalência, ficando entre as causas mais frequentes de descompensação da IC. O Dietary Sodium Restriction Questionnaire (DSRQ) tem como objetivo identificar fatores que afetam a adesão à restrição dietética de sódio para pacientes com IC. No Brasil, não existem instrumentos que avaliem tais fatores. OBJETIVO: Realizar a adaptação transcultural do DSRQ. MÉTODOS: Estudo metodológico que envolveu as seguintes etapas: tradução, síntese, retrotradução, revisão por um comitê de especialistas, pré-teste da versão final e análise de concordância interobservador. No pré-teste foram avaliados os itens e sua compreensão, além da consistência interna pelo coeficiente alfa de Cronbach. O instrumento foi aplicado por dois pesquisadores simultânea e independentemente, sendo utilizado o teste Kappa para análise da concordância. RESULTADOS: Apenas uma questão sofreu alterações semânticas e/ou culturais maiores. No pré-teste, o alfa de Cronbach obtido para o total foi de 0,77, e para as escalas de Atitude, Norma subjetiva e Controle Comportamental obtiveram-se, respectivamente, 0,66, 0,50 e 0,85. Na etapa de concordância, o Kappa foi calculado para 12 das 16 questões, com valores que variaram de 0,62 a 1,00. Nos itens em que o cálculo não foi possível, a incidência de respostas iguais variou de 95 por cento a 97,5 por cento. CONCLUSÃO: A partir da adaptação transcultural do DSRQ foi possível propor uma versão do questionário para posterior avaliação das propriedades psicométricas.

BACKGROUND: Sodium restriction is a non-pharmacological measure often recommended to patients with heart failure (HF). However, adherence is low, being among the most common causes of HF decompensation. The Dietary Sodium Restriction Questionnaire (DSRQ) aims at identifying factors that affect adherence to dietary sodium restriction by patients with HF. In Brazil, there are no instruments to assess these factors. OBJECTIVE: Perform the transcultural adaptation of DSRQ. METHODS: Methodological study that involved the following steps: translation, synthesis, back-translation, review by an expert committee, pretest of the final version and analysis of interobserver agreement. In the pretest, items and their understanding were evaluated, as well as internal consistency by Cronbach's alpha. The instrument was simultaneously and independently administered by two researchers and the kappa test was used for agreement analysis. RESULTS: Only one question underwent major semantic and/or cultural alteration. At the pretest, Cronbach's alpha for the total obtained was 0.77; for the Attitude, Subjective Norm and Behavioral Control scales were obtained, respectively: 0.66, 0.50 and 0.85. At the agreement step, the Kappa was calculated for 12 of the 16 questions, with values ranging from 0.62 to 1.00. In items for which the calculation was not possible, the incidence of equal responses ranged from 95 percent to 97.5 percent. CONCLUSION: Based on the transcultural adaptation of DSRQ, it was possible to propose a version of the questionnaire for further evaluation of psychometric properties.

FUNDAMENTO: La restricción de sodio es una medida no farmacológica a menudo dirigida a los pacientes con Insuficiencia Cardíaca (IC). Sin embargo, la adhesión es de baja prevalencia, y queda entre las causas más comunes de descompensación de la IC. El Dietary Sodium Restriction Questionnaire (DSRQ) tiene como objetivo, identificar los factores que afectan la adhesión a la restricción dietética de sodio para pacientes con IC. En Brasil, no existen instrumentos que evalúen tales factores. OBJETIVOS: Realizar la adaptación transcultural del DSRQ. MÉTODOS: Estudio metodológico que contó con las siguientes etapas: traducción, síntesis, versión, revisión por parte de un comité de expertos, test previo de la versión final y análisis de concordancia interobservador. En el test anterior se evaluaron los ítems y su comprensión, además de la consistencia interna por el coeficiente alfa de Cronbach. El instrumento lo aplicaron dos investigadores de forma simultánea e independiente, siendo utilizado el test Kappa para el análisis de la concordancia. RESULTADOS: Solamente una pregunta tuvo alteraciones semánticas y/o culturales relevantes. En el test anterior, el alfa de Cronbach obtenido para el total fue de 0,77 y para las escalas de Actitud, Norma subjetiva y Control Comportamental obtuvimos, respectivamente, 0,66, 0,50 y 0,85. En la etapa de concordancia el Kappa fue calculado para 12 de las 16 preguntas, con valores que variaron de 0,62 a 1,00. En los ítems en que el cálculo no fue posible, el aparecimiento de las respuestas iguales varió de un 95 por ciento a un 97,5 por ciento. CONCLUSIONES: A partir de la adaptación transcultural del DSRQ se pudo proponer una versión del cuestionario para una posterior evaluación de las propiedades psicométricas.

Cross-cultural adaptation into Brazilian portuguese of the Dietary Sodium Restriction Questionnaire (DSRQ).

BACKGROUND: Sodium restriction is a non-pharmacological measure often recommended to patients with heart failure (HF). However, adherence is low, being among the most common causes of HF decompensation. The Dietary Sodium Restriction Questionnaire (DSRQ) aims at identifying factors that affect adherence to dietary sodium restriction by patients with HF. In Brazil, there are no instruments to assess these factors. OBJECTIVE: Perform the transcultural adaptation of DSRQ. METHODS: Methodological study that involved the following steps: translation, synthesis, back-translation, review by an expert committee, pretest of the final version and analysis of interobserver agreement. In the pretest, items and their understanding were evaluated, as well as internal consistency by Cronbach's alpha. The instrument was simultaneously and independently administered by two researchers and the kappa test was used for agreement analysis. RESULTS: Only one question underwent major semantic and/or cultural alteration. At the pretest, Cronbach's alpha for the total obtained was 0.77; for the Attitude, Subjective Norm and Behavioral Control scales were obtained, respectively: 0.66, 0.50 and 0.85. At the agreement step, the Kappa was calculated for 12 of the 16 questions, with values ranging from 0.62 to 1.00. In items for which the calculation was not possible, the incidence of equal responses ranged from 95% to 97.5%. CONCLUSION: Based on the transcultural adaptation of DSRQ, it was possible to propose a version of the questionnaire for further evaluation of psychometric properties.

A importância do sódio no manejo nutricional de cães e gatos cardiopatas / The importance of sodium in the nutritional management of cardiac dogs and cats

As dietas hipossódicas são utilizadas como adjuvantes terapêuticos há anos em pacientes cardiopatas,com a fi nalidade de redução da pré-carga cardíaca. Recentemente questionaram-se os seus benefíciosem pacientes com doenças cardíacas diagnosticadas precocemente, uma vez que restrições severaspodem ativar exageradamente o sistema renina angiotensina aldosterona e agravar o processo fi siopatológicoda insufi ciência cardíaca. A utilização de medicamentos como diuréticos e vasodilatadorestornaram a modifi cação dietética menos relevante para o controle da pré-carga, especialmente emcães das classes I-a e I-b, nos quais pode haver ativação neurohormonal após a restrição grave de sódio.São discutidas as recomendações propostas para a restrição de sódio em animais com diferentesclasses de insufi ciência cardíaca. É importante ressaltar que petiscos, alimentos utilizados para a administraçãode medicamentos e até mesmo a água podem ser fonte de sódio e devem ser consideradosna abordagem nutricional do paciente com doenças cardíacas. Animais com insufi ciência cardíacacongestiva diagnosticada precocemente podem se benefi ciar de restrições leves de sódio. Por sua vez,a restrição severa somente deve ser indicada para cães com sinais congestivos clínicos graves, comquadros de edema pulmonar e efusões

In patients with heart diseases, the low sodium diets are used as adjuvant therapy for years, with theaim of reducing preload. Recently, there were questions about its benefi ts in patients with heart diseasesdiagnosed early, since overly severe restrictions may activate the renin angiotensin aldosteronesystem and aggravate the pathophysiological process of heart failure. The use of medications suchas diuretics and vasodilators have become less relevant dietary modifi cation to control the preload,especially in dogs in classes I-a and I-b, which may present neurohormonal activation after severesodium restriction. There are proposed recommendations for sodium restriction in animals with differentclasses of heart failure. Importantly, snacks, foods used to administer medicine and even watermay be source of sodium and should be considered in the nutritional management of patients with heart disease. Animals with congestive heart failure diagnosed early may benefit from mild sodium restriction. Inturn, severe restriction must be indicated only for dogs with severe congestive signs, with clinical presentation of pulmonary edema and effusions

A importância do sódio no manejo nutricional de cães e gatos cardiopatas / The importance of sodium in the nutritional management of cardiac dogs and cats

As dietas hipossódicas são utilizadas como adjuvantes terapêuticos há anos em pacientes cardiopatas,com a fi nalidade de redução da pré-carga cardíaca. Recentemente questionaram-se os seus benefíciosem pacientes com doenças cardíacas diagnosticadas precocemente, uma vez que restrições severaspodem ativar exageradamente o sistema renina angiotensina aldosterona e agravar o processo fi siopatológicoda insufi ciência cardíaca. A utilização de medicamentos como diuréticos e vasodilatadorestornaram a modifi cação dietética menos relevante para o controle da pré-carga, especialmente emcães das classes I-a e I-b, nos quais pode haver ativação neurohormonal após a restrição grave de sódio.São discutidas as recomendações propostas para a restrição de sódio em animais com diferentesclasses de insufi ciência cardíaca. É importante ressaltar que petiscos, alimentos utilizados para a administraçãode medicamentos e até mesmo a água podem ser fonte de sódio e devem ser consideradosna abordagem nutricional do paciente com doenças cardíacas. Animais com insufi ciência cardíacacongestiva diagnosticada precocemente podem se benefi ciar de restrições leves de sódio. Por sua vez,a restrição severa somente deve ser indicada para cães com sinais congestivos clínicos graves, comquadros de edema pulmonar e efusões

In patients with heart diseases, the low sodium diets are used as adjuvant therapy for years, with theaim of reducing preload. Recently, there were questions about its benefi ts in patients with heart diseasesdiagnosed early, since overly severe restrictions may activate the renin angiotensin aldosteronesystem and aggravate the pathophysiological process of heart failure. The use of medications suchas diuretics and vasodilators have become less relevant dietary modifi cation to control the preload,especially in dogs in classes I-a and I-b, which may present neurohormonal activation after severesodium restriction. There are proposed recommendations for sodium restriction in animals with differentclasses of heart failure. Importantly, snacks, foods used to administer medicine and even watermay be source of sodium and should be considered in the nutritional management of patients with heart disease. Animals with congestive heart failure diagnosed early may benefit from mild sodium restriction. Inturn, severe restriction must be indicated only for dogs with severe congestive signs, with clinical presentation of pulmonary edema and effusions(AU)