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1.
Complement Ther Med ; 45: 211-214, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331563

RESUMO

BACKGROUND: Individuals diagnosed with congestive heart failure (CHF) have a 50% five-year mortality rate and approximately 650,000 new cases of CHF are diagnosed annually. Plant-based diets are known to improve plasma lipid concentrations, reduce blood pressure, and as part of a lifestyle intervention, lead to the regression of atherosclerotic lesions. However, a paucity of data exists with regards to plant-based diets in the treatment of CHF. METHODS: Three patients diagnosed with CHF opted to undergo a dietary intervention consisting of a defined plant-based diet as an adjunct to standard medical treatment for CHF. Cardiac magnetic resonance imaging was performed. Patients' consumed the defined plant-based diet for an average of ˜79 days. RESULTS: Follow-up cardiac magnetic resonance images revealed a 92% increase in ejection fraction [mean ±â€¯standard deviation for all data] (22.0 ±â€¯6.9% vs 42.2 ±â€¯18.4%), 21% reduction in left ventricular mass (214 ±â€¯90 g vs 170 ±â€¯102 g), 62% increase in stroke volume (55.8 ±â€¯24.3 cc vs 90.3 ±â€¯30.6 cc) and a 17% increase in cardiac output (3.6 ±â€¯1.2 L/min vs 4.2 ±â€¯1.6 L/min). In patient 1, 90-95% ostial stenosis of the left anterior descending artery nearly completely regressed following the dietary intervention. All patients subjectively reported significant clinical improvements, including less angina, shortness of breath and fatigue. CONCLUSION: As an adjunct treatment, a defined plant-based diet may contribute to the reversal of cardiac morphological and functional abnormalities in the setting of CHF.


Assuntos
Insuficiência Cardíaca/dietoterapia , Idoso , Aterosclerose/fisiopatologia , Pressão Sanguínea/fisiologia , Débito Cardíaco/fisiologia , Dieta Vegetariana , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico/fisiologia
2.
Nutrients ; 11(6)2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31212940

RESUMO

Heart failure in older individuals is normally associated with a high body mass index and relatively low lean body mass due to, in part, a resistance to the normal anabolic effect of dietary protein. In this study we have investigated the hypothesis that consumption of a specially-formulated composition of essential amino acids (HiEAAs) can overcome anabolic resistance in individuals with heart failure and stimulate the net gain of body protein to a greater extent than a commercially popular protein-based meal replacement beverage with greater caloric but lower essential amino acid (EAA) content (LoEAA). A randomized cross-over design was used. Protein kinetics were determined using primed continuous infusions of L-(2H5)phenylalanine and L-(2H2)tyrosine in the basal state and for four hours following consumption of either beverage. Both beverages induced positive net protein balance (i.e., anabolic response). However, the anabolic response was more than two times greater with the HiEAA than the LoEAA (p < 0.001), largely through a greater suppression of protein breakdown (p < 0.001). Net protein accretion (g) was also greater in the HiEAA when data were normalized for either amino acid or caloric content (p < 0.001). We conclude that a properly formulated EAA mixture can elicit a greater anabolic response in individuals with heart failure than a protein-based meal replacement. Since heart failure is often associated with obesity, the minimal caloric value of the HiEAA formulation is advantageous.


Assuntos
Aminoácidos Essenciais/farmacocinética , Anabolizantes/farmacocinética , Proteínas na Dieta/farmacocinética , Alimentos Formulados/análise , Insuficiência Cardíaca/dietoterapia , Idoso , Bebidas , Feminino , Humanos , Refeições
3.
Arq Bras Cardiol ; 112(2): 165-170, 2019 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30785581

RESUMO

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.


Assuntos
Dieta Hipossódica/estatística & dados numéricos , Insuficiência Cardíaca/dietoterapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Padrões de Referência , Comportamento de Redução do Risco , Sódio na Dieta , Estatísticas não Paramétricas , Inquéritos e Questionários
4.
Curr Atheroscler Rep ; 21(1): 1, 2019 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-30631963

RESUMO

PURPOSE OF REVIEW: Omega-3 fatty acids (ω-3 FA) are among the most well-recognized health supplements but their cardiovascular benefits have long been controversial owing to inconsistent results from previous cardiovascular outcomes trials (CVOT). In this article, we provide a short review of existing literature followed by recent randomized clinical trial data, with a discussion of the potential clinical implications of these new findings. RECENT FINDINGS: Data from the randomized, controlled trial REDUCE-IT, when viewed within the context of other recently published trials ASCEND and VITAL, add to a growing body of evidence on the use of ω-3 FA therapies in the treatment of atherosclerotic cardiovascular disease (ASCVD). Given the different formulations, dosages, and patient populations studied, CVOTs of ω-3 FA have provided valuable insight into the use of these agents in cardioprotection. Current data suggest that higher dosages of pure eicosapentaenoic acid ω-3 FA formulations provide additional benefit in reduction of ASCVD events.


Assuntos
Cardiotônicos/uso terapêutico , Doenças Cardiovasculares/dietoterapia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/dietoterapia , Ácidos Docosa-Hexaenoicos/uso terapêutico , Ácido Eicosapentaenoico/uso terapêutico , Insuficiência Cardíaca/dietoterapia , Infarto do Miocárdio/dietoterapia , Cardiotônicos/administração & dosagem , Cardiotônicos/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Ácidos Docosa-Hexaenoicos/administração & dosagem , Ácidos Docosa-Hexaenoicos/efeitos adversos , Ácido Eicosapentaenoico/administração & dosagem , Ácido Eicosapentaenoico/efeitos adversos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertrigliceridemia/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Crit Rev Food Sci Nutr ; 59(6): 965-981, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30507249

RESUMO

BACKGROUND: Multiple micronutrient supplementation has been suggested to have a role on health outcomes in patients with heart failure (HF), but the evidence is inconclusive. OBJECTIVE: To elucidate the role of multiple micronutrient supplementation in heart failure we performed a comprehensive review of the literature. METHODS AND RESULTS: The search in databases included PUBMED (until June 2018) to detect randomized controlled trials (RCTs) and meta-analyzes that investigated the impact of micronutrient supplementation in HF. RESULTS: With more than 2357 titles and abstracts reviewed, we included only the studies suitable for the final review. Whether alone or in combination, micronutrients have been found to improve the health outcomes of patients with HF by improving symptoms, work capacity and left ventricular ejection fraction (LVEF), thus increasing the quality of life in these patients. CONCLUSION: Future studies are needed to document the effects of multiple micronutrient associations in order to include them in nutritional guidelines to increase survival and to improve quality of life in patients with heart failure.


Assuntos
Suplementos Nutricionais , Insuficiência Cardíaca/dietoterapia , Micronutrientes/uso terapêutico , Terapia Nutricional , Aminoácidos , Carnitina , Bases de Dados Factuais , Metabolismo Energético , Ácidos Graxos Ômega-3 , Ácido Fólico , Homocisteína , Humanos , Magnésio , Miocárdio/metabolismo , Estresse Oxidativo , Potássio , Qualidade de Vida , Selênio , Taurina , Ubiquinona/análogos & derivados , Vitaminas
6.
Nat Rev Cardiol ; 16(3): 137-154, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30410105

RESUMO

Advances in our understanding of how the gut microbiota contributes to human health and diseases have expanded our insight into how microbial composition and function affect the human host. Heart failure is associated with splanchnic circulation congestion, leading to bowel wall oedema and impaired intestinal barrier function. This situation is thought to heighten the overall inflammatory state via increased bacterial translocation and the presence of bacterial products in the systemic blood circulation. Several metabolites produced by gut microorganisms from dietary metabolism have been linked to pathologies such as atherosclerosis, hypertension, heart failure, chronic kidney disease, obesity, and type 2 diabetes mellitus. These findings suggest that the gut microbiome functions like an endocrine organ by generating bioactive metabolites that can directly or indirectly affect host physiology. In this Review, we discuss several newly discovered gut microbial metabolic pathways, including the production of trimethylamine and trimethylamine N-oxide, short-chain fatty acids, and secondary bile acids, that seem to participate in the development and progression of cardiovascular diseases, including heart failure. We also discuss the gut microbiome as a novel therapeutic target for the treatment of cardiovascular disease, and potential strategies for targeting intestinal microbial processes.


Assuntos
Bactérias/metabolismo , Dieta , Metabolismo Energético , Microbioma Gastrointestinal , Insuficiência Cardíaca/microbiologia , Intestinos/microbiologia , Animais , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Disbiose , Microbioma Gastrointestinal/efeitos dos fármacos , Insuficiência Cardíaca/dietoterapia , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Intestinos/efeitos dos fármacos , Valor Nutritivo , Prebióticos , Probióticos/uso terapêutico
7.
Nutr. clín. diet. hosp ; 39(1): 22-31, 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184183

RESUMO

Background: A variety of studies have detailed the "paradox of patients with obesity and heart failure". There exists a reverse epidemiology: obesity predisposes the development of cardiovascular diseases and heart failure, but a high body mass index improves survivability at two and at five years. Subsequently, other studies have been shifting this focus not with the body mass index, but instead with the nutritional status and unplanned weight loss. It is not clear the role of the nutritional treatment in these patients. Aims: Evaluation of 2-part intervention (dietary recommendations + supplements) over the nutritional status, quality of life and functional capacity in heart failure patients who exhibit malnutrition or the risk thereof after 3 months treatment. Methods: A sample of 76 chronic heart failure patients who exhibit malnutrition or the risk thereof participated in a clinical trial on an intention-to-treat basis. The intervention group received structured recommendations combined with dietary supplements for 12 weeks and control group received the standard intervention. Assessors were blinded. The nutritional status was measured with Subjective Global Assessment (SGA), QOL with Minnesota Living with Heart Failure Questionnaire and functional capacity with the 6- minute walk test. Results: At three months, the intervention group improved four times the nutritional status measured with SGA. The control group remained similar. The intervention group improved in the same variables as the control group (except in mean total proteins) and also improved in parameters associated with energy reserves (triceps skin fold, mid-upper arm fat area and cholesterol). Conclusion: Nutritional counseling, accompanied by normoproteic hypercaloric supplements, in patients with chronic heart failure, treated with ACEI / ARA II or beta-blockers, can improve the nutritional status at three months


Antecedentes: Una variedad de estudios han detallado la "paradoja de pacientes con obesidad e insuficiencia cardíaca ". Existe un epidemiología inversa: la obesidad predispone al desarrollo de las enfermedades cardiovasculares y la insuficiencia cardíaca, pero un cuerpo con alto IMC mejora la supervivencia a los dos años y a los cinco años. Posteriormente, otros estudios han ido cambiando este enfoque no con el índice de masa corporal, sino con el estado nutricional y la pérdida de peso no planificada. No está claro el papel del tratamiento nutricional en estos pacientes. Objetivos: Evaluación de la intervención en 2 partes (recomendaciones dietéticas + suplementos) sobre el estado nutricional, calidad de vida y capacidad funcional en pacientes con insuficiencia cardíaca, quienes presentan desnutrición o riesgo de sufrirla después de 3 meses de tratamiento. Métodos: muestra de 76 pacientes con insuficiencia cardíaca crónica que presenten malnutrición o riesgo. El grupo de intervención recibió recomendaciones estructuradas combinadas con Suplementos dietéticos durante 12 semanas y el grupo control recibió la intervención estándar. Los asesores fueron cegados. El estado de nutrición se midió con l Evaluación Global Subjetiva (SGA), la calidad de vida con Minnesota Living with Heart y la capacidad funcional con la prueba de la caminata en 6 minutos. Resultados: A los tres meses, el grupo de intervención mejoró por cuatro veces el estado nutricional medido con SGA. El grupo control se mantuvo similar. El grupo de intervención mejoró en las mismas variables que el grupo de control (excepto en la media total proteínas) y también mejoró en los parámetros asociados con reservas de energía (pliegues de la piel del tríceps, área de la parte media de la grasa del brazo y colesterol). Conclusión: el asesoramiento nutricional, acompañado de dieta normoproteica, y suplementos hipercalóricos, en pacientes con enfermedades crónicas de insuficiencia cardíaca, tratada con ACEI / ARA II o bloqueadores beta, puede mejorar el estado nutricional a los tres meses


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Terapia Nutricional/métodos , Insuficiência Cardíaca/dietoterapia , Suplementos Nutricionais/estatística & dados numéricos , Desnutrição/dietoterapia , Terapia Nutricional/estatística & dados numéricos , Avaliação de Resultado de Intervenções Terapêuticas , Caquexia/dietoterapia , Fatores de Risco , Pesos e Medidas Corporais/estatística & dados numéricos
8.
Vopr Pitan ; 87(2): 94-102, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30592873

RESUMO

The aims of this study was to develop recipe composition and to evaluate the use of new oxygen cocktail with high protein content in the dietary therapy of cardiological patients. Objects of the study were: the control sample - an oxygen-containing product prepared using dairy whey, fruit and berry juice, highly esterified pectin; experimental samples - oxygen-containing products, which differed from the control sample by additional introduction of whey protein hydrolysate. Experimental samples have been modified by adding to them whey protein hydrolysate in the amount of 1-3% from the total weight of composition. Technological scheme to produce protein-carbohydrate basis with high content of protein 3% has been developed, parameters of the production process were worked out. Analysis of product chemical composition has shown that 100 g contained 3.4-3.6 g of protein, 0.2-0.3 g of fat, 6.0-8.0 g of carbohydrates. Food value of the product made up 34-46 kcal (162-196 kJ). Assessment of effectiveness of new oxygen-containing product in the diet in conditions of cardiological hospital was carried out. 30 patients aged 60-75 years were included in local open prospective study, meeting the following criteria: patients with chronic heart failure I-IIА stage I-II functional classes, were hospitalized in the cardiology department, not having contraindications to enteral oxygen therapy and signed an informed consent form. In combination with standard therapy patients received new oxygenated product with high content of protein in the dose 250 ml (from 100 g of the basis) daily for 10 days during the second breakfast. By the end of the observation period, according to results of the survey, the psycho-emotional state of patients improved. It has been found that the developed oxygen-containing product with high protein content in combination with a standard diet and drug therapy of the disease was well tolerated by patients.


Assuntos
Carboidratos da Dieta/administração & dosagem , Alimentos Formulados , Insuficiência Cardíaca/dietoterapia , Oxigênio/administração & dosagem , Hidrolisados de Proteína/administração & dosagem , Proteínas do Soro do Leite/administração & dosagem , Idoso , Doença Crônica , Feminino , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
JAMA Intern Med ; 178(12): 1693-1700, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30398532

RESUMO

Importance: Recent estimates suggest that more than 26 million people worldwide have heart failure. The syndrome is associated with major symptoms, significantly increased mortality, and extensive use of health care. Evidence-based treatments influence all these outcomes in a proportion of patients with heart failure. Current management also often includes advice to reduce dietary salt intake, although the benefits are uncertain. Objective: To systematically review randomized clinical trials of reduced dietary salt in adult inpatients or outpatients with heart failure. Evidence Review: Several bibliographic databases were systematically searched, including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL. The methodologic quality of the studies was evaluated, and data associated with primary outcomes of interest (cardiovascular-associated mortality, all-cause mortality, and adverse events, such as stroke and myocardial infarction) and secondary outcomes (hospitalization, length of inpatient stay, change in New York Heart Association [NYHA] functional class, adherence to dietary low-salt intake, and changes in blood pressure) were extracted. Findings: Of 2655 retrieved references, 9 studies involving 479 unique participants were included in the analysis. None of the studies included more than 100 participants. The risks of bias in the 9 studies were variable. None of the included studies provided sufficient data on the primary outcomes of interest. For the secondary outcomes of interest, 2 outpatient-based studies reported that NYHA functional class was not improved by restriction of salt intake, whereas 2 studies reported significant improvements in NYHA functional class. Conclusions and Relevance: Limited evidence of clinical improvement was available among outpatients who reduced dietary salt intake, and evidence was inconclusive for inpatients. Overall, a paucity of robust high-quality evidence to support or refute current guidance was available. This review suggests that well-designed, adequately powered studies are needed to reduce uncertainty about the use of this intervention. Protocol Registration: PROSPERO Identifier: CRD42015019504.


Assuntos
Dieta Hipossódica , Insuficiência Cardíaca/dietoterapia , Humanos , Cloreto de Sódio na Dieta
10.
Nutrients ; 10(10)2018 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-30301251

RESUMO

(1) Background: Burden scales are useful in estimating the impact of interventions from patients' perspectives. This is overlooked in sodium diet/heart failure (HF). The aim of this study is to develop and validate a specific tool to assess the burden associated with low-sodium diets in HF: the Burden scale In Restricted Diets (BIRD). (2) Methods: Based on the literature and reports from patients, 14 candidate items were identified for the following dietary-related domains: organization, pleasure, leisure, social life, vitality, and self-rated health. The validation study was conducted prospectively. The questionnaire was refined via item reduction according to inter-item correlations and exploratory factor analysis. Internal consistency was determined using Cronbach's alpha (Cα) and convergent validity by assessing correlations between BIRD and the health-related quality of life (HRQoL) Minnesota Living with HF questionnaire (MLHF). (3) Results: Of the 152 invited patients, 96 (63%) returned the questionnaire. The median score was 6.5 (IQR 2.0⁻14.0). The results showed good acceptability (non-response rates/item from 2.0% to 12.1%), an excellent internal consistency (Cα = 0.903) and a good convergent validity (rhos = 0.37 (physical), 0.4 (mental), and 0.45 (global); all p < 0.05). (4) Conclusions: BIRD demonstrates good psychometric properties and is useful to quantify the burden associated with sodium restriction. It may help optimize dietary interventions and improve the overall management of patients with HF.


Assuntos
Efeitos Psicossociais da Doença , Dieta Hipossódica , Insuficiência Cardíaca/dietoterapia , Qualidade de Vida , Cloreto de Sódio na Dieta , Sódio , Inquéritos e Questionários , Idoso , Doença Crônica , Dieta Hipossódica/efeitos adversos , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Sódio/administração & dosagem , Cloreto de Sódio na Dieta/administração & dosagem , Inquéritos e Questionários/normas
11.
Circ Heart Fail ; 11(8): e004886, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30354562

RESUMO

Background In patients with heart failure (HF), malnutrition and dietary sodium excess are common and may worsen outcomes. No prior studies have provided low-sodium, nutritionally complete meals following HF hospitalization. Methods and Results The GOURMET-HF study (Geriatric Out-of-Hospital Randomized Meal Trial in Heart Failure) randomized patients discharged from HF hospitalization to 4 weeks of home-delivered sodium-restricted Dietary Approaches to Stop Hypertension meals (DASH/SRD; 1500 mg sodium/d) versus usual care. The primary outcome was the between-group change in the Kansas City Cardiomyopathy Questionnaire summary score from discharge to 4 weeks postdischarge. Additional outcomes included changes in the Kansas City Cardiomyopathy Questionnaire clinical summary score and cardiac biomarkers. All patients were followed 12 weeks for death/all-cause readmission and potential diet-related adverse events (symptomatic hypotension, hyperkalemia, acute kidney injury). Sixty-six patients were randomized 1:1 at discharge to DASH/SRD versus usual care (age, 71±8 years; 30% female; ejection fraction, 39±18%). The Kansas City Cardiomyopathy Questionnaire summary score increased similarly between groups (DASH/SRD 46±23-59±20 versus usual care 43±19-53±24; P=0.38), but the Kansas City Cardiomyopathy Questionnaire clinical summary score increase tended to be greater in DASH/SRD participants (47±22-65±19 versus 45±20-55±26; P=0.053). Potentially diet-related adverse events were uncommon; 30-day HF readmissions (11% versus 27%; P=0.06) and days rehospitalized within that timeframe (17 versus 55; P=0.055) trended lower in DASH/SRD participants. Conclusions Home-delivered DASH/SRD after HF hospitalization appeared safe in selected patients and had directionally favorable effects on HF clinical status and 30-day readmissions. Larger studies are warranted to clarify the effects of postdischarge nutritional support in patients with HF. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02148679.


Assuntos
Reabilitação Cardíaca/métodos , Dieta Hipossódica , Abordagens Dietéticas para Conter a Hipertensão , Serviços de Alimentação , Insuficiência Cardíaca/dietoterapia , Desnutrição/prevenção & controle , Refeições , Alta do Paciente , Fatores Etários , Idoso , Dieta Hipossódica/efeitos adversos , Abordagens Dietéticas para Conter a Hipertensão/efeitos adversos , Feminino , Avaliação Geriátrica/métodos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Michigan , Cidade de Nova Iorque , Estado Nutricional , Valor Nutritivo , Readmissão do Paciente , Qualidade de Vida , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
12.
Am Heart J ; 205: 87-96, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30205241

RESUMO

BACKGROUND: Patients with heart failure (HF) remain at high risk for future events despite medical and device therapy. Dietary sodium reduction is often recommended based on limited evidence. However, it is not known whether dietary sodium reduction reduces the morbidity or mortality associated with HF. METHODS: The SODIUM study is a pragmatic, randomized, open-label trial assessing the efficacy of dietary sodium reduction to <1500 mg daily counseling compared to usual care for patients with chronic HF. The intervention is provided by trained personnel at the site and uses 3-day food records for directing counseling. The primary outcome is an intention-to-treat analysis on the time to first cardiovascular event or death measured at 12 months. Secondary end points include the change in quality of life (using the Kansas City Cardiomyopathy Questionnaire), change in New York Heart Association class, and change in 6-minute walk test. The first patient was enrolled in March 2014, and subsequently, 27 sites in 6 countries enrolled patients. CONCLUSIONS: The SODIUM-HF trial will provide a robust evaluation of the effects of dietary sodium reduction in patients with HF. Results are expected in 2020.


Assuntos
Dieta Hipossódica/métodos , Insuficiência Cardíaca/dietoterapia , Hospitalização/estatística & dados numéricos , Qualidade de Vida , Volume Sistólico/fisiologia , Idoso , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Teste de Caminhada
14.
Appl Nurs Res ; 42: 17-21, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30029710

RESUMO

AIM: This literature review analyzed ten articles investigating the effects of low dietary sodium intake on neurohormonal and fluid overload on heart failure (HF). BACKGROUND: Recommendations for low dietary sodium to HF patients has been debated in the past one to two decades. METHODS: This report presents a literature review of interventional studies from 2006 to 2015 investigating adult HF patients. RESULTS: The results of the neurohormonal outcome variables seem to be the primary consideration for recommending a low sodium diet to patients with HF. Most of articles in this review reported that 2.6-3 g/day of dietary sodium is effective for decreased BNP, renin, and aldosterone (neurohormonal) plasma levels in patients with HF. CONCLUSIONS: We have to provide the reason, effect, and amount of dietary sodium when providing dietary sodium recommendations to patients.


Assuntos
Dieta Hipossódica , Edema/induzido quimicamente , Edema/dietoterapia , Insuficiência Cardíaca/dietoterapia , Insuficiência Cardíaca/fisiopatologia , Neurotransmissores/efeitos adversos , Sódio na Dieta/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Nutrients ; 10(7)2018 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-29949894

RESUMO

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.


Assuntos
/tendências , Comportamento Alimentar , Insuficiência Cardíaca/dietoterapia , Comportamento de Redução do Risco , Prevenção Secundária/tendências , Dieta com Restrição de Carboidratos/tendências , Dieta Rica em Proteínas/tendências , Dieta Mediterrânea , Abordagens Dietéticas para Conter a Hipertensão/tendências , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Estado Nutricional , Valor Nutritivo , Fatores de Proteção , Fatores de Risco , Prevenção Secundária/métodos , Resultado do Tratamento
17.
Nutrition ; 54: 111-117, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29793053

RESUMO

OBJECTIVES: Sodium and fluid restriction is commonly prescribed for heart failure patients. However, its role in the treatment of heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the effect of a diet with sodium and fluid restriction with an unrestricted diet in patients admitted for decompensated HFpEF. METHODS: Patients were randomized to a diet with sodium (0.8 g/d) and fluid (800 mL/d) restriction (intervention group [IG]) or an unrestricted diet (control group [CG]) and followed for 7 d or hospital discharge. The primary outcome was weight loss. Secondary outcomes included clinical stability, perception of thirst, neurohormonal activation, nutrient intake, readmission, and mortality rate after 30 d. RESULTS: Fifty-three patients were included (30, IG; 23, CG). The mean ejection fraction was 62% ± 8% for IG and 60% ± 7% for CG (P = 0.44). Weight loss was similar in both groups, being 1.6 ± 2.2 kg in the IG and 1.8 ± 2.1 kg in CG (P = 0.49) as well as the reduction in the congestion score (IG = 3.4 ± 3.5; CG = 3.8 ± 3.4; P = 0.70). The daily perception of thirst was higher in the IG (P = 0.03). Lower energy consumption was seen in the IG (P <0.001). No significant between-group differences at 30 d were found. CONCLUSIONS: Aggressive sodium and fluid restriction does not provide symptomatic or prognosis benefits, but does produce greater perception of thirst, may impair the patient's food intake, and does not seem to have an important neurohormonal effect in patients admitted for decompensated HFpEF.


Assuntos
Dieta Hipossódica/métodos , Insuficiência Cardíaca/dietoterapia , Volume Sistólico , Privação de Água , Idoso , Idoso de 80 Anos ou mais , Ingestão de Energia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sede , Resultado do Tratamento , Perda de Peso
18.
Cardiovasc Res ; 114(7): 979-991, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29490017

RESUMO

Aims: Heart failure (HF) is characterized by reduced fatty acid (FA) utilization associated with mitochondrial dysfunction. Recent evidence has shown that enhancing FA utilization may provide cardioprotection against HF. Our aim was to investigate the effects and the underlying mechanisms of cardiac FA utilization on cardiac function in response to pressure overload. Methods and results: Transverse aortic constriction (TAC) was used in C57 mice to establish pressure overload-induced HF. TAC mice fed on a high fat diet (HFD) exhibited increased cardiac FA utilization and improved cardiac function and survival compared with those on control diet. Such cardioprotection could also be provided by cardiac-specific overexpression of CD36. Notably, both HFD and CD36 overexpression attenuated mitochondrial fragmentation and improved mitochondrial function in the failing heart. Pressure overload decreased ATP-dependent metalloprotease (YME1L) expression and induced the proteolytic cleavage of the dynamin-like guanosine triphosphatase OPA1 as a result of suppressed FA utilization. Enhancing FA utilization upregulated YME1L expression and subsequently rebalanced OPA1 processing, resulting in restoration of mitochondrial morphology in the failing heart. In addition, cardiac-specific overexpression of YME1L exerted similar cardioprotective effects against HF to those provided by HFD or CD36 overexpression. Conclusions: These findings demonstrate that enhancing FA utilization ameliorates mitochondrial fragmentation and cardiac dysfunction via rebalancing OPA1 processing in pressure overload-induced HF, suggesting a unique metabolic intervention approach to improving cardiac functions in HF.


Assuntos
Dieta Hiperlipídica , Metabolismo Energético , Ácidos Graxos/metabolismo , GTP Fosfo-Hidrolases/metabolismo , Insuficiência Cardíaca/dietoterapia , Mitocôndrias Cardíacas/metabolismo , Miócitos Cardíacos/metabolismo , Animais , Antígenos CD36/genética , Antígenos CD36/metabolismo , Células Cultivadas , Modelos Animais de Doenças , GTP Fosfo-Hidrolases/genética , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Masculino , Metaloendopeptidases/genética , Metaloendopeptidases/metabolismo , Camundongos Endogâmicos C57BL , Mitocôndrias Cardíacas/patologia , Miócitos Cardíacos/patologia , Proteólise , Ratos Sprague-Dawley , Função Ventricular Esquerda
19.
J AOAC Int ; 101(4): 939-941, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29566776

RESUMO

It is estimated that over 1 billion people worldwide have a deficiency of vitamin D, also known as hypovitaminosis D, which the World Health Organization has defined as a public health problem. Beyond its historical homeostasis regulatory function of calcium and phosphorus, in relation to the preservation of the skeletal system, several studies show today a close connection between hypovitaminosis D and the genesis of rheumatic, autoimmune, neoplastic, and cardiovascular diseases. With exclusive reference to cardiovascular aspects, multiple heart diseases such as hypertension, myocardial ischemia, and heart failures might have deficiency in vitamin D as an important causative factor. Because of the influence of concomitant pathologies caused by antibiotic-resistant agents, the function of this vitamin should be critically evaluated. However, the role of vitamin D remains to be established; only a few studies have tested the effects of its supplementation in patients with chronic heart failure diseases, and reported results are unclear. It is important to implement studies in this field in order to assess the real benefits induced by vitamin D supplementation in cardiovascular patients and, in particular, in patients with heart failure. Should the research confirm actual clinical improvement after treatment with vitamin D, such a supplementation might represent a new low-cost therapeutic approach to improving quality of life.


Assuntos
Insuficiência Cardíaca/dietoterapia , Vitamina D/sangue , Vitamina D/uso terapêutico , Cromatografia Líquida de Alta Pressão/métodos , Suplementos Nutricionais , Insuficiência Cardíaca/etiologia , Humanos , Espectrometria de Massas em Tandem/métodos , Deficiência de Vitamina D/complicações
20.
Sci Rep ; 8(1): 1169, 2018 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-29348609

RESUMO

Vitamin D is reported to have anti-inflammatory properties; however the effects of vitamin D supplementation on inflammation in patients with heart failure (HF) have not been established. We performed a systematic review and meta-analysis examining effects of vitamin D supplementation on inflammatory markers in patients with HF. MEDLINE, CINAHL, EMBASE, All EBM, and Clinical Trials registries were systematically searched for RCTs from inception to 25 January 2017. Two independent reviewers screened all full text articles (no date or language limits) for RCTs reporting effects of vitamin D supplementation (any form, route, duration, and co-supplementation) compared with placebo or usual care on inflammatory markers in patients with heart failure. Two reviewers assessed risk of bias and quality using the grading of recommendations, assessment, development, and evaluation approach. Seven studies met inclusion criteria and six had data available for pooling (n = 1012). In meta-analyses, vitamin D-supplemented groups had lower concentrations of tumor necrosis factor-alpha (TNF-α) at follow-up compared with controls (n = 380; p = 0.04). There were no differences in C-reactive protein (n = 231), interleukin (IL)-10 (n = 247) or IL-6 (n = 154) between vitamin D and control groups (all p > 0.05). Our findings suggest that vitamin D supplementation may have specific, but modest effects on inflammatory markers in HF.


Assuntos
Suplementos Nutricionais , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/dietoterapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Vitamina D/administração & dosagem , Viés , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Insuficiência Cardíaca/fisiopatologia , Humanos , Inflamação , Interleucina-10/sangue , Interleucina-6/sangue , Fatores de Risco , Fator de Necrose Tumoral alfa/sangue
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