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1.
Nutr. hosp ; 37(3): 422-431, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193846

RESUMO

INTRODUCTION: malnutrition is commonly associated with, and worsens the prognosis of heart failure. The management of chronic heart failure and its complications based only on the application of pharmacologic guidelines is incomplete. The benefits of interventions to improve nutritional status may be limited by the multifactorial nature of malnutrition. The objective of the present study was to determine whether nutritional advice and nutritional supplementation can improve the nutritional status of patients with chronic heart failure. METHODS: we performed a randomized clinical trial on an intention-to-treat basis with blinded observers. We divided a sample of 76 patients into 2 groups: one that received structured advice combined with nutritional supplements for 12 weeks (test group), and one that received treatment as usual (control group). The outcome measure was nutritional status as evaluated using the Subjective Global Assessment and the Mini Nutritional Assessment tools. After 12 weeks of treatment the test group received a leaflet that served as a reminder. No further interventions were applied in either group. Patients were followed for 1 year. RESULTS AND CONCLUSION: at 3 months of follow-up nutritional status improved 4-fold in the test group, whereas no change was observed in the control group. At 9 months nutritional status in the intervention group had improved 2-fold with respect to the baseline visit, whereas no differences were recorded in the control group. Differences in mortality and length of stay at 1 year did not reach statistical significance


INTRODUCCIÓN: la desnutrición se asocia comúnmente con la insuficiencia cardíaca y empeora su pronóstico. El tratamiento de la insuficiencia cardíaca crónica basado exclusivamente en la aplicación de las guías clínicas farmacológicas resulta insuficiente. Los beneficios de las intervenciones para mejorar el estado nutricional pueden quedar enmascarados por el carácter multifactorial de la desnutrición. El objetivo del estudio fue determinar si el asesoramiento nutricional más suplementos nutricionales puede mejorar el estado nutricional de los pacientes con insuficiencia cardiaca. MÉTODO: ensayo clínico aleatorizado basado en la intención de tratar con evaluadores sometidos a enmascaramiento. Una muestra de 76 pacientes en 2 grupos: uno que recibió asesoramiento estructurado más suplementos nutricionales durante 12 semanas (grupo de intervención) y otro que siguió el tratamiento habitual (grupo de control). El parámetro del resultado fue el estado nutricional evaluado utilizando como herramientas la Valoración Global Subjetiva y el Mini Nutritional Assesment. Después de 12 semanas de tratamiento, el grupo de intervención recibió a modo de recuerdo un folleto informativo. No se aplicaron más intervenciones en ninguno de los grupos. Se siguió a los pacientes durante 1 año. RESULTADOS Y CONCLUSIÓN: a los 3 meses de seguimiento, el estado nutricional mejoró cuatro veces en el grupo de intervención, mientras que no se observó ningún cambio en el grupo de control. A los 9 meses, el estado nutricional en el grupo de intervención había mejorado 2 veces con respecto a la visita inicial, mientras que no se registraron diferencias en el grupo de control. Las diferencias de mortalidad y estancia hospitalaria al cabo de 1 año no alcanzaron la significación estadística


Assuntos
Humanos , Insuficiência Cardíaca/dietoterapia , Avaliação Nutricional , Estado Nutricional , Qualidade de Vida , Prognóstico , Desnutrição/complicações , Suplementos Nutricionais
2.
Biochem Soc Trans ; 48(1): 51-59, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32096539

RESUMO

Much of the world's prominent and burdensome chronic diseases, such as diabetes, Alzheimer's, and heart disease, are caused by impaired metabolism. By acting as both an efficient fuel and a powerful signalling molecule, the natural ketone body, d-ß-hydroxybutyrate (ßHB), may help circumvent the metabolic malfunctions that aggravate some diseases. Historically, dietary interventions that elevate ßHB production by the liver, such as high-fat diets and partial starvation, have been used to treat chronic disease with varying degrees of success, owing to the potential downsides of such diets. The recent development of an ingestible ßHB monoester provides a new tool to quickly and accurately raise blood ketone concentration, opening a myriad of potential health applications. The ßHB monoester is a salt-free ßHB precursor that yields only the biologically active d-isoform of the metabolite, the pharmacokinetics of which have been studied, as has safety for human consumption in athletes and healthy volunteers. This review describes fundamental concepts of endogenous and exogenous ketone body metabolism, the differences between the ßHB monoester and other exogenous ketones and summarises the disease-specific biochemical and physiological rationales behind its clinical use in diabetes, neurodegenerative diseases, heart failure, sepsis related muscle atrophy, migraine, and epilepsy. We also address the limitations of using the ßHB monoester as an adjunctive nutritional therapy and areas of uncertainty that could guide future research.


Assuntos
Ácido 3-Hidroxibutírico/metabolismo , Ácido 3-Hidroxibutírico/uso terapêutico , Diabetes Mellitus/dietoterapia , Dieta Cetogênica , Suplementos Nutricionais , Epilepsia/dietoterapia , Jejum/metabolismo , Insuficiência Cardíaca/dietoterapia , Hepatócitos/metabolismo , Humanos , Doenças Neurodegenerativas/dietoterapia , Sepse/dietoterapia
3.
Am J Med ; 133(1): 32-38, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419422

RESUMO

Restricting dietary sodium is a common recommendation given by clinicians to patients with heart failure and is one supported by current guidelines. However, the quality of evidence for this recommendation is suboptimal, and there is no consensus on the optimal level of sodium intake. Though excessive sodium intake is associated with left ventricular hypertrophy and hypertension, recent data have suggested that very low sodium intake is paradoxically associated with worse outcomes for patients with heart failure. This is possibly explained by the association between low sodium intake and activation of the sympathetic and renin-angiotensin-aldosterone systems. Nevertheless, sodium restriction is routinely recommended and remains a cornerstone of heart failure and blood pressure therapy. In this review we discuss the pros and cons of sodium restriction for patients with heart failure from the current literature.


Assuntos
Pressão Sanguínea , Dieta Hipossódica , Insuficiência Cardíaca/dietoterapia , Sistema Renina-Angiotensina , Insuficiência Cardíaca/metabolismo , Humanos , Hipertensão , Hipertrofia Ventricular Esquerda , Guias de Prática Clínica como Assunto , Cloreto de Sódio na Dieta
4.
J Nurs Res ; 28(1): e65, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31107776

RESUMO

BACKGROUND: Nutritional deficiency is a critical factor in the development and prognosis of heart failure. An optimal diet should be ensured and maintained to manage the symptoms of heart failure. PURPOSE: This study assessed the dietary habits of patients with chronic heart failure using diet quality indices with the goal of determining their nutritional status. METHODS: Forty-four female patients and 56 male patients (mean age: 66 ± 11.38 years) who had been admitted to the cardiology clinics of a university hospital in Istanbul between March 2012 and August 2014 were included in this study. RESULTS: In terms of body mass index, 34% of the participants were normal weight, 37% were overweight, and 21% were obese. Furthermore, this study found the mean daily total energy intake to be inadequate and the total mean score of the Healthy Eating Index to be 74.6 ± 9.32. The diet quality of most participants fell into the "needs improvement" category. CONCLUSIONS: This study used the Healthy Eating Index, a measure developed to assess diet quality, to assess the food consumption patterns of patients with chronic heart failure. The findings support using this index before providing diet recommendations to patients.


Assuntos
Comportamento Alimentar/psicologia , Insuficiência Cardíaca/psicologia , Idoso , Índice de Massa Corporal , Feminino , Qualidade dos Alimentos , Insuficiência Cardíaca/dietoterapia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
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
6.
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
7.
Heart Fail Rev ; 24(5): 671-700, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31016426

RESUMO

Chronic heart failure (CHF) and nutritional disorders are recognized as major challenges for contemporary medicine. This study aims to estimate the role of nutritional disorders as risk factors for CHF development and prognostic factors for CHF patients and the outcome of nutritional intervention in CHF. Full-text English articles published between January 2013 and February 2019 available in the PubMed and Scopus databases were considered. Seventy-five prospective, retrospective, and cross-sectional studies as well as meta-analyses on patients with CHF, reporting correlation of their nutritional status with the risk and prognosis of CHF and the outcome of nutritional interventions in CHF were all included. Higher BMI increases the risk of CHF by 15-70%, especially when associated with severe, long-lasting and abdominal obesity. Overweight and obesity are associated with the reduction of mortality in CHF by 24-59% and 15-65%, respectively, and do not affect the outcome of invasive CHF treatment. Malnutrition increases the risk of mortality (by 2- to 10-fold) and the risk of hospitalization (by 1.2- to 1.7-fold). Favorable outcome of nutritional support in CHF patients was reported in a few studies. Nutritional disorders are prevalent in patients with CHF and play a significant role in the incidence, course, and prognosis of the disease. The existence of an "obesity paradox" in patients with CHF was confirmed. Further studies on the effect of nutritional support and body weight reduction in patients with CHF are necessary.


Assuntos
Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Estado Nutricional , Obesidade Abdominal/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doença Crônica , Feminino , Insuficiência Cardíaca/dietoterapia , Insuficiência Cardíaca/cirurgia , Hospitalização , Humanos , Incidência , Masculino , Desnutrição/dietoterapia , Pessoa de Meia-Idade , Obesidade Abdominal/dietoterapia , Prevalência , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
8.
Heart Fail Rev ; 24(4): 565-573, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30923990

RESUMO

Heart failure (HF) is a chronic, systemic disorder that presents a serious and growing public health problem due to its high prevalence, mortality, and cost of care. Due to the aging of the population and medical advances that prolong the life of HF patients, more effective, widespread strategies for improved HF management in this rapidly growing patient population are needed. While the prevalence of malnutrition in HF patients has been well characterized, evidence is limited regarding the effects of specific macro- and micronutrient deficiencies on HF outcomes and their interaction with other aspects of HF management, including pharmacotherapy. There is a mounting appreciation for the effects of nutritional intervention on pathophysiology, treatment, and outcomes in patients with HF. Heart-healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), carry importance for the prevention and treatment of hypertension. While preliminary evidence looks promising regarding effects of DASH eating pattern consumption on ventricular function and 30-day hospitalizations in HF patients, more research is needed to confirm its effects on short-term and long-term HF outcomes while better understand underlying mechanisms in the context of HF pharmacotherapy.


Assuntos
Abordagens Dietéticas para Conter a Hipertensão/métodos , Insuficiência Cardíaca/dietoterapia , Cardiotônicos/farmacologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Desnutrição/etiologia , Micronutrientes/deficiência , Estado Nutricional/efeitos dos fármacos , Estado Nutricional/fisiologia , Sódio na Dieta/administração & dosagem
9.
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
10.
Arq. bras. cardiol ; 112(2): 165-170, Feb. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-983818

RESUMO

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.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dieta Hipossódica/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Insuficiência Cardíaca/dietoterapia , Padrões de Referência , Brasil , Sódio na Dieta , Inquéritos e Questionários , Curva ROC , Estatísticas não Paramétricas , Comportamento de Redução do Risco
11.
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
12.
Nutr Res Rev ; 32(1): 1-27, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30113009

RESUMO

Growing evidence has emerged about the role of dietary patterns and components in heart failure (HF) incidence and severity. The objective here is to provide a comprehensive summary of the current evidence regarding dietary patterns/components and HF. A comprehensive search of online databases was conducted using multiple relevant keywords to identify relevant human studies. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets have consistently been associated with decreased HF incidence and severity. Regarding specific dietary components, fruit, vegetables, legumes and whole grains appear beneficial. Current evidence suggests that red/processed meats, eggs and refined carbohydrates are harmful, while fish, dairy products and poultry remain controversial. However, there is a notable lack of human intervention trials. The existing but limited observational and interventional evidence from human studies suggests that a plant-based dietary pattern high in antioxidants, micronutrients, nitrate and fibre but low in saturated/trans-fat and Na may decrease HF incidence/severity. Potential mechanisms include decreased oxidative stress, homocysteine and inflammation but higher antioxidant defence and NO bioavailability and gut microbiome modulation. Randomised, controlled trials are urgently required.


Assuntos
Dieta Mediterrânea , Abordagens Dietéticas para Conter a Hipertensão , Comportamento Alimentar , Insuficiência Cardíaca/prevenção & controle , Plantas/química , Antioxidantes , Fibras na Dieta , Insuficiência Cardíaca/dietoterapia , Humanos , Micronutrientes , Nitratos
13.
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
14.
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
15.
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
16.
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
17.
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
18.
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
19.
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
20.
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
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