Nutrition and Heart Failure: what we know and don’t know

By Audrey Shively, MCHES
Official ACCN16 Blogger
Dr. Scott Hummel’s presentation on heart failure (HF) and nutrition provided great insights in to what research has told us to date and what we still need to learn.
One in five people have congestive heart failure which equates to six million people and one in nine deaths in the United States. It is a large and growing problem defined as the heart not being able to meet the physiologic demands of the body.
The presentation focused on dietary guidelines, malnutrition and frailty, micronutrient deficiencies, and energy interventions. It was full of lots of great data and I strongly encourage you to view this recorded session to see the complete picture. I am only going to be able to address the highlights here.
Nutrition intervention in heart failure encompasses a variety of issues such as diet adherence, neurohormonal affects, metabolic aspects, and the physical effects of malnutrition. We often ask why our HF patients cannot eat a more healthy diet but such things as a decreased sense of smell, early satiety, and medications all affect how patients eat.
There are several comorbidities associated with HF such as cognitive dysfunction, disability, and polypharmacy with studies showing HF patients can easily have five or more comorbidities to be addressed.
Dr. Hummel focused a great deal of his talk on the Academy of Nutrition and Dietetics (AND) guidelines for heart failure. I will share in overview of his remarks here.
Sodium and fluid intake: should be adapted to the patient and should allow for adequate protein in the diet.The dietary sodium debate has not been answered based on both observational and random control studies.
Malnutrition: if a patient is deemed malnourished there are more adverse outcomes; this is true of fragility as well. If one is malnourished most often they are also frail.
Micronutrients: HF patients are encouraged to take folate, vitamin B6, vitamin B12, thiamine, and magnesium; it is felt these prove to be more beneficial when coming from foods rather than supplements.
Energy metabolism: HF patients have impaired energy production and nutrient deficiency can affect this.
Dr. Hummel spent time addressing new mechanisms that may be promising for HF treatment. These include dietary nitrates, metabolic improvements, microbiomes, and vascular salt sensitivity.
There are also many studies still underway that will have an impact on HF treatments including those looking at the effect of calorie restrictions, sodium intake and quality of life, and the correlation between sodium intake and energy.
His overall takeaway messages were:
  1. Heart failure is a large and growing problem
  2. Nutrition is important but is incompletely understood
  3. Sodium intake must be adapted to each patient
  4. New mechanisms may improve our knowledge base
His final message gives us all sound advice about our nutrition and health and that is we should adopt a whole food dietary approach to eating healthy.
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