The role of diet and nutrition in heart failure: A state-of-the-art narrative review

Abstract

Heart Failure (HF) incidence is increasing steadily worldwide, while prognosis remains poor. Though nutrition is a lifestyle factor implicated in prevention of HF, little is known about the effects of macro- and micronutrients as well as dietary patterns on the progression and treatment of HF. This is reflected in a lack of nutrition recommendations in all major HF scientific guidelines. In this state-of-the-art review, we examine and discuss the implications of evidence contained in existing randomized control trials as well as observational studies covering the topics of sodium restriction, dietary patterns and caloric restriction as well as supplementation of dietary fats and fatty acids, protein and amino acids and micronutrients in the setting of pre-existing HF. Finally, we explore future directions and discuss knowledge gaps regarding nutrition therapies for the treatment of HF.

Keywords: Caloric restriction; Dietary patterns; Fatty acids; Heart failure; Protein supplementation; Sodium restriction.

Figure 1.. Effects of sodium restriction in heart failure.

The figure illustrates the pathophysiology of sodium and fluid handling by the failing heart which results in fluid retention and worsening heart failure (HF) symptoms. As sodium restriction has not been proven to be beneficial nor harmful in randomized clinical trials, we show the potential mechanisms for benefits, which may result in lowered fluid retention and improved HF symptoms as well as the possible mechanisms of harm which paradoxically include increased fluid retention and worsening HF symptoms through compensatory mechanisms adapted from discussion in Khan et al. RAAS: renin-angiotensin-aldosterone system.

Figure 2.. Continuum of dietary pattern effects in heart failure.

Existing literature from Hummel S et al.,(–45) Rifai et al.(41), Miro et al.(40) and Carbone et al (56,57) demonstrates a possible benefit of the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean dietary patterns and their components (i.e., unsaturated fatty acids) (MedDiet) on clinical outcomes in patients with HF. Preclinical and observational clinical data from Carbone et al (56,112) demonstrates possible worsening cardiac function from a Westernized dietary pattern, specifically a diet high in saturated fatty acids and sugars, though this requires confirmation in larger clinical studies.