Dietary Management of Heart Failure: DASH Diet and Precision Nutrition Perspectives

Abstract

Heart failure (HF) is a major health care burden increasing in prevalence over time. Effective, evidence-based interventions for HF prevention and management are needed to improve patient longevity, symptom control, and quality of life. Dietary Approaches to Stop Hypertension (DASH) diet interventions can have a positive impact for HF patients. However, the absence of a consensus for comprehensive dietary guidelines and for pragmatic evidence limits the ability of health care providers to implement clinical recommendations. The refinement of medical nutrition therapy through precision nutrition approaches has the potential to reduce the burden of HF, improve clinical care, and meet the needs of diverse patients. The aim of this review is to summarize current evidence related to HF dietary recommendations including DASH diet nutritional interventions and to develop initial recommendations for DASH diet implementation in outpatient HF management. Articles involving human studies were obtained using the following search terms: Dietary Approaches to Stop Hypertension (DASH diet), diet pattern, diet, metabolism, and heart failure. Only full-text articles written in English were included in this review. As DASH nutritional interventions have been proposed, limitations of these studies are the small sample size and non-randomization of interventions, leading to less reliable evidence. Randomized controlled interventions are needed to offer definitive evidence related to the use of the DASH diet in HF management.

Keywords: DASH diet; diet pattern; dietary approaches to stop hypertension; heart failure; metabolism; metabolomics; personalized nutrition; precision nutrition.

Figure 1

The potential role of the DASH diet in heart failure management. Assessment of patients with heart failure (HF) stages (A–D) is followed by comprehensive clinical care management, which includes an individual-level DASH diet recommendation. Once successfully adopted and adhered to, the DASH diet can improve patients’ physical and functional capacities through reductions in blood pressure, body weight, and LDL cholesterol concentration and improvements in cardiac function, arterial compliance, exercise capacity, and quality of life. The positive effects of the DASH diet implemented as part of a comprehensive care plan for risk reduction and disease management and monitoring can contribute to improved health outcomes.

Figure 2

Potential predictors of DASH diet success and mechanisms underlying its positive effects in heart failure. The DASH diet effectiveness in HF risk reduction and management can be influenced by many different factors. Examples of individual patient-level factors (I) and factors associated with the environment, society, and culture (II), which are also intertwined with the individual patient-level factors, are shown. In addition, there are factors specifically associated with the clinical management of heart failure that may influence DASH diet success (III) Once successfully implemented and adhered to, the DASH diet may reduce HF risk through several different mechanisms associated with improved systemic and local responses (IV).