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Review
. 2022 Apr 26;79(16):1623-1635.
doi: 10.1016/j.jacc.2022.02.025.

Nutrition Assessment and Dietary Interventions in Heart Failure: JACC Review Topic of the Week

Elissa Driggin  1 , Laura P Cohen  2 , Dympna Gallagher  3 , Wahida Karmally  4 , Thomas Maddox  5 , Scott L Hummel  6 , Salvatore Carbone  7 , Mathew S Maurer  2
Affiliations
Review

Nutrition Assessment and Dietary Interventions in Heart Failure: JACC Review Topic of the Week

Elissa Driggin et al. J Am Coll Cardiol. .

Abstract

Despite the high prevalence of nutrition disorders in patients with heart failure (HF), major HF guidelines lack specific nutrition recommendations. Because of the lack of standardized definitions and assessment tools to quantify nutritional status, nutrition disorders are often missed in patients with HF. Additionally, a wide range of dietary interventions and overall dietary patterns have been studied in this population. The resulting evidence of benefit is, however, conflicting, making it challenging to determine which strategies are the most beneficial. In this document, we review the available nutritional status assessment tools for patients with HF. In addition, we appraise the current evidence for dietary interventions in HF, including sodium restriction, obesity, malnutrition, dietary patterns, and specific macronutrient and micronutrient supplementation. Furthermore, we discuss the feasibility and challenges associated with the implementation of multimodal nutrition interventions and delineate potential solutions to facilitate addressing nutrition in patients with HF.

Keywords: diet; heart failure; nutrition.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Gallagher has received grant support from National Institutes of Health (UG3 DK128302-01, P30 DK26687-41 and 5T32DK007559-31). Dr Karmally is a health advisor at Sesame Workshop; and is a member of Heali Diet Advisory Group and a member of the Abbott Diversity Council. Dr Maddox has received grant funding from the National Institutes of Health National Center for Advancing Translational Sciences (1U24TR002306-01: A National Center for Digital Health Informatics Innovation); has received honoraria and/or expense reimbursement in the past 3 years from the Henry Ford health system (March 2019), the University of California, San Diego (January 2020), the University of Chicago (January 2021), George Washington University (January 2021), Baylor College of Medicine (April 2021), and the New York Cardiological Society (May 2021); has received compensation and travel expense reimbursement for American College of Cardiology leadership roles and meetings; is currently employed as a cardiologist and vice president of digital products and innovation at BJC HealthCare/Washington University School of Medicine, and in this capacity is advising Myia Labs, for which his employer is receiving equity compensation in the company (he is receiving no individual compensation from the company); and is a compensated director for a New Mexico–based foundation, the J.F. Maddox Foundation. Dr Hummel has grant support from the National Institutes of Health (R01-HL39813, R01-AG062582, R61-HL155498), American Heart Association (20-SFRN35370008), and Veterans Affairs Clinical Science Research & Development (CARA-009-16F9050); has received previous grant support from PurFoods, LLC; and has institutional support in the form of clinical trial funding from Pfizer, Novartis, Corvia, and Axon Therapeutics. Dr Carbone is supported by a Career Development Award (19CDA34660318) from the American Heart Association and by the Clinical and Translational Science Awards Program (UL1TR002649) from the National Institutes of Health to Virginia Commonwealth University. Dr Maurer has grant support from the National Institutes of Health (R01HL139671, R21AG058348, and K24AG036778); has received consulting income from Eidos, Prothena, Akcea, Alnylam, Intellia, and GlaxoSmithKline; and has received institutional support in the form of clinical trial funding from Pfizer, Ionis, Eidos, and Alnylam. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1. Pathophysiologic Mechanisms for Malnutrition and Wasting in Heart Failure
Schematic representing of the pathophysiologic mechanisms involved in the development and progression of malnutrition and wasting in patients with HF, including inflammation, neurohormonal activation, and reduced intake and/or physical activity. CAF = C-terminal agrin fragment; GDF = growth differentiation factor; IL = interleukin; P3NP = N-terminal propeptide of type III procollagen; TNF = tumor necrosis factor.
FIGURE 2
FIGURE 2. Approach to the Management of Malnutrition in Heart Failure
Suggested considerations for screening, diagnostics, and intervention with regard to malnutrition in heart failure. DXA = dual-energy X-ray absorptiometry; MR = magnetic resonance.
FIGURE 3
FIGURE 3. Multidisciplinary Care Team for Nutrition Disorders in Heart Failure
Suggested members of the multidisciplinary team and potential contributions for the care of patients with HF and nutritional disorders. HF ¼ heart failure.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Major Heart Failure Nutrition Domains and Challenges to Implementation
Schematic representing the major nutrition-related research focus areas in the context of potential challenges to the implementation of nutrition interventions in heart failure.
See this image and copyright information in PMC

References

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