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Current Heart Failure Reports
Published in: Current Heart Failure Reports 3/2018

01-06-2018 | Pharmacologic Therapy (W.H.W. Tang, Section Editor)

Nutritional Interventions in Heart Failure: Challenges and Opportunities

Author: Conor P. Kerley

Published in: Current Heart Failure Reports | Issue 3/2018

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Abstract

Purpose of Review

There is a growing body of evidence that nutritional factors influence the incidence of heart failure (HF). The current manuscript aims to collate evidence relating to nutritional intervention in the treatment of HF as well as to provide context regarding challenges and opportunities in the field.

Recent Findings

Despite the accepted importance of nutritional factors relating to cardiovascular disease severity, there is surprisingly little human intervention research regarding dietary intake and HF. Further, existing nutritional interventions in HF were mostly pilot studies with small samples and short follow-up.

Summary

There is consistent evidence that nutritional factors majorly influence HF. Despite limited research, there is evidence that nutritional modification can rapidly and profoundly influence multiple aspects of HF. There is an urgent need for well-conducted research to ascertain if nutritional modification can alter the long-term course of HF.
Literature
1.
Rich MW, Hauptman PJ. Nutrition in heart failure: more than drugs and devices. J Card Fail. 2015;21:943–4.CrossRefPubMed
2.
Ershow AG, Costello RB. Dietary guidance in heart failure: a perspective on needs for prevention and management. Heart Fail Rev. 2006;11:7–12.CrossRefPubMed
3.
Van Horn L, Yancy C. Diet prevention and therapy for heart failure? Circ Heart Fail. 2013;6:1109–11.CrossRefPubMed
4.
Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial re-infarction: Diet and Re-infarction Trial (DART). Lancet. 1989;2:757–61.
5.
Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336:1117–24.
6.
• Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90. This is the initial report from the largest primary prevention trial regarding nutrition and cardiovascular disease to date. CrossRefPubMed
7.
8.
Folsom AR, Yamagishi K, Hozawa A, Chambless LE, for the Atherosclerosis Risk in Communities Study Investigators. Absolute and attributable risks of heart failure incidence in relation to optimal risk factors. Circ Heart Fail. 2009;2:11–7.CrossRefPubMedPubMedCentral
9.
Wang Y, Tuomilehto J, Jousilahti P, Antikainen R, Mahonen M, Katzmarzyk PT, et al. Lifestyle factors in relation to heart failure among Finnish men and women. Circ Heart Fail. 2011;4:607–12.
10.
Avery CL, Loehr LR, Baggett C, Chang PP, Kucharska-Newton AM, Matsushita K, et al. The population burden of heart failure attributable to modifiable risk factors: the ARIC (Atherosclerosis Risk in Communities) study. J Am Coll Cardiol. 2012;60:1640–6.
11.
Khawaja O, Kotler G, Gaziano JM, Djoussé L. Usefulness of desirable lifestyle factors to attenuate the risk of heart failure among offspring whose parents had myocardial infarction before age 55 years. Am J Cardiol. 2012;110:326–30.CrossRefPubMedPubMedCentral
12.
Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE, et al. Healthy lifestyle and decreasing risk of heart failure in women: the Women’s Health Initiative observational study. J Am Coll Cardiol. 2014;64:1777–85.
13.
Del Gobbo LC, Kalantarian S, Imamura F, et al. Contribution of major lifestyle risk factors for incident heart failure in older adults: the Cardiovascular Health Study. JACC Heart Fail. 2015;3:520–8.CrossRefPubMedPubMedCentral
14.
Folsom AR, Shah AM, Lutsey PL, et al. American Heart Association’s Life’s Simple 7: avoiding heart failure and preserving cardiac structure and function. Am J Med. 2015;128:970-6.e2.CrossRefPubMed
15.
Larsson SC, Tectomidis TG, Gigante B, Akesson A, Wolk A. Healthy lifestyle and risk of heart failure: results from two prospective cohort studies. Circ Heart Fail. 2016;9:e002855.CrossRefPubMed
16.
Belin RJ, Greenland P, Allison M, Martin L, Shikany JM, Larson J, et al. Diet quality and the risk of cardiovascular disease: the Women’s Health Initiative (WHI). Am J Clin Nutr. 2011;94:49–57.
17.
Dehghan M, Mente A, Teo KK, Gao P, Sleight P, Dagenais G, et al. Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention: a prospective cohort study of 31 546 high-risk individuals from 40 countries. Circulation. 2012;126(23):2705–12.
18.
Nguyen HT, Bertoni AG, Nettleton JA, Bluemke DA, Levitan EB, Burke GL. DASH eating pattern is associated with favorable left ventricular function in the multi-ethnic study of atherosclerosis. J Am Coll Nutr. 2012;31:401–7.CrossRefPubMedPubMedCentral
19.
Levitan EB, Wolk A, Mittleman MA. Relation of consistency with the dietary approaches to stop hypertension diet and incidence of heart failure in men aged 45 to 79 years. Am J Cardiol. 2009;104:1416–20.CrossRefPubMedPubMedCentral
20.
Levitan EB, Wolk A, Mittleman MA. Consistency with the DASH diet and incidence of heart failure. Arch Intern Med. 2009;69:851–7.
21.
•• Levitan EB, Lewis CE, Tinker LF, et al. Mediterranean and DASH diet scores and mortality in women with heart failure: the Women’s Health Initiative. Circ Heart Fail. 2013;6:1116–23. This observational study among 2,215 women with pre-existing HF reported that highest vs. lowest scores for DASH and Mediterranean were associated with 16 and 15% lower mortality. CrossRefPubMedPubMedCentral
22.
23.
Wirth J, di Giuseppe R, Boeing H, Weikert C. A Mediterranean-style diet, its components and the risk of heart failure: a prospective population-based study in a non-Mediterranean country. Eur J Clin Nutr. 2016;70:1015–21.CrossRefPubMed
24.
• Tektonidis TG, Åkesson A, Gigante B, Wolk A, Larsson SC. Adherence to a Mediterranean diet is associated with reduced risk of heart failure in men. Eur J Heart Fail. 2016;18(3):253–9. This observational study reported decreased HF incidence in healthy males as well as decreased mortality in those who went on to develop HF. Further, benefit was observed in a dose-response manner benefit. CrossRefPubMed
25.
Tektonidis TG, Åkesson A, Gigante B, Wolk A, Larsson SC. A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: a population-based cohort study. Atherosclerosis. 2015;243(1):93–8.CrossRefPubMed
26.
Chrysohoou C, Panagiotakos DB, Aggelopoulos P, Kastorini CM, Kehagia I, Pitsavos C, et al. The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event. Am J Clin Nutr. 2010;92:47–54.
27.
• Pastori D, Carnevale R, Bartimoccia S, et al. Does Mediterranean diet reduce cardiovascular events and oxidative stress in atrial fibrillation? Antioxid Redox Signal. 2015;23:682–7. This observational study reported decreased HF incidence in adults with pre-existing atrial fibrillation. Further, benefit was observed in a dose-response manner benefit. CrossRefPubMed
28.
Chrysohoou C, Pitsavos C, Metallinos G, Antoniou C, Oikonomou E, Kotroyiannis I, et al. Cross-sectional relationship of a Mediterranean type diet to diastolic heart function in chronic heart failure patients. Heart Vessel. 2012;27(6):576–84.
29.
de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779–85.CrossRefPubMed
30.
Ashaye A, Gaziano J, Djoussé L. Red meat consumption and risk of heart failure in male physicians. Nutr Metab Cardiovasc Dis. 2011;21:941–6.CrossRefPubMed
31.
Djoussé L, Petrone AB, Gaziano JM. Consumption of fried foods and risk of heart failure in the physicians’ health study. J Am Heart Assoc. 2015;4:e001740.CrossRefPubMedPubMedCentral
32.
Rautiainen S, Levitan EB, Mittleman MA, Wolk A. Fruit and vegetable intake and rate of heart failure: a population-based prospective cohort of women. Eur J Heart Fail. 2015;17:20–6.CrossRefPubMed
33.
Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases—incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition. 2013;29:611–8.CrossRefPubMed
34.
• Liyanage T, Ninomiya T, Wang A, et al. Effects of the Mediterranean diet on cardiovascular outcomes—a systematic review and meta-analysis. PLoS One. 2016;11:e0159252. This systematic review and meta-analysis, involving 10,950 participants comparing, randomized controlled trials of Mediterranean to control diets suggested 70% decreased HF incidence with MedDiet. CrossRefPubMedPubMedCentral
35.
Kempner W. Treatment of cardiac failure with the rice diet; history of a patient with myocardial aneurysm. N C Med J. 1947;8(3):128–31. No abstract availablePubMed
36.
Tuttle KR, Shuler LA, Packard DP, Milton JE, Daratha KB, Bibus DM, et al. Comparison of low-fat versus Mediterranean-style dietary intervention after first myocardial infarction (from The Heart Institute of Spokane Diet Intervention and Evaluation Trial). Am J Cardiol. 2008;101:1523–30.
37.
Hummel SL, Seymour EM, Brook RD, Kolias TJ, Sheth SS, Rosenblum HR, et al. Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction. Hypertension. 2012;60:1200–6.
38.
•• Hummel SL, Seymour EM, Brook RD, et al. Low-sodium DASH diet improves diastolic function and ventricular-arterial coupling in hypertensive heart failure with preserved ejection fraction. Circ Heart Fail. 2013;6:1165–71. This small, unblinded, and controlled trial demonstrated an improvement in biomarkers and cardiac function with trend towards increased exercise capacity after 3 weeks on the DASH diet. CrossRefPubMedPubMedCentral
39.
Mathew AV, Seymour EM, Byun J, Pennathur S, Hummel SL. Altered metabolic profile with sodium-restricted dietary approaches to stop hypertension diet in hypertensive heart failure with preserved ejection fraction. J Card Fail. 2015;21:963–7.CrossRefPubMedPubMedCentral
40.
•• Rifai L, Pisano C, Hayden J, Sulo S, Silver MA. Impact of the DASH diet on endothelial function, exercise capacity, and quality of life in patients with heart failure. Proc (Bayl Univ Med Cent). 2015;28:151–6. This small unblended, randomized, controlled trial reported significant improvements in biomarkers, cardiac function, exercise capacity, and quality of life after 12 weeks on the DASH diet. CrossRef
41.
Evangelista LS, Heber D, Li Z, Bowerman S, Hamilton MA, Fonarow GC. Reduced body weight and adiposity with a high-protein diet improves functional status, lipid profiles, glycemic control, and quality of life in patients with heart failure: a feasibility study. J Cardiovasc Nurs. 2009;24:207–15.CrossRefPubMedPubMedCentral
42.
Andersson J, Mellberg C, Otten J, Ryberg M, Rinnström D, Larsson C, et al. Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention. Int J Cardiol. 2016;216:92–6.
43.
•• González-Islas D, Orea-Tejeda A, Castillo-Martínez L, Olvera-Mayorga G, Rodríguez-García WD, Santillán-Díaz C, et al. The effects of a low-carbohydrate diet on oxygen saturation in heart failure patients: a randomized controlled clinical trial. Nutr Hosp. 2017;34(4):792–8. https://​doi.​org/​10.​20960/​nh.​784. This single-blinded, randomized, controlled 2-year trial among patients with pre-existing HF reported significant improvements in arterial oxygen saturation with a moderately low-carbohydrate diet.
44.
• Choi EY, Allen K, McDonnough M, et al. A plant-based diet and heart failure: case report and literature review. J Geriatr Cardiol. 2017;4:375–8. Case report demonstrating marked improvements in improved cardiac biomarkers, exercise tolerance, and ejection fraction after only 2 months of a plant-based diet.
45.
Lookbourow DG, Galbraith AL, Palmer RS. Effect of the rice diet on the level of the blood pressure in essential hypertension. N Engl J Med. 1949;240:910–4.CrossRef
46.
Kempner W, Newborg BC, Peschel RL, Skyler JS. Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss. Arch Intern Med. 1975;135(12):1575–84.CrossRefPubMed
47.
Estes EH, Kerivan L. An archaeologic dig: a rice-fruit diet reverses ECG changes in hypertension. J Electrocardiol. 2014;47:599–607.CrossRefPubMed
48.
Klemmer P, Grim CE, Luft FC. Who and what drove Walter Kempner? The rice diet revisited. Hypertension. 2014;64:684–8.CrossRefPubMed
49.
de Lorgeril M, Salen P, Martin JL, et al. Effect of a Mediterranean type of diet on the rate of cardiovascular complications in patients with coronary artery disease. Insights into the cardioprotective effect of certain nutriments. J Am Coll Cardiol. 1996;28:1103–8.CrossRefPubMed
50.
• Fitó M, Estruch R, Salas-Salvadó J, Martínez-Gonzalez MA, Arós F, Vila J, et al. Effect of the Mediterranean diet on heart failure biomarkers: a randomized sample from the PREDIMED trial. Eur J Heart Fail. 2014;16(5):543–50. This interim analysis of the PREIMED trial reported that randomization to a Mediterranean diet led to improvement in HF relevant biomarkers.
51.
Sacks FM, Obarzanek E, Windhauser MM, Svetkey LP, Vollmer WM, McCullough M, et al. Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann Epidemiol. 1995;5:108–18.
52.
53.
Singh RB, Rastogi SS, Verma R, Laxmi B, Singh R, Ghosh S, et al. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ. 1992;304:1015–9.
54.
Ornish D, Scherwitz LW, Doody RS, Kesten D, McLanahan S, Brown SE, et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA. 1983;249:54–9.
55.
Chainani-Wu N, Weidner G, Purnell DM, Frenda S, Merritt-Worden T, Kemp C, et al. Relation of B-type natriuretic peptide levels to body mass index after comprehensive lifestyle changes. Am J Cardiol. 2010;105:1570–6.
56.
Pischke CR, Weidner G, Elliott-Eller M, Ornish D. Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of <or=40% or >40% in the Multicenter Lifestyle Demonstration Project. Eur J Heart Fail. 2007;9:928–34.CrossRefPubMed
57.
Pischke CR, Elliott-Eller M, Li M, Mendell N, Ornish D, Weidner G. Clinical events in coronary heart disease patients with an ejection fraction of 40% or less: 3-year follow-up results. J Cardiovasc Nurs. 2010;25:E8–E15.CrossRefPubMed
58.
Abshire M, Xu J, Baptiste D, et al. Nutritional interventions in heart failure: a systematic review of the literature. J Card Fail. 2015;21:988–98. 18CrossRef
59.
Ferrante D, Varini S, Macchia A, et al. Long-term results after a telephone intervention in chronic heart failure: DIAL (randomized trial of 794 phone intervention in chronic heart failure) follow-up. J Am Coll Cardio. 2010;795(56):372–8.CrossRef
60.
• Rifai L, Silver MA. A Review of the DASH diet as an optimal dietary plan for symptomatic heart failure. Prog Cardiovasc Dis. 2016;58:548–5. Review article focusing on the therapeutic potential of the DASH diet in HF. CrossRefPubMed
61.
Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960–84.
62.
Hu FB. Dietary pattern analysis: a new direction in nutritional 903 epidemiology. Curr Opin Lipidol. 2002;13:3–9.CrossRefPubMed
63.
64.
Tangalos EG. Congestive heart failure. Nutrition management for older adults. Washington DC: Nutrition Screening Initiative, American Dietetic Association, Chicago, and American Academy of Family Physicians; 2002.
65.
Institute of Medicine, Food and Nutrition Board. Dietary reference intakes: water, potassium, sodium, chloride, sulfate. Washington DC: National Academy Press; 2005.
66.
Institute of Medicine, Food and Nutrition Board. Dietary reference intakes: calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington DC: National Academy Press; 1997.
67.
68.
•• Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2016;315(1):36–46. https://​doi.​org/​10.​1001/​jama.​2015.​17346. Well-controlled and conducted trial demonsrtrating that both dietary restriction and exercise improve HF. Interestingly, nutrition alone was more effective than exercise alone but effects were additive.
69.
70.
71.
Nishi I, Seo Y, Hamada-Harimura Y, Sato K, Sai S, Yamamoto M, et al. Nutritional screening based on the controlling nutritional status (CONUT) score at the time of admission is useful for long-term prognostic prediction in patients with heart failure requiring hospitalization. Heart Vessel. 2017;32(11):1337–49. https://​doi.​org/​10.​1007/​s00380-017-1001-8.
72.
73.
Leaf A. Dietary prevention of coronary heart disease: the Lyon Diet Heart Study. Circulation. 1999;99:733–5.CrossRefPubMed
Metadata
Title
Nutritional Interventions in Heart Failure: Challenges and Opportunities
Author
Conor P. Kerley
Publication date
01-06-2018
Publisher
Springer US
Published in
Current Heart Failure Reports / Issue 3/2018
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-018-0388-6

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