The Modern Aspects of Nutrition during Chronic Heart Failure

Abstract

Nutrition occupies one of the important places in the programs of prevention and non-drug therapy of CHF and associated diseases. At the same time, the validity of dietary recommendations to patients regarding salt intake, dietary habits and the use of individual nutraceuticals is questionable. The purpose of this review is to present up-to-date data of clinical and experimental studies concerning sodium restriction, the use of various diets, nutraceuticals, and means for correcting intestinal dysbiosis in CHF. Materials and methods: the articles are searched in the databases eLibraryRU and Medline by key terms and their combinations: “heart failure”, “diet”, “sodium restriction”, “nutraceuticals”, “nutrition”, “cardiac cachexia”, “nutritional support”, “salt”, “dietary supplement”, “probiotic”, “prebiotic”, “enteral nutrition” in Russian and English. We select articles containing the results of clinical and experimental studies published from 1997 to 2021. The research data indicate that the pathogenesis of anorexia, malnutrition and “metabolic remodeling” of the myocardium in CHF is based on complex mechanisms determined by stagnant phenomena in the liver, impaired permeability of the edematous intestinal wall, dysbiosis and chronic systemic infl ammation. The recommendations on the consumption of sodium from 2 to 2.5 g/day and table salt from 5 to 6 g/day in patients with CHF are justified. Limitation of fluid intake is relevant only for decompensation of CHF. The use of the Mediterranean and antihypertensive (DASH) diets is recognized by most authors as a promising direction for the prevention and treatment of CHF. The enrichment of the diet of patients with CHF with ω-3 polyunsaturated fatty acids, coenzyme Q10, dietary fibers, polyphenols and saponins is justified. The benefits of enteral nutrition and the complex use of nutraceuticals in order to slow the progression of weight loss, reduce the severity of neurohormonal and pro-inflammatory shifts are shown. Promising trends of research are the creation of personalized diets taking into account the peculiarities of the course of CHF, the nutritional status, the composition of the intestinal microbiota and its metabolites.