Nutritional intervention in patients with heart failure. 3 month results of a clinical trial

Background: A variety of studies have detailed the "paradox of patients with obesity and heart failure". There exists a reverse epidemiology: obesity predisposes the development of cardiovascular diseases and heart failure, but a high body mass index improves survivability at two and at five years. Subsequently, other studies have been shifting this focus not with the body mass index, but instead with the nutritional status and unplanned weight loss. It is not clear the role of the nutritional treatment in these patients. Aims: Evaluation of 2-part intervention (dietary recommendations + supplements) over the nutritional status, quality of life and functional capacity in heart failure patients who exhibit malnutrition or the risk thereof after 3 months treatment. Methods: A sample of 76 chronic heart failure patients who exhibit malnutrition or the risk thereof participated in a clinical trial on an intention-to-treat basis. The intervention group received structured recommendations combined with dietary supplements for 12 weeks and control group received the standard intervention. Assessors were blinded. The nutritional status was measured with Subjective Global Assessment (SGA), QOL with Minnesota Living with Heart Failure Questionnaire and functional capacity with the 6-minute walk test. Results: At three months, the intervention group improved four times the nutritional status measured with SGA. The control group remained similar. The intervention group improved in the same variables as the control group (except in mean total proteins) and also improved in parameters associated with energy reserves (triceps skin fold, mid-upper arm fat area and cholesterol). Conclusion: Nutritional counseling, accompanied by normoproteic hypercaloric supplements, in patients with chronic heart failure, treated with ACEI/ARA II or beta-blockers, can improve the nutritional status at three months.