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Cardio Diabetes Medicine 2017 599

Medical Nutrition Therapy in

Heart Failure

DR.MEENAKSHI BAJAJ

PG.DND., M.Sc., C.D.E., R.D., CCN (U.S.A).,(PhD).,
DIETICIAN, Tamil Nadu Govt. Multi Super Specialty Hospital,Chennai

Introduction Therapy for HF Box 1
Medical Nutritional Therapy (MNT) is an integral com-
ponent of diabetes prevention, management and self Treat hypertension, Encourage smoking cessation
- management education. It is defined as “nutritional Treat lipid disorders, Encourage regular exercise
diagnostic, therapy, and counselling services for pur- Discourage alcohol intake, illicit drug use
pose of disease management.”
Control metabolic syndrome
All individuals with diabetes should receive individual-
ized medical nutrition therapy (MNT), preferably pro- Referral to a registered dietitian is needed for (Med-
vided by a registered dietitian RD who is knowledge- ical Nutrition Therapy) MNT which can lead to im-
able and skilled in providing diabetes MNT. There is proved dietary pattern and quality of life, decreased
not a one-size-fits-all eating pattern for individuals oedema and fatigue, more optimal pharmacological
(3)
with diabetes there is no single ideal dietary distri- management, and fewer hospitalizations.
butionof calories among carbohydrates, fats, and The RD provides MNT, which includes assessment,
proteins for people with diabetes, macronutrient dis- a nutrition diagnosis, and interventions
tribution should be individualized while keeping total
calorie and metabolic goals in mind . 1 Nutrition Intervention & Objectives (4,5)
As many as 50% of patients with type 2 diabetes may * Lessen demands on the heart and restore hemo-
2
develop heart failure (HF) . Diseases of the heart can dynamic stability.
be caused by CHD, previous heart attack, history of * Prevent cardiogenic shock, thromboembolism, and
cardiomyopathy, chronic obstructive pulmonary dis- renal failure.
ease, severe anaemia, excessive alcohol consump-
tion, or low thyroid function. * Maintain target Blood Pressure.

Advanced HF is a multifactorial metabolic syndrome * A significant reduction in systolic blood pressure in
that can lead to cardiac cachexia. It is defined as in- those at increased risk for cardiovascular disease is
voluntary weight loss of at least 6% of non-oedema- a novel strategy to prevent HF (3)
tous body weight during a 6-month period. * Eliminate or reduce oedema.
Aggressive therapy to halt progression of the various * Avoid distention and elevation of diaphragm, which
risk factors can have a major impact on controlling reduces vital capacity. Avoid overfeeding in cachexic
or curing HF. patients to prevent refeeding syndrome.

* Attain desirable BMI and WHR to decrease oxygen
requirements and tissue nutrient demands.
* Replenish lean body mass (LBM) when needed
Nutrition Assessment

Determination of body weight. Altered fluid balance

Cardio Diabetes Medicine