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600 Medical Nutrition Therapy in Heart Failure

complicates assessment of body weight in the pa- For persons with hypertension, the DASH diet is rec-
tient with HF. Weights should be taken before eating ommended with adequate potassium, calcium, and
and after voiding at the same time each day followed magnesium.Sodium intake less than 2 g/d to im-
by evaluation of Body Mass Index 4 prove clinical symptoms and quality of life (3).
Waist circumference; waist to hip ratio (WHR) A one-size-fits-all sodium restriction is not possible.
The HF stage, amount of oedema present, overall nu-
Dietary assessment for: SFA, -fatty acids, omega-3 tritional status, and medications must be taken into
fatty acids, fibre, sodium, alcohol, sugar and phyto- consideration. There is consensus that high sodium
nutrients
intake (above 3 g/day) is contraindicated for HF.
Anorexia • Nausea, abdominal pain and feeling of
fullness • Constipation • Malabsorption • Malnutrition Table 1 Sodium and Salt Measurement Equivalents
• Cardiac cachexia • Hypomagnesemia • Hyponatre- (4)
mia Sodium chloride is approximately 40% (39.3%) so-
MNT in Hf (4,5) dium and 60% chloride.
Nutrition education to promote behaviour change is To convert a specized weight of sodium chloride to
a critical component of MNT. its sodium equivalent,
multiply the weight by 0.393.
Patients with HF often tolerate small, frequent meals
better than larger, infrequent meals because the lat- Sodium also is measured in milliequivalents (mEq).
ter are more tiring to consume, can contribute to
abdominal distention, and markedly increase oxygen To convert milligrams of sodium to mEq, divide by
consumption. the atomic weight of 23.
To convert sodium to sodium chloride (salt), multi-
In assessing energy needs for patients with heart fail-
ure, most of studies indicate that use of indirect cal- ply by 2.54.
orimetry best determines energy needs. The energy Millimoles (mmol) and milliequivalents (mEq) of so-
(3)
needs of patients with HF depend on their current dry dium are the same.
weight, activity restrictions, and the severity of the
HF. If patient is obese, a calorie-controlled diet can be For example:
recommended. Caloric reduction must be monitored 1 tsp of salt = approximately 6 g NaCl
carefully to avoid rapid body protein catabolism
6096 mg NaCl * 0.393 = 2396 mg Na (approx. 2400
Appropriate daily intake of protein for clinically sta- mg)
ble patients,HF patients have significantly higher pro- 2396 mg Na/23 = 104 mEq Na
tein needs than those without HF Protein restriction
(3).
warranted in case of raise in Blood Urea Nitrogen. 1 g Na # 1000 mg/23 = 43 mEq or mmol
For dyslipidemia or atherosclerosis, a heart-healthy 1 tsp of salt = 2400 mg or 104 mEq Na
diet low in SFAs, trans fatty acids, and cholesterol
and high in fibre, whole grains, fruits, and vegetables Patients with HF are at risk for thiamine defeciency
is recommended. because of poor food intake; use of loop diuretics,
A vegan pattern may be helpful with five to six small which increases excretion; and advanced age. Thia-
meals daily. Beans, cabbage, onions, cauliflower, and mine supplementation (e.g., 100mg/day) can improve
Brussels sprouts may cause heartburn or flatulence; left ventricular ejection fraction and symptoms.
avoid if needed. A multi-vitamin/mineral containing B12 or a combina-
Whole grains cut the risk for HF while eggs and high- tion of B6, B12 and folate could be recommended in
fat dairy products contribute to it, according to the Patients. This level of B12 supplementation (200-500
ARIC study Add soluble fiber to the diet from apples mcg daily), given with other vitamins/minerals, has
or oat bran. been shown to have beneficial clinical heart failure
outcomes (3).
Pistachios, sunflower kernels, sesame seeds, and
wheat germ are high in phytosterols; use often. Patients with HF are at increased risk of developing
osteoporosis. Caution must be used with calcium

GCDC 2017