Miján Alberto, Martín Elvira, de Mateo Beatriz
Area de Nutrición y Bromatología, Facultad de Medicina, UVA, Valladolid.
Nutr Hosp. 2006 May;21 Suppl 3:84-93.
Chronic heart failure (CHF), especially affecting the right heart, frequently leads to malnutrition. If the latter is severe and is combined to other factors, it may lead to cardiac cachexia. This one is associated to increased mortality and lower survival of patients suffering from it. The causes of cardiac cachexia are diverse, generally associated to maintenance of a negative energy balance, with increasing evidence of its multifactorial origin. Neurohumoral, inflammatory, immunological, and metabolic factors, among others, are superimposed in the patient with CHF, leading to involvement and deterioration of several organs and systems, since this condition affects both lean (or active cellular) mass and adipose and bone tissue osteoporosis. Among all, the most pronounced deterioration may be seen at skeletal muscle tissue, at both structural and functional levels, the heart not being spared. As for treatment, it should be based on available scientific evidence. Assessment of nutritional status of any patient with CHF is a must, with the requirement of nutritional intervention in case of malnutrition. In this situation, especially if accompanied by cardiac cachexia, it is required to modify energy intake and oral diet quality, and to consider the indication of specific complementary or alternative artificial nutrition. Besides, the causal relationship of the beneficial role of moderate physical exertion is increasing, as well as modulation of metabolic and inflammatory impairments observed in cardiac cachexia with several drugs, leading to a favorable functional and structural response in CHF patients.
慢性心力衰竭（CHF），尤其是影响右心的情况，常常会导致营养不良。如果营养不良严重并伴有其他因素，可能会导致心源性恶病质。心源性恶病质与患者死亡率增加和生存率降低相关。心源性恶病质的病因多种多样，通常与负能量平衡的维持有关，越来越多的证据表明其起源具有多因素性。神经体液、炎症、免疫和代谢等因素在CHF患者中相互叠加，导致多个器官和系统受累及功能恶化，因为这种情况会影响瘦体重（或活跃细胞质量）以及脂肪和骨组织骨质疏松。其中，骨骼肌组织在结构和功能层面的恶化最为明显，心脏也难以幸免。至于治疗，应基于现有的科学证据。对任何CHF患者进行营养状况评估是必要的，若存在营养不良则需要进行营养干预。在这种情况下，尤其是伴有心源性恶病质时，需要调整能量摄入和口服饮食质量，并考虑特定补充或替代人工营养的适应证。此外，适度体育锻炼有益作用的因果关系日益增强，同时多种药物对心源性恶病质中观察到的代谢和炎症损伤的调节作用，也使CHF患者产生了良好的功能和结构反应。
