Colin-Ramirez Eloisa, Arcand JoAnne, Ezekowitz Justin A
National Council of Science and Technology (CONACYT), National Institute of Cardiology 'Ignacio Chavez, Mexico, Mexico.
Faculty of Health Sciences, University of Ontario Institute of Technology, Ontario, Canada.
Curr Treat Options Cardiovasc Med. 2017 Mar;19(3):19. doi: 10.1007/s11936-017-0515-9.
Dietary management of heart failure (HF) has largely been focused on sodium and fluid restrictions. Although safety and efficacy of these interventions in HF remain unclear, a daily sodium intake between 2000 and 3000 mg/day appears to be safe in these patients. Ongoing clinical research will inform on the safety and efficacy of a more restrictive sodium intake to less than 1500 mg/day. Data shows that routine fluid restriction in HF regardless of symptoms may be unnecessary; however, in patients with signs of congestion, fluid restriction to 2.0 L/day may be advisable. Recently, more attention has been paid to other nutritional aspects of HF beyond sodium and fluid intake, although there is still little evidence available to guide nutritional management of HF. Assuring that patients meet daily requirements for key micronutrients, such as calcium, magnesium, potassium, folate, vitamin E, vitamin D, zinc, and thiamine, is essential in order to prevent deficiencies. More appropriate macronutrient composition of the diet is still to be determined; however, a diet containing 50-55% carbohydrates, 25-30% fat, and 15-20% protein seems acceptable for patients with HF with or without non-end-stage renal disease. Additionally, increased protein intake may be considered in malnourished/cachectic patients. Consulting a registered dietitian is especially helpful for patients with recent HF exacerbations or for patients with multiple comorbidities who may need to follow several dietary restrictions and may benefit of individualized dietary counseling in order to ensure appropriate intake of energy, protein, and micronutrients. Today, there are still several knowledge gaps in guiding the dietary management of HF. In this article, we review current recommendations for the dietary management of HF and the evidence supporting this practice.
心力衰竭（HF）的饮食管理主要集中在钠和液体限制方面。尽管这些干预措施在HF中的安全性和有效性仍不明确，但对于这些患者而言，每日钠摄入量在2000至3000毫克/天之间似乎是安全的。正在进行的临床研究将为更严格的钠摄入量（低于1500毫克/天）的安全性和有效性提供信息。数据表明，无论有无症状，常规对HF患者进行液体限制可能并无必要；然而，对于有充血迹象的患者，将液体摄入量限制在2.0升/天可能是可取的。最近，除了钠和液体摄入量之外，HF的其他营养方面受到了更多关注，尽管目前仍缺乏足够证据来指导HF的营养管理。确保患者满足钙、镁、钾、叶酸、维生素E、维生素D、锌和硫胺素等关键微量营养素的每日需求，对于预防营养缺乏至关重要。饮食中更合适的宏量营养素组成仍有待确定；然而，对于患有或未患有非终末期肾病的HF患者，含有50 - 55%碳水化合物、25 - 30%脂肪和15 - 20%蛋白质的饮食似乎是可以接受的。此外，对于营养不良/恶病质患者，可以考虑增加蛋白质摄入量。咨询注册营养师对于近期HF病情加重的患者或患有多种合并症且可能需要遵循多种饮食限制、可能从个性化饮食咨询中受益以确保适当摄入能量、蛋白质和微量营养素的患者尤其有帮助。如今，在指导HF的饮食管理方面仍存在一些知识空白。在本文中，我们回顾了HF饮食管理的当前建议以及支持该做法的证据。
