Post Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Nutrition Program, Universidade Federal do Pampa, UNIPAMPA, Itaqui, RS, Brazil; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Post Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Heart Failure and Transplant Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Nutrition. 2018 Oct;54:111-117. doi: 10.1016/j.nut.2018.02.007. Epub 2018 Mar 21.
Sodium and fluid restriction is commonly prescribed for heart failure patients. However, its role in the treatment of heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the effect of a diet with sodium and fluid restriction with an unrestricted diet in patients admitted for decompensated HFpEF.
Patients were randomized to a diet with sodium (0.8 g/d) and fluid (800 mL/d) restriction (intervention group [IG]) or an unrestricted diet (control group [CG]) and followed for 7 d or hospital discharge. The primary outcome was weight loss. Secondary outcomes included clinical stability, perception of thirst, neurohormonal activation, nutrient intake, readmission, and mortality rate after 30 d.
Fifty-three patients were included (30, IG; 23, CG). The mean ejection fraction was 62% ± 8% for IG and 60% ± 7% for CG (P = 0.44). Weight loss was similar in both groups, being 1.6 ± 2.2 kg in the IG and 1.8 ± 2.1 kg in CG (P = 0.49) as well as the reduction in the congestion score (IG = 3.4 ± 3.5; CG = 3.8 ± 3.4; P = 0.70). The daily perception of thirst was higher in the IG (P = 0.03). Lower energy consumption was seen in the IG (P <0.001). No significant between-group differences at 30 d were found.
Aggressive sodium and fluid restriction does not provide symptomatic or prognosis benefits, but does produce greater perception of thirst, may impair the patient's food intake, and does not seem to have an important neurohormonal effect in patients admitted for decompensated HFpEF.
钠和液体限制通常被用于心力衰竭患者的治疗。然而，其在射血分数保留的心衰（HFpEF）治疗中的作用仍不清楚。本研究旨在比较钠和液体限制饮食与不限饮食在失代偿性 HFpEF 患者中的疗效。
患者被随机分配到钠（0.8g/d）和液体（800ml/d）限制饮食（干预组[IG]）或不限饮食（对照组[CG]），并随访 7 天或出院。主要结局是体重减轻。次要结局包括临床稳定、口渴感、神经激素激活、营养素摄入、再入院和 30 天后的死亡率。
共纳入 53 例患者（IG30 例，CG23 例）。IG 的平均射血分数为 62%±8%，CG 为 60%±7%（P=0.44）。两组的体重减轻相似，IG 组为 1.6±2.2kg，CG 组为 1.8±2.1kg（P=0.49），充血评分的降低也相似（IG=3.4±3.5；CG=3.8±3.4；P=0.70）。IG 组每日口渴感更高（P=0.03）。IG 组的能量消耗较低（P<0.001）。两组在 30 天时无显著差异。
积极的钠和液体限制并不能提供症状或预后益处，但会产生更强烈的口渴感，可能会损害患者的食物摄入，且似乎对失代偿性 HFpEF 患者没有重要的神经激素作用。
