Department of Medicine, University of Mississippi, Jackson, MS, USA.
Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
Eur J Heart Fail. 2021 Sep;23(9):1468-1476. doi: 10.1002/ejhf.2278. Epub 2021 Jul 8.
To appraise meta-analytically determined effect of dietary interventions and nutritional supplements on heart failure (HF)-related outcomes, and create an evidence map to visualize the findings and certainty of evidence.
Online databases were systematically searched for meta-analyses of randomized controlled trials (RCTs) evaluating the effect of dietary interventions and nutritional supplements on HF outcomes and incidence. These were then updated if new RCTs were available. Estimates were pooled using a random-effects model and reported as risk ratios (RRs) or mean differences with 95% confidence intervals. We identified 14 relevant meta-analyses, to which 21 new RCTs were added. The total evidence base reviewed included 122 RCTs (n = 176 097 participants) assessing 14 interventions. We found that coenzyme Q10 was associated with lower all-cause mortality [RR 0.69 (0.50-0.96); I = 0%; low certainty of evidence] in HF patients. Incident HF risk was reduced with Mediterranean diet [RR 0.45 (0.26-0.79); I = 0%; low certainty of evidence]. Vitamin E supplementation was associated with a small but significant increase in the risk of HF hospitalization [RR 1.21 (1.04-1.40); I2 = 0%; moderate certainty of evidence]. There was moderate certainty of evidence that thiamine, vitamin D, iron, and L-carnitine supplementation had a beneficial effect on left ventricular ejection fraction.
Coenzyme Q10 may reduce all-cause mortality in HF patients, while a Mediterranean diet may reduce the risk of incident HF; however, the low certainty of evidence warrants the need for further RCTs to confirm a definite clinical role. RCT data were lacking for several common interventions including intermittent fasting, caffeine, DASH diet, and ketogenic diet. More research is needed to fill the knowledge gap.
系统评价饮食干预和营养补充剂对心力衰竭（HF）相关结局的影响，并创建一个证据图谱以可视化研究结果和证据质量。
系统检索了在线数据库中评价饮食干预和营养补充剂对 HF 结局和发生率影响的随机对照试验（RCT）的荟萃分析，并在有新 RCT 时进行更新。使用随机效应模型汇总估计值，并以风险比（RR）或均数差值及 95%置信区间报告。我们确定了 14 项相关的荟萃分析，并纳入了 21 项新的 RCT。共纳入了 122 项 RCT（n=176097 名参与者）评估了 14 种干预措施的研究。我们发现辅酶 Q10 可降低 HF 患者的全因死亡率[RR 0.69（0.50-0.96）；I²=0%；证据质量低]。地中海饮食可降低 HF 发生风险[RR 0.45（0.26-0.79）；I²=0%；证据质量低]。维生素 E 补充剂与 HF 住院风险的小幅但显著增加相关[RR 1.21（1.04-1.40）；I²=0%；证据质量中等]。有中等质量的证据表明，硫胺素、维生素 D、铁和左旋肉碱补充剂对左心室射血分数有有益影响。
辅酶 Q10 可能降低 HF 患者的全因死亡率，而地中海饮食可能降低 HF 发生率；然而，低质量的证据需要进一步的 RCT 来证实其明确的临床作用。对于间歇性禁食、咖啡因、DASH 饮食和生酮饮食等几种常见干预措施，缺乏 RCT 数据。需要进一步研究以填补知识空白。
