Kida Keisuke, Miyajima Isao, Suzuki Norio, Greenberg Barry H, Akashi Yoshihiro J
Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Clinical Nutrition, Chikamori Hospital, Kochi, Japan.
J Cardiol. 2023 Mar;81(3):283-291. doi: 10.1016/j.jjcc.2022.11.001. Epub 2022 Nov 9.
Nutrition in the cardiovascular field to date has focused on improving lifestyle-related diseases such as hypertension and diabetes from the viewpoint of secondary prevention. For these conditions, "nutrition for weight loss" is recommended, and nutritional guidance that restricts calories is provided. On the other hand, in symptomatic Stage C and D heart failure, it is known that underweight patients who manifest poor nutrition, sarcopenia, and cardiac cachexia have a poor prognosis. This is referred to as the "Obesity paradox". In order to "avoid weight loss" in patients with heart failure, a paradigm shift to nutritional management to prevent weight loss is needed. Rather than prescribing uniform recommendation for salt reduction of 6 g/day or less, awareness of the behavior change stage model is attracting attention. In this setting, the value of salt restriction will need to be determined to determine the priority level of intervention for undernutrition versus the need to prevent congestive signs and symptoms. In the Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) for acute heart failure, nutritional intervention should be considered within 48 h of admission. Key points are selection of access route, timing of intervention, and monitoring of side effects. In nutritional management at home and in end-of-life care, food is a reflection of an individual's values, as well as a source of joy and encouragement. The importance of digestive tract should also be recognized in heart failure from oral flail to intestinal edema, constipation, and the intestinal bacteria called the heart-gut axis. Finally, we would like to propose a new term "heart nutrition" for nutritional management in patients with heart failure in this review. Compared to the evidence for exercise therapy in heart failure, studies assessing nutritional management remain scarce and there is a need for research in this area in the future.
迄今为止，心血管领域的营养研究主要集中在从二级预防的角度改善与生活方式相关的疾病，如高血压和糖尿病。针对这些疾病，推荐“减重营养”，并提供限制热量的营养指导。另一方面，在有症状的C期和D期心力衰竭患者中，已知存在营养不良、肌肉减少症和心脏恶病质的体重过轻患者预后较差。这被称为“肥胖悖论”。为了在心力衰竭患者中“避免体重减轻”，需要将范式转变为预防体重减轻的营养管理。与其规定统一的每天6克或更少的减盐建议，行为改变阶段模型的意识正受到关注。在这种情况下，需要确定限盐的价值，以确定针对营养不良的干预优先级与预防充血症状和体征的需求。在急性心力衰竭的重症监护病房（ICU）/心脏监护病房（CCU）中，应在入院后48小时内考虑营养干预。关键点包括通路选择、干预时机和副作用监测。在家庭营养管理和临终关怀中，食物不仅反映个人价值观，也是快乐和鼓励的源泉。从口腔功能障碍到肠道水肿、便秘以及称为心-肠轴的肠道细菌，消化道在心力衰竭中的重要性也应得到认识。最后，在本综述中，我们想为心力衰竭患者的营养管理提出一个新术语“心脏营养”。与心力衰竭运动疗法的证据相比，评估营养管理的研究仍然很少，未来这一领域需要进行研究。
