Der Mangel an Nährstoffen oder Spurenelementen als beteiligte Ursache einer Herzinsuffizienz
ist selten, jedoch in Einzelfällen relevant. Dieser Beitrag zeigt, welche bisher unterschätzte
Rolle in der Therapie die Ernährung spielt.
Abstract
Heart failure is a complex clinical syndrome, which is associated with high morbidity
and mortality. Clinical symptoms comprise exercise intolerance, dyspnoea, fatigue
and fluid retention. Dietary deficiencies in micro- and macronutrients play a role
in the development of a catabolic state and in the progression of heart failure. In
its advanced stages, heart failure is often accompanied by an involuntary weight loss
(cardiac cachexia) alongside a progressive loss of skeletal muscle mass and strength
(sarcopenia). Inadequate nutritional status is per se associated with adverse clinical
outcomes. This article summarizes the available clinical evidence supporting the role
of nutrition in the treatment of heart failure irrespective of the presence of wasting
syndromes. The restriction of salt to 6 g per day is advisable in patients with heart
failure, whereas fluid restriction to 1.5–2 L/day may be considered chiefly in patients
with advanced heart failure. Application of iron and polyunsaturated fatty acids has
beneficial effects. Some clinical studies have investigated the role of nutraceuticals,
which are critically discussed. In patients with manifest heart failure, obesity may
have beneficial effects, a phenomenon that has been named the “obesity paradox”. Consequently,
weight loss is not recommended for patients with heart failure and a body mass index
below 35 kg/m2. Nutritional counselling could prevent or ameliorate these heart failure-associated
wasting disorders. The importance of nutrition is immense, but often underestimated
in heart failure treatment. Nutritional approaches in heart failure should be adjusted
to the patient’s current body weight.
Schlüsselwörter Herzinsuffizienz - Ernährung - kardiale Kachexie
Keywords heart failure - nutrition - cardiac cachexia
