Ernährungstherapie bei Herzinsuffizienz und kardialer Kachexie

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.

Kernaussagen

• Die Ernährung spielt eine große, wenngleich bisher unterschätzte Rolle in der Therapie der Herzinsuffizienz.

• Die meisten vorhandenen Empfehlungen sind für die HFrEF vorhanden.

• Insgesamt müssen Ernährungsempfehlungen am aktuellen Gewicht des Patienten orientiert werden.

• Eine Gewichtsreduktion sollte nur empfohlen werden, wenn der BMI über 35 kg/m² beträgt.

• Bei kardialer Kachexie und Muskelverlust sind zusätzliche Kalorien wichtig.

• Daneben sollten nachgewiesene Mangelzustände an Vitaminen oder Spurenelementen behoben werden.

• Einige Nutraceuticals haben interessante Hinweise gezeigt, so insbesondere n-3-PUFA und Eisen.

Schlüsselwörter

Herzinsuffizienz - Ernährung - kardiale Kachexie

Keywords

heart failure - nutrition - cardiac cachexia

Publikationsverlauf

Artikel online veröffentlicht:
07. Dezember 2020

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