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.

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

Publication History

Article published online:
13 April 2023

• Literatur

• 1 Ponikowski P, Voors AA, Anker SD. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891-975
• 2 McMurray JVJ, Packer M, Desai AS. et al. Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure. N Eng J Med 2014; 371: 993-1004
• 3 Strohm D, Bechthold A, Ellinger S. et al. Revised reference values for the intake of sodium and chloride. Ann Nutr Metab 2018; 72: 12-17
• 4 Strohm D, Boeing H, Leschik-Bonnet E. et al. Salt intake in Germany, health consequences, and resulting recommendations for action. A scientific statement from the German Nutrition Society (DGE). Ernahrungs Umschau 2016; 63: 62-70
• 5 Kalogeropoulos A, Papadimitriou L, Georgiopoulou VV. et al. Low-Versus Moderate-Sodium Diet in Patients With Recent Hospitalizations for Heart Failure. The PROHIBIT (Prevent Adverse Outcomes in Heart Failure by Limiting Sodium) Pilot Study. Circ Heart Fail 2020; 13: e006389
• 6 Philipson H, Ekman I, Forslund HB. et al. Salt and fluid restriction is effective in patients with chronic heart failure. Eur J Heart Fail 2013; 1304-1310
• 7 Mahtani KR, Heneghan C, Onakpoya I. et al. Reduced Salt Intake for Heart Failure: A Systematic Review. JAMA Intern Med 2018; 178: 1693-1700
• 8 Travers B, O’Loughlin C, Murphy NF. et al. Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability. J Card Fail 2007; 13: 128-132
• 9 Cohen N, Almoznino-Sarafian D, Zaidenstein R. et al. Serum magnesium aberrations in furosemide (frusemide) treated patients with congestive heart failure: pathophysiological correlates and prognostic evaluation. Heart 2003; 89: 411-416
• 10 Gorelik O, Almoznino-Sarafian D, Feder I. et al. Dietary intake of various nutrients in older patients with congestive heart failure. Cardiology 2003; 99: 177-181
• 11 Witte KK, Nikitin NP, Parker AC. et al. The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure. Eur Heart J 2005; 26: 2238-2244
• 12 Cicero AFG, Colletti A, von Haehling S. et al. Nutraceutical support in heart failure: a position paper of the International Lipid Expert Panel (ILEP). Nutr Res Rev 2020; 16: 1-25
• 13 Tavazzi L, Maggioni AP, Marchioli R. et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008; 372: 1223-1230
• 14 von Haehling S, Ebner N, Evertz R. et al. Iron Deficiency in Heart Failure: An Overview. JACC Heart Fail 2019; 7: 36-46
• 15 von Haehling S, Ottenjann H, Anker SD. Eisenmangel – erkennen und behandeln. Internist (Berl) 2017; 58: 627-638
• 16 von Haehling S, Gremmler U, Krumm M. et al. Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry. Clin Res Cardiol 2017; 106: 436-443
• 17 Bianchi VE. Nutrition in chronic heart failure patients: a systematic review. Heart Fail Rev 2020; 25: 1017-1026
• 18 von Haehling S, Doehner W, Anker SD. Obesity and the heart a weighty issue. J Am Coll Cardiol 2006; 47: 2274-2276
• 19 Doehner W, Anker SD. Cardiac cachexia in early literature: a review of research prior to Medline. Int J Cardiol 2002; 85: 7-14
• 20 von Haehling S, Ebner N, Dos Santos MR. et al. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol 2017; 14: 323-341
• 21 Mauriac C. Essai sur les maladies de coeur: de la mort subite dans l’insuffisance des valvules sigmoides de l’aorte. Paris: L. Leclerc; 1860
• 22 von Haehling S. The wasting continuum in heart failure: from sarcopenia to cachexia. Proc Nutr Soc 2015; 74: 367-377
• 23 Rozentryt P, von Haehling S, Lainscak M. et al. The effects of a high-caloric protein-rich oral nutritional supplement in patients with chronic heart failure and cachexia on quality of life, body composition, and inflammation markers: a randomized, double-blind pilot study. J Cachexia Sarcopenia Muscle 2010; 1: 35-42
• 24 Konishi M, Ishida J, von Haehling S. et al. Nutrition in cachexia: from bench to bedside. J Cachexia Sarcopenia Muscle 2016; 7: 107-109
• 25 Kondrup J, Allison SP, Elia M. et al. ESPEN guidelines for nutritional screening 2002. Clin Nutr 2003; 22: 415-421
• 26 Saitoh M, Dos Santos MR, Ebner N. et al. Nutritional status and its effects on muscle wasting in patients with chronic heart failure: insights from Studies Investigating Co-morbidities Aggravating Heart Failure. Wien Klin Wochenschr 2016; 128: 497-504
• 27 Jacobsson A, Pihl-Lindgren E, Fridlund B. Malnutrition in patients suffering from chronic heart failure; the nurse’s care. Eur J Heart Fail 2001; 3: 449-456
• 28 Wessler JD, Hummel SL, Maurer MS. Dietary interventions for heart failure in older adults: re-emergence of the hedonic shift. Prog Cardiovasc Dis 2014; 57: 160-167
• 29 Boban M, Bulj N, Kolačević Zeljković M. et al. Nutritional Considerations of Cardiovascular Diseases and Treatments. Nutr Metab Insights 2019; 22: 12