(Mal-)nutrition of micro- and macronutrients has great impact on the human heart and especially on its ability to recover from damage and consequently associates with prognosis. Improper nutrient intake is frequently observed in HF patients, affecting ~50% of this population. Inadequate daily (caloric) intake of multiple micronutrients, such as vitamin A, calcium, magnesium, selenium, zinc, iron, vitamin D and iodine, and macronutrients, such as low-protein, high-glucose and high-fat have been documented, without necessarily establishing a causative association between them and the onset of HF. Conversely, the failing heart switches its metabolism away from fatty acid oxidation and toward glucose or ketone body, this opening a fascinating field of optimized alternate substrate utilization.
Available clinical evidence supports the usefulness of supplementation with some micronutrients to improve HF management in addition to evidence-based pharmacological therapy. However, ESC HF guidelines do not recommend macro- or micronutrient supplementation, other than correcting iron deficiency with intravenous iron. The HFSA provided valuable recommendations on diet and nutrition in their most recent guidelines. Adjustment of nutritional status and energy supplementation are recommended in patients with advanced HF. It was also suggested that daily evidence-based multi-micronutrient supplementation should be considered for all patients with HF, particularly those receiving diuretic therapy or restricted diets. In this topic we aim to address the broad spectrum of micro- and macronutrient malnutrition and replacement in the setting of CVD and provide a platform for both basic and clinical evidence that endorse (multi-)nutrient diversification for patients with CVD.
(Mal-)nutrition of micro- and macronutrients has great impact on the human heart and especially on its ability to recover from damage and consequently associates with prognosis. Improper nutrient intake is frequently observed in HF patients, affecting ~50% of this population. Inadequate daily (caloric) intake of multiple micronutrients, such as vitamin A, calcium, magnesium, selenium, zinc, iron, vitamin D and iodine, and macronutrients, such as low-protein, high-glucose and high-fat have been documented, without necessarily establishing a causative association between them and the onset of HF. Conversely, the failing heart switches its metabolism away from fatty acid oxidation and toward glucose or ketone body, this opening a fascinating field of optimized alternate substrate utilization.
Available clinical evidence supports the usefulness of supplementation with some micronutrients to improve HF management in addition to evidence-based pharmacological therapy. However, ESC HF guidelines do not recommend macro- or micronutrient supplementation, other than correcting iron deficiency with intravenous iron. The HFSA provided valuable recommendations on diet and nutrition in their most recent guidelines. Adjustment of nutritional status and energy supplementation are recommended in patients with advanced HF. It was also suggested that daily evidence-based multi-micronutrient supplementation should be considered for all patients with HF, particularly those receiving diuretic therapy or restricted diets. In this topic we aim to address the broad spectrum of micro- and macronutrient malnutrition and replacement in the setting of CVD and provide a platform for both basic and clinical evidence that endorse (multi-)nutrient diversification for patients with CVD.
