Investigators Present New Heart Failure Nutrition Guidelines at HFSA

Amanda Vest, MBBS, MPH

Finding the right diet can be a daunting task, especially for heart failure (HF) patients.

However, during the Heart Failure Society of America (HFSA) 2019 Scientific Sessions in Philadelphia, PA, Amanda Vest, MBBS, MPH, Tufts Medical Center, presented a new nutritional guideline for heart failure patients that focuses on dietary composition and counseling, obesity management, and cachexia malnutrition.

“So, the concept of food as medicine has gotten momentum lately that leveraging the diet to prevent or treat heart failure remains in my opinion a missed opportunity for so many of our patients with heart failure,” Vest said. “Given the lack of detailed nutrition recommendations and existing heart failure guidelines, I recently led a multi-disciplinary writing group several times a day, including cardiologists, dietitians, nurses and pharmacists to assemble a consensus statement on nutrition for patients with heart failure.”

Vest said some of the popular diets that would be good for heart failure patients would be the DASH or Mediterranean diet, as well as plant-based diets. Vest also acknowledged ongoing randomized trials on the optimal sodium intake, but for the time being it is recommended limiting sodium to 2-3 grams per day for heart failure patients.

She also said bariatric surgery should be considered for all eligible patients, which has been shown retrospectively in several different cohorts to cut the risk of incident heart failure in half.

Vest explained that while the guidelines suggest replacing saturated fats with modern polyunsaturated fats such as olive oil and fish oil, there are no longer specified limits on saturated fats. They also do not include a specific sodium limit, but suggest limiting processed meats, refined carbohydrates and sweetened beverages and strongly recommend against the consumption of any trans fats.

The guidelines recommend that patients with heart failure and the body mass index of 35 or above receive counseling on a calorie restricted diet that aims for 5-10% weight loss.

Vest said dietary consultation is a key tenant in the new recommendations.

“And it just contains a lot of recommendations for all patients with heart failure to receive a 30 to 60-minute dietician consultation with a follow up encounter in 4 to 6 weeks,” Vest said.

Vest explained that the government’s mind plate approach to diet, which includes suggestions on healthy dietary composition and appropriate portion sizes, was created using controversial evidence, leading to other guides emerging.

“And so, for example, the Harvard School of Public Health has released its own edited version that replaces the milk with a water as a preferred beverage, and also adds a serving of healthy fat,” she said. “The 2019 [American College of Cardiology/American Heart Association] Primary Prevention Guidelines about data the concept of a heart healthy diet is the most recent evidence from epidemiological data.

“These guidelines emphasize the diet rich in fruits, vegetables, legumes, nuts, whole grains and fish, due to the associations between these foods and lower rates of atherosclerosis, muscular disease.”