Heart Failure

HF: Executive Summary of Recommendations (2008)

Heart Failure Evidence-Based Nutrition Practice Guideline

Executive Summary

Below are the major recommendations and ratings for the Academy of Nutrition and Dietetics Heart Failure Evidence-Based Nutrition Practice Guideline. View the Guideline Overview from the Introduction tab. More detail (including the evidence analysis supporting these recommendations) is available on this website to Academy members and EAL subscribers under Major Recommendations.

To see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence) click here.

[Note: If you mouse-over underlined acronyms and terms, a definition will pop up.]

Medical Nutrition Therapy

 Heart Failure (HF) Medical Nutrition Therapy and Heart Failure

HF: MNT and Heart Failure

Referral to a registered dietitian for Medical Nutrition Therapy (MNT) is recommended whenever an individual has heart failure. A planned initial visit lasting at least 45 minutes and at least one to three planned follow-up visits (at least 30 minutes each) can lead to improved dietary pattern and quality of life and decreases in edema and fatigue. Along with optimal pharmacological management, MNT may also reduce hospitalizations.


Strong
Imperative

Nutrition Assessment

Heart Failure (HF) Protein Needs in Heart Failure Patients

HF: Protein Needs

In assessing protein needs for patients with heart failure, clinically stable depleted patients should have a daily intake of at least 1.37 g protein/kg and normally nourished patients should have a daily intake 1.12 g protein/kg in order to preserve their actual body composition or limit the effects of hypercatabolism. Research indicates that HF patients have significantly higher protein needs than those without HF, as measured by negative nitrogen balance.


Fair
Imperative

Heart Failure (HF) Energy Needs in Heart Failure Patients

HF: Energy Needs in Heart Failure Patients

In assessing energy needs for patients with heart failure, the majority of studies indicate that use of indirect calorimetry best determines energy needs. When indirect calorimetry is not possible consider starting with usual predictive equations and adjusting for increased catabolic state.


Fair
Imperative

Nutrition Intervention

Heart Failure (HF) Sodium and Fluid Restriction and Heart Failure

HF: Fluid Intake

For patients with heart failure, fluid intake should be between 1.4 and 1.9 L (48-64 oz.) per day, depending on clinical symptoms (i.e. edema, fatigue, shortness of breath). Fluid restriction will improve clinical symptoms and quality of life.


Fair
Imperative

HF: Sodium Intake

For patients with heart failure, sodium intake should be less than 2000 mg (2 g) per day. Sodium restriction will improve clinical symptoms (i.e. edema, fatigue) and quality of life.


Fair
Imperative

Heart Failure (HF) Folate, B12, and Heart Failure

HF: Folate and heart failure

The practitioner should encourage patients with HF to consume at least the DRI for folate through food and/or a combination of B6, B12, and folate supplementation. Folate supplementation given with other vitamins/minerals has been shown to have beneficial clinical HF outcomes.


Fair
Imperative

HF: B12 and heart failure

A multi-vitamin/mineral containing B12 or a combination of B6, B12 and folate could be recommended in HF patients.  This level of B12 supplementation (200-500 mcg daily), given with other vitamins/minerals, has been shown to have beneficial clinical heart failure outcomes.


Fair
Imperative

Heart Failure (HF) Thiamine Supplementation and Heart Failure

HF: Thiamine Supplementation

Since diurectic use can lead to thiamine deficiency in patients with heart failure (HF), then the practitioner should evaluate thiamine status.  The practitioner should encourage the patient to consume at least the DRI through food and/or supplements.  The practitioner should stay alert to future research involving thiamine.


Fair
Conditional

Heart Failure (HF) Magnesium Supplementation and Heart Failure

HF: Magnesium Supplementation

The practitioner should encourage patients with heart failure (HF) to consume at least the DRI for magnesium through food and/or supplements.  Low levels of magnesium may be present in patients with heart failure and irregular heart rhythms may occur.  The practitioner should stay alert to future research involving magnesium.


Fair
Conditional

Heart Failure (HF) Alcohol and Heart Failure

HF: Alcohol and Heart Failure

Current limited evidence does not justify encouraging those who do not drink alcohol to start doing so. If a patient currently drinks alcohol, and if not contraindicated, then a maximum of one drink per day for women and up to two drinks per day for men may be tolerated. This level of alcohol consumption has been demonstrated to not be harmful in heart failure patients.


Fair
Conditional

Heart Failure (HF) L-Arginine, Carnitine, Coenzyme Q10 and Hawthorn and Heart Failure

HF: L-Arginine, Carnitine, Coenzyme Q10 and Hawthorn

If a patient inquires about or is currently taking L-arginine, carnitine, coenzyme Q10 or hawthorn supplements, then the practitioner may discuss the limited evidence available regarding clinical heart failure outcomes. Research is inconclusive. The practitioner should stay alert to future research involving these supplements.


Weak
Conditional