Running head: NUTRITION ASSESSMENT 1

Nutrition Assessment:

Dietary Interventions for Congestive Heart Failure

Rebecca Netjes

University of South Florida

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Disease processes are complex phenomenon that vary by patient, requiring multiple

faceted treatment regimens. While pharmacologic management can be effective treatment, there

is strong support for supplementation with dietary interventions. It is critical that the diet be

specific to the pathology of the diagnosis and that appropriate education is provided.

Disease Process

Congestive heart failure (CHF) is characterized by the inability of the heart to adequately

perfuse blood to the periphery. Typically, CHF is caused by a pre-existing condition that lead to

ventricular hypertrophy or vascular damage. In many cases, CHF patients’ prognosis is

dependent upon the health of their blood vessels and endothelial lining. The endothelium is often

damaged by inflammatory cytokines causing a decrease in elasticity- which results in inefficient

blood flow. As a result of this damage to the vasculature, and impaired contractility of the heart,

edema is created. Many of the symptoms that CHF patients report are related to the edema and

fluid overload that are hallmarks for this disease process.

Dietary Recommendations

For many years, the standard of care for CHF patients has been a low sodium diet

coupled with strict fluid restrictions. Water perfuses to areas of high sodium concentration, so

excess sodium in the diet would cause fluid retention. If consuming excess salt, CHF patients

could exacerbate their condition, placing further stress on the heart and vasculature. One study

showed that if clinicians include the patient in a discussion to determine a unique

recommendation for sodium and fluid intake, there is a greater chance of therapeutic effect and

compliance (Philipson, Ekman, Forslund, Swedberg, & Schaufelberger, 2013).

Recently, there has been evidence suggesting that there may be additional nutrients that

are tied to the health of CHF patients. Researchers agree that excessive sodium intake is not
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ideal; but there is a discrepancy over what the maximum intake should be (Gupta et al., 2012). It

has been suggested that the DASH diet (Dietary Approaches to Stop Hypertension) encourages

nutrient intake that could benefit patients with CHF. Magnesium may be beneficial in preserving

the elasticity of the endothelium, and vitamin D has been associated with an increase in release

of anti-inflammatory cytokines. Thiamine, a nutrient CHF patients often lack as it is found in

conjunction with sodium, has been shown to improve the function of the left ventricle (Rifai &

Silver, 2016).

Patient Teaching

While there is discussion on what diet should be encouraged, it remains critical that

patients are taught in a way that is tailored to their needs. Patient teaching should include that

their body does not distribute fluid properly, and excess sodium will exacerbate this condition as

it would cause the body to retain fluid. It was found that “patients are likely to benefit most and

be engaged the most when dietary recommendations are combined in a pattern of eating rather

than isolated rules” (Rifai & Silver, 2016, p.551). Information regarding their medications, such

as diuretics, should be presented. Patients should be advised that there is a chance for diuretics to

cause a nutrient imbalance, so they should adjust accordingly.

Conclusion

Patients with CHF have a unique set of problems that accompany their disease process. A

reduction in sodium and restriction of fluid is a helpful place to begin as the patient develops an

understanding of their diagnosis. As the patient becomes engaged in their treatment plan, it

would be advantageous to examine additional dietary interventions. Rather than focusing solely

on what has been recommended in the past, clinicians should strive to find a dynamic way to

approach their clients unique needs and consider the possibility of new regimens.
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References

Gupta, D., Georgiopoulou, V. V., Kalogeropoulos, A. P., Dunbar, S. B., Reilly, C. M., Sands, J.

M., . . . Butler, J. (2012). Dietary Sodium Intake in Heart Failure. Circulation, 126(4),

479-485. doi:10.1161/circulationaha.111.062430

Philipson, H., Ekman, I., Forslund, H. B., Swedberg, K., & Schaufelberger, M. (2013). Salt and

fluid restriction is effective in patients with chronic heart failure. European Journal of

Heart Failure, 15(11), 1304-1310. doi:10.1093/eurjhf/hft097

Rifai, L., & Silver, M. A. (2016). A Review of the DASH Diet as an Optimal Dietary Plan for

Symptomatic Heart Failure. Progress in Cardiovascular Diseases, 58(5), 548-554. doi:

10.1016/j.pcad.2015.11.001