Enteral Nutrition in Congestive Heart Failure and Cardiac Cachexia
The Influence of Enteral Nutrition on Functional Status and Inflammatory Activation in Patients With Congestive Heart Failure and Cardiac Cachexia.
The purpose of this study was to determine the effects of a high caloric drink on weight and
several other clinical markers including quality of life in patients with unintentional
weight loss (cachexia) due to chronic heart failure.
Cardiac cachexia has been shown to be powerful independent predictor of mortality in
patients with congestive heart failure (CHF). Unlike starvation, cachectic CHF patients
present with a decrease of muscles and/or fat tissue. This probably depends, at least in
part, on the level of inflammatory activation. Theoretically, it seems clear that
nutritional status has to be improved in cardiac cachexia. It has been suggested that
inflammatory activation in CHF may be due to endotoxin translocation through the edematous
gut wall. Elevated endotoxin levels have been found in patients with acutely decompensated
CHF, but these levels normalized with diuretic treatment. This finding may be of utmost
importance. From one side it underscores the need for aggressive diuretic treatment to
prevent translocation, from another side however, it suggests potential area for enteral
treatment. Enteral route of nutrition may be highly beneficial by diminishing bacterial
translocation from guts and/or endotoxin transfer, finally resulting in lower inflammatory
activation Numerous experimental studies display that enteral feeding reduces bacterial
translocation, endotoxin absorption and positively modulates function of local immune
A search of the literature shows that very little is known about the effectiveness of
nutritional support on functional performance in cachectic CHF patients and actually no
reports concern the influence of enteral feeding on immune activation of cachectic CHF
patients. Recent information of some links existing between leptin, which is increased in
CHF, and inflammatory activation in this syndrome speculate on a functional role of leptin
in immune activation in CHF. As leptin is one of the most important hormones in the
regulation of body energy metabolism, we think it is reasonable to look also into enteral
feeding -induced changes of leptin and concomitant fluctuations of plasma cytokines.
During the last 12 months we have been using nutritional support in cachectic patients with
CHF as an adjunct to standard therapy. We were surprised by a significant functional
improvement that we observed in many instances. As most of these patients were subjected to
aggressive multi-drug diuretic therapy as well, it was impossible to appreciate the role of
enteral nutrition in this respect. We think, these observations are worth verification in
more controlled prospective studies.
Chronic Heart Failure, Cardiac Cachexia
Heart failure, cachexia
National Heart and Lung Institute
National Heart and Lung Institute, Nutricia Research Fundation
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