Dietetics Education Focused on Malnutrition Prevention
Impact of Dietetics Education Focused on Prevention of Malnutrition, on Reducing Morbidity and Improving Life Quality of Patients With Chronic Heart Failure (CHF): A Randomized Controlled Multicenter Clinical Trial
The intervention tested in this research project aims to reduce the unplanned
hospitalizations in CHF patients by preventing the malnutrition using a personalized
dietetic education program. This new program provides concrete solutions to patients by
offering balanced menu ideas, adapted to their tastes and social-cultural habits, and a
panel of recipes easy to make, inexpensive and tasty (despite the lack of salt). This new
educational program should improve the dietary behavior of patients and reinforce the
importance of dietary guidance in support of the CHF.
Context: The Chronic Heart Failure (CHF) is a major public health problem in terms of
frequency, mortality and costs. The care integrates a low-salt diet to reduce fluid
retention and cardiac decompensation. A large observational study (ODIN) shows the
effectiveness of the Patient's Therapeutic Education program (PTE which provides learning
management sodium intake by the intervention of a dietician, I-CARE) on reducing mortality.
But prognosis of CHF remains serious leading to many hospitalizations. The nutritional
status of patients with CHF is threatened by inadequate energy intake in connection with the
low sodium diet and the rest energetic cost (REC). Malnutrition increases the risk of
hospitalization because it causes an immune deficiency responsible for infections, bones
weakness and impaired cognitive function.
Hypotheses: The investigators postulate that an educational diet focusing on prevention of
malnutrition would reduce morbidity and improve quality of life for patients with CHF. For
this, the investigators propose a new educational method: adding a personalized program
monitoring energy and protein intake in addition to managing sodium intake, notably by
offering personalized menu ideas and recipes.
Main objective: Demonstrate that a dietetic education program involving the prevention of
malnutrition and managing sodium intake is more effective than the usual dietetic education
(based only on management of sodium intake) on the frequency of unplanned hospitalizations
(all causes ) at 6 months in CHF patients.
Secondary Objectives: Demonstrate the superiority of the dietetic education program
involving the prevention of malnutrition and managing sodium intake over the usual dietetic
education, by improving the nutritional status, the quality of life, the survival, the
adherence to dietary recommendations and the reduction of hospitalizations for cardiac
decompensation, the burden associated with low sodium diet and the costs.
Chronic Heart Failure (CHF)
Chronic Heart Failure (CHF), Dietetics education, Malnutrition
Assistance Publique - Hôpitaux de Paris
Assistance Publique - Hôpitaux de Paris
Nicol SM, Carroll DL, Homeyer CM, Zamagni CM. The identification of malnutrition in heart failure patients. Eur J Cardiovasc Nurs. 2002 Jun;1(2):139-47.
Arcand J, Floras V, Ahmed M, Al-Hesayen A, Ivanov J, Allard JP, Newton GE. Nutritional inadequacies in patients with stable heart failure. J Am Diet Assoc. 2009 Nov;109(11):1909-13. doi: 10.1016/j.jada.2009.08.011.
Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, Kosiborod M, Portnay EL, Sokol SI, Bader F, Krumholz HM. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005 Jan 10;165(1):55-61. Erratum in: Arch Intern Med. 2008 Mar 24;168(6):567.
Beck CA, Shah S. Research on health-related quality of life and cardiac conditions. Home Healthc Nurse. 2012 Jan;30(1):54-60. doi: 10.1097/NHH.0b013e31823aa740.
Ferrante D, Varini S, Macchia A, Soifer S, Badra R, Nul D, Grancelli H, Doval H; GESICA Investigators.. Long-term results after a telephone intervention in chronic heart failure: DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure) follow-up. J Am Coll Cardiol. 2010 Jul 27;56(5):372-8. doi: 10.1016/j.jacc.2010.03.049.