Influence of creatine supplementation on the functional capacity of patients with heart failure. Nutritional Intervention in Malnourished Hospitalized Patients with Heart Failure. An exploratory study on the efficacy and safety of a BCAA preparation used in combination with cardiac rehabilitation for patients with chronic heart failure The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials The effects of a high-caloric protein-rich oral nutritional supplement in patients with chronic heart failure and cachexia on quality of life, body composition, and inflammation markers: a randomized, double-blind pilot study Creatine supplementation in chronic heart failure increases skeletal muscle creatine phosphate and muscle performance. Changes in body composition in heart failure patients after a resistance exercise program and branched chain amino acid supplementation. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Nutritional intervention in acute heart failure patients with undernutrition and normalbuminemia: A subgroup analysis of PICNIC study. Wasting as independent risk factor for mortality in chronic heart failure Effect of taurine supplementation on exercise capacity of patients with heart failure. Self-rating of quality of life provides additional prognostic information in heart failure. Insights into the EPICAL study. Oral amino acid supplements improve exercise capacities in elderly patients with chronic heart failure.
BACKGROUND Heart failure ( HF ) is a complex syndrome characterized by intolerance to exertion and reduced functional capacity . OBJECTIVE To assess the functional capacity of patients with HF and supplemented with creatine .  METHODS Prospect i ve , r and omized , double-blind study . Thirty-three male patients over the age of 18 years with functional class II to IV HF were r and omized into two groups as follows : the experimental group ( CRE , n = 17 ) , supplemented with 5 g/day of creatine for six months ; and the placebo group ( PLA , n = 16 ) , receiving 5 g/day of maltodextrin for that same period . Both groups underwent functional capacity assessment by use of cardiopulmonary exercise test and 6-minute walk test ( 6MWT ) before and after the intervention . The Ancova statistical model and Pearson correlation were used to assess the groups and the treatment . RESULTS Of the variables assessed on the cardiopulmonary exercise test , peak oxygen consumption ( peak VO₂ ) , anaerobic threshold ( AT ) , and oxygen pulse ( O₂ pulse ) showed no significant differences between the groups ( P>0.05 ) . On the 6MWT , no significant difference was observed in the covered distance . CONCLUSION Creatine supplementation in patients with HF did not significantly improve functional capacity BACKGROUND AND AIMS Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status . We undertook this study to assess whether a nutritional intervention in malnourished hospitalized patients with heart failure benefits morbidity and mortality . METHODS A multicenter , r and omized , controlled clinical trial was conducted . A total of 120 malnourished hospitalized patients due to acute heart failure were r and omised to conventional heart failure treatment or conventional heart failure treatment combined with an individualized nutritional intervention . The primary endpoint of this study was a composite of all-cause death or readmission for worsening of HF , with a maximum follow-up of 12 months . Analysis was by intention to treat . RESULTS Recruitment was stopped early according to the study protocol after completing the follow-up of the first 120 patients enrolled ( 59 in the intervention group and 61 in the control group ) . Both groups were homogeneous in baseline characteristics . At 12 months , the primary outcome occurred in 27.1 % of patients in the intervention group and in 60.7 % of patients in the control group ( hazard ratio 0.45 ; 95 % confidence interval [ CI ] , 0.19 - 0.62 , p = 0.0004 ) . In total , 20.3 % of patients died in the intervention group and 47.5 % in the control group ( hazard ratio 0.37 , 95 % CI , 0.19 - 0.72 , p = 0.003 ) . Readmission due to heart failure was also lower in the intervention group ( 10.2 vs. 36.1 % , p = 0.001 ) . CONCLUSION Nutritional intervention in malnourished hospitalized patients with heart failure reduces the risk of death from any cause and the risk of readmission for worsening of heart failure ( Clinical Trial.govNCT01472237 ) Background Sarcopenia is generally complicated with patients with chronic heart failure ( CHF ) and its presence negatively affects the course of heart failure , however effective nutritional intervention had not been eluci date d yet . The primary objective of this study is to explore whether the addition of a branched-chain amino acid ( BCAA ) preparation for cardiac rehabilitation ( CR ) of patients with CHF further improves cardiopulmonary functions , skeletal muscle functions , and metabolism in comparison with conventional CR . Methods This is a r and omized , parallel-group comparative study . The elderly patients that were participated in CR and complicated with left ventricular systolic or diastolic dysfunction are r and omized into two groups , CR + BCAA and CR . 20 weeks later , the second r and omization is performed , which divide subjects into two groups with and without BCAA intervention without CR . Primary outcome measure is the rate of change of the anaerobic threshold workload from baseline to post-intervention . Secondary outcome include parameters of exercise capacity , cardiac function and psychological status . Discussion In the current study the effect of a promising new intervention , BCAA , will be assessed to determine whether its addition to CR improve exercise capacity in patients with heart failure , who are generally complicated with sarcopenia . Trial registration This clinical trial was registered with the University Hospital Medical Information Network— Clinical Trials Registry ( UMIN – CTR ; JPRN – UMIN R000022440 ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The prevalence of cardiac cachexia in chronic heart failure is approximately 5 % to 15 % and 18-month mortality rates can reach 50 % . Treatment with angiotensin-converting enzyme inhibitors and beta-blockers may confer some benefit but no proven therapy exists . We tested the effects of an oral nutritional supplement in cachectic patients with heart failure . This was a prospect i ve , r and omized , double-blind , placebo-controlled pilot study which r and omized 29 patients to a high-caloric ( 600 kcal ) high-protein ( 20 g ) oral nutritional supplement or placebo for a duration of 6 weeks in addition to the patients ’ usual food intake . At baseline , 6 weeks , and 18 weeks , we measured body weight , quality of life , body composition , heart function , laboratory parameters , and exercise performance . Edema-free body weight increased in 19 of 20 patients receiving intervention at 6 weeks and in 17 of 19 patients at 18 weeks with an average weight gain of 2.0 ± 1.7 kg ( 3.1 ± 2.4 % , p = 0.0001 ) and 2.3 ± 3.1 kg ( 3.6 ± 4.7 % , p = 0.007 ) at 6 and 18 weeks , respectively . Most of the weight gain was fat tissue with an absolute gain of 1.5 ± 1.7 kg ( p = 0.003 ) and 1.6 ± 2.7 kg ( p = 0.008 ) . A significant improvement in quality of life and decrease in serum levels of tumor necrosis factor-α were observed ( p < 0.05 for both ) . We demonstrated the feasibility of oral nutritional supplement in cachectic patients with heart failure and significant clinical benefit in terms of body size and body composition , laboratory parameters , and quality of life ( www . clinical trials.gov identifier NCT00654719 ) BACKGROUND Cardiac creatine levels are depressed in chronic heart failure . Oral supplementation of creatine to healthy volunteers has been shown to increase physical performance . AIM To evaluate the effects of creatine supplementation on ejection fraction , symptom-limited physical endurance and skeletal muscle strength in patients with chronic heart failure . METHODS With a double-blind , placebo-controlled design 17 patients ( age 43 - 70 years , ejection fraction < 40 ) were supplemented with creatine 20 g daily for 10 days . Before and on the last day of supplementation ejection fraction was determined by radionuclide angiography as was symptom-limited 1-legged knee extensor and 2-legged exercise performance on the cycle ergometer . Muscle strength as unilateral concentric knee extensor performance ( peak torque , Nm at 180 degrees/s ) was also evaluated . Skeletal muscle biopsies were taken for the determination of energy-rich phosphagens . RESULTS Ejection fraction at rest and at work did not change . Performance before creatine supplementation did not differ between placebo and creatine groups . While no change was seen in the placebo group compared to baseline , creatine supplementation increased skeletal muscle total creatine and creatine phosphate by 17 + /- 4 % ( P < 0.05 ) and 12 + /- 4 % ( P < 0.05 ) , respectively . Increments were seen only in patients with < 140 mmol total creatine/kg d.w . ( P < 0.05 ) . One-legged performance ( 21 % , P < 0.05 ) , 2-legged performance ( 10 % , P < 0.05 ) , and peak torque , Nm ( 5 % , P < 0.05 ) increased . Both peak torque and 1-legged performance increased linearly with increased skeletal muscle phosphocreatine ( P < 0.05 ) . The increments in 1-legged , 2-legged and peak torque were significant compared to the placebo group , ( P < 0.05 ) . CONCLUSIONS One week of  creatine supplementation to patients with chronic heart failure did not increase ejection fraction but increased skeletal muscle energy-rich phosphagens and performance as regards both strength and endurance . This new therapeutic approach merits further attention BACKGROUND & AIMS Heart Failure ( HF ) is a complex syndrome , which can include the physiological , neural hormonal and metabolic complications known as " Cardiac Cachexia " ( CC ) . In the development of CC there is a release of catabolic cytokines ( Tumor Necrosis Factor-α , interleukins 1 and 6 ) that cause a decrease of fat free mass and fat mass . These changes in body composition might be reversed with a therapeutic combination of resistance exercise and branched chain amino acid supplementation ( BCAA ) . AIM Evaluate changes in body composition after a resistance exercise program and BCAA supplementation in patients with HF . METHODS In a r and omized clinical trial with 3 month of follow-up anthropometric body composition analysis and stress tests were evaluated at the beginning and in the end of the study . Patients were divided into two groups ; the experimental group performed the resistance exercise program and received 10 g/day BCAA supplementation , and the control group only performed the resistance exercise program . Both groups were provided with individualized diets and conventional medical treatment . RESULTS Changes were found in hip circumference between the groups ( p = 0.02 ) , and muscle strength was increased in the experimental group ( 8 % ) and the control group ( 11.4 % ) with no difference between them . METS and VO2Max also increased in experimental and control groups ( 16.6 % and 50.1 % respectively ) . Regarding changes in symptoms , improvements in fatigue ( 45.4 % ) , decubitus intolerance ( 21.8 % ) and dyspnea ( 25.4 % ) were observed in the overall sample . CONCLUSION Improvements in physical and functional capacities are attributed to resistance exercise program but not to the BCAA supplementation . CLINICAL TRIALS IDENTIFIER NCT02240511 BACKGROUND Hospitalized , malnourished older adults have a high risk of readmission and mortality . OBJECTIVE Evaluation of a high-protein oral nutritional supplement ( HP-HMB ) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished , hospitalized older adults . DESIGN Multicenter , r and omized , placebo-controlled , double-blind trial . SETTING Inpatient and posthospital discharge . PATIENTS Older ( ≥65 years ) , malnourished ( Subjective Global Assessment [ SGA ] class B or C ) adults hospitalized for congestive heart failure , acute myocardial infa rct ion , pneumonia , or chronic obstructive pulmonary disease . INTERVENTIONS St and ard-of-care plus HP-HMB ( n = 328 ) or a placebo supplement ( n = 324 ) , 2 servings/day . MEASUREMENTS Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission . Other endpoints included 30- and 60-day postdischarge incidence of death or readmission , length of stay ( LOS ) , SGA class , body weight , and activities of daily living ( ADL ) . RESULTS The primary composite endpoint was similar between HP-HMB ( 26.8 % ) and placebo ( 31.1 % ) . No between-group differences were observed for 90-day readmission rate , but 90-day mortality was significantly lower with HP-HMB relative to placebo ( 4.8 % vs. 9.7 % ; relative risk 0.49 , 95 % confidence interval [ CI ] , 0.27 to 0.90 ; p = 0.018 ) . The number-needed-to-treat to prevent 1 death was 20.3 ( 95 % CI : 10.9 , 121.4 ) . Compared with placebo , HP-HMB result ed in improved odds of better nutritional status ( SGA class , OR , 2.04 , 95 % CI : 1.28 , 3.25 , p = 0.009 ) at day 90 , and an increase in body weight at day 30 ( p = 0.035 ) . LOS and ADL were similar between treatments . LIMITATIONS Limited generalizability ; patients represent a selected hospitalized population . CONCLUSIONS Although no effects were observed for the primary composite endpoint , compared with placebo HP-HMB  decreased mortality and improved indices of nutritional status during the 90-day observation period . CLINICAL TRIAL REGISTRATION www . Clinical Trials.govNCT01626742 BACKGROUND & AIMS Hypoalbuminemia is common in acute heart failure ( HF ) patients and has been associated with increased hospital mortality and long-term mortality . Undernutrition is a factor causing hypoalbuminemia . The PICNIC study results show that a nutritional intervention in undernourished acute HF patients reduces the risks of all-cause death and of readmission for HF . We aim ed to investigate whether the efficacy of a nutritional intervention is consistent among the subgroups of patients with and without hypoalbuminemia . METHODS In PICNIC study , a total of 120 malnourished hospitalized patients due to acute HF were r and omized to conventional HF treatment or conventional HF treatment combined with an individualized nutritional intervention . The primary endpoint was a composite of all-cause death or readmission for worsening of HF , with a maximum follow-up of 12 months . In this post-hoc sub- analysis we assessed the interaction of the effects of a nutritional intervention among patients with and without hypoalbuminemia . Analysis was by intention to treat . RESULTS 59 ( 49,2 % ) patients demonstrated hypoalbuminemia and 61 ( 50,8 % ) had normalbuminemia  . At 12 months , the number of events for the primary endpoint in the intervention group compared with the control group was consistent among patients with hypoalbuminemia ( 28.6 % intervention vs 61.3 % control , HR 0,35 , 95 % CI 0,15 - 0,81 ) and those without ( 25.8 % intervention vs 60 % control , HR 0,35 , 95 % CI 0,15 - 0,79 ; interaction p = 0,86 ) . CONCLUSION There was no evidence that the relative efficacy of a nutritional intervention in undernourished acute HF patients was different between patients with normalbuminemia and those with hypoalbuminemia BACKGROUND Wasting in chronic heart failure ( CHF ) has long been known but is little investigated . We sought to find out whether the cachectic state in CHF provides additional prognostic information about all-cause mortality . METHODS Between June , 1993 , and May , 1995 , we studied 171 consecutive patients with CHF ( mean age 60 years [ SD 11 ; range 27 - 86 ] ; 17 female ) . We assessed exercise capacity ( peak oxygen consumption ; mean 17.5 mL kg-1 min-1 [ 6.7 ] ) , functional status ( New York Heart Association [ NYHA ] class : 21 class I , 63 class II , 68 class III , 19 class IV ) , and left-ventricular ejection fraction ( mean 30 % [ SD 15 ] ; n = 115 ) . The cachectic status was defined prospect ively as a non-intentional documented weight loss of at least 7.5 % of previous normal weight ( 28 patients ; range 9 - 36 % or 6 - 30 kg ) during at least 6 months . The Cox proportional-hazards model was used to assess the association of variables with survival , and Kaplan-Meier cumulative survival plots were constructed to estimate the influence of risk factors . FINDINGS At the end of follow-up in November , 1996 , 49 patients had died ( after a mean 324 days [ SD 283 ] ) . The mean follow-up of the survivors was 834 days ( SD 186 ; range 549 - 1269 ) . The cachectic state was predictive of 18-month mortality independent of age , NYHA class , left-ventricular ejection fraction , and peak oxygen consumption . Mortality in the cachectic patients ( n = 28 ) was 18 % at 3 months , 29 % at 6 months , 39 % at 12 months , and 50 % at 18 months . Patients who had a peak oxygen consumption below 14 mL kg-1 min-1 ( n = 53 ) had mortality at 3 , 6 , 12 , and 18 months of 19 % , 30 % , 40 % , and 51 % . 18-month survival was 23 % ( 95 % CI 0 - 46 ) for the 13 patients with both of these risk factors ( cachexia and low peak oxygen consumption ) compared with 93 % ( 88 - 98 ) in those ( n = 103 ) with neither risk factor ( p < 0.0001 ) . INTERPRETATION The cachectic state is a strong independent risk factor for mortality in patients with CHF . Combined with a low peak oxygen consumption , it identifies a subset of patients at extremely high risk of death . Assessment of cachexia should be included in transplant programmes and studies that investigate the effect of interventions by survival analyses BACKGROUND Taurine ( 2-aminoethanesulfonic acid ) is a semi-essential amino acid found in mammalian tissues that is not involved in protein synthesis . The function of taurine is not completely understood . Some studies have demonstrated that taurine supplementation reduces death rate in rabbits with heart failure ( HF ) and diminishes HF severity in human models of congestive HF . In this study we have evaluated the effect of taurine supplementation on exercise capacity of patients with HF . METHODS A r and omized single-blind placebo-controlled clinical trial was conducted on 29 patients with HF with left ventricular ejection fraction ( LVEF ) less than 50 % who were in functional class II or III according to New York Heart Association classification . A total of 15 patients received taurine supplementation 500 mg three times a day while the remaining 14 patients received placebo for 2 weeks . All patients performed exercise tolerance test before and after taurine and placebo supplementation . RESULTS The mean age of patients was 60.57 ± 6.54 years , they were mostly male ( 26 of 29 ) , and had mean LVEF of 29.27 ± 6.97 % . There were no significant differences in terms of LVEF , body mass index , and also exercise time , metabolic equivalents ( METS ) and exercise distance before supplementation . Exercise time , METS , and exercise distance increased significantly in patients who received taurine supplement for 2 weeks ( p-value<0.0001 for all ) , but did not increase significantly in patients who received placebo ( p-values 0.379 , 0.244 , and 0.577 respectively ) . CONCLUSION Taurine supplementation in patients with HF who are taking st and ard medical treatment can increase their exercise capacity BACKGROUND The relationship between quality of life ( QoL ) and survival have been poorly investigated . The aim of this study was to determine the value of QoL score as a prognostic factor in a prospect i ve cohort of patients with advanced chronic heart failure ( CHF ) . METHODS QoL assessment was performed with a generic question naire : the Duke Health Profile ( DHP ) and a disease-specific instrument : the Minnesota Living With Heart Failure Question naire ( LIhFE ) , in a sample of 108 patients registered in the EPICAL program ( hospitalised patients with severe CHF defined by a NYHA grade III/IV , oedema or hypotension , and LVEF < 30 % ) . Prognostic value of general , physical , mental and social dimensions on survival and hospital-free survival were tested in a Cox model . RESULTS One-year survival rate was 76 % , 1-year hospital-free survival 38 % . QoL was significantly associated with outcomes : for both question naires , a 10-point decrement in baseline score was associated with a 23 - 36 % increase in the risk of death or hospitalisation for heart failure . For hospital-free survival , this relationship remained significant after adjustment for others prognostic factors . CONCLUSION  QoL score  is a predictive factor of survival and an independent predictive factor of hospital-free survival in patients with advanced CHF . This assessment may provide additional information for clinical management and therapeutic decisions We investigated whether 30 days of oral supplementation with a special mixture of amino acids ( AAs ) , together with conventional therapy , could improve exercise capacity in elderly out patients with chronic heart failure ( CHF ) . A group of 95 out patients ( 12 women and 83 men ; New York Heart Association class II-III ) aged 65 - 74 years were studied . This was a r and omized , double-blind , placebo-controlled study . The patients performed a basal exercise test and were then r and omly assigned to a special oral nutritional mixture of AAs 4 g twice daily ( n = 43 ) or placebo ( n = 42 ) . After 30 days we repeated the exercise test . In both tests we measured the following : oxygen consumption ( VO2 ) , CO2 production ( VCO2 ) , minute ventilation ( VE ) , oxygen cost of ventilation ( VO2/VE ) , CO2 elimination per liter of ventilation ( VCO2/VE ) , respiratory exchange ratio ( RER ; calculated as VCO2/VO2 ) , oxygen pulse ( VO2/heart rate [ HR ] ) and anaerobic metabolism during exercise ( ANA-VO2 ) . At day 30 , exercise capacity in the AA group had improved ( + 11 + /- 8 W , p < 0.01 ; + 67.5 + /- 44 seconds , p < 0.02 ) . This improvement was associated with both reduced circulatory dysfunction and increased peripheral oxygen availability . Indeed , peak VO2 increased by 1.2 + /- 1.1 mL/kg per min ( + 12.7 % + /- 13 % ; p<0.02 ) and VO2/HR improved by 1.5 + /- 1.4 mL O2 per heartbeat ( p < 0.05 ) . ANA-VO2 was reduced by > 50 % in patients on AAs ( from 20.2 + /- 10 mL/kg at day 0 to 10.9 + /- 5 mL/kg at day 30 ; p < 0.02 ) . These variables did not significantly change for patients who received placebo . In conclusion , the study showed that oral AA supplementation , in conjunction with st and ard pharmacologic therapy , appears to increase exercise capacity by improving circulatory function , muscle oxygen consumption , and aerobic production of energy in elderly out patients with CHF
Malnutrition is common in heart failure ( HF ) , and it is associated with higher hospital readmission and mortality rates .
This review aims to answer the question whether nutritional interventions aim ing to increase protein and energy intake are effective at improving outcomes for patients with HF who are malnourished or at risk of malnutrition or cachexia .