1. Introduction
HF, muscle atrophy, human diseases, fatigue, illness, Malnutrition, cancer, inflammation, sarcopenia, Sarcopenia, malnutrition, reduced skeletal muscle mass, heart failure, coronary heart disease, impaired muscle function
MUSCLE ATROPHY, MALNUTRITION, CANCER, INFLAMMATION, SARCOPENIA, FRAGILITY, ADVERSE EFFECTS, SARCOPENIA, MALNUTRITION, HEART FAILURE, CORONARY HEART DISEASE
Background: Malnutrition and sarcopenia frequently affect patients with heart failure (HF), in which clinical outcomes and survival is decreased. Thus, appropriate nutritional screening and early nutrition support are highly recommended. Currently, nutritional support is not a standard of care in patients with HF, and the use of commercially available oral supplements (OSs) could provide an additional benefit to medical treatment in these patients. Aim: To compare the effect of the Mediterranean diet in combination with hypercaloric, hyperproteic OS in patients with HF. Patients and methods: An open label, controlled clinical study in which patients were randomly assigned to receive a Mediterranean diet (control group) vs. hypercaloric, hyperproteic OS (intervention group) for twenty-four weeks. Thirty-eight patients were included; epidemiological, clinical, anthropometric, ultrasound (muscle echography of the rectus femoris muscle of the quadriceps and abdominal adipose tissue), and biochemical evaluations were performed. All patients received additional supplementation with vitamin D. Results: Baseline malnutrition according to the GLIM criteria was observed in 30% of patients, while 65.8% presented with sarcopenia. Body cell mass, lean mass, and body mass increased in the intervention group (absolute increase of 0.5, Nutritional support is essential in several human diseases [Sarcopenia is characterized by decreased muscle strength and fatigue due to reduced skeletal muscle mass, which is accompanied by muscle atrophy and decreased quality of muscle tissue. Specifically, muscle fibers are replaced by fibrotic tissue, which results in increased fragility and impaired muscle function [Currently, there are no specific guidelines or recommendations concerning nutritional support in HF [In the 1960s, the Seven Countries Study revealed that coronary heart disease and cancer rates were not elevated in a cohort of four Mediterranean areas: Crete and Corfu in Greece, Dalmatia in Croatia, and Montegiorgio in Italy. Specifically, at that moment, the Greek diet had the highest content of olive oil and was high in fruit, the Dalmatian diet was highest in fish, and the Italian diet was high in vegetables. These results represent the base of the Mediterranean diet, which recommends the consumption of plant food (fruits, vegetables, whole-grain cereals, nuts, and legumes); olive oil as the principal source of fat; moderate amounts of fish and poultry; and relatively low consumption of red meat [The European and American Societies of Enteral and Parenteral Nutrition state that oral nutritional supplements provide additional nutrients, including protein and energy, for people who are not meeting their nutrition needs through food alone, due to decreased appetite or food intake, increased nutrition needs, or poor absorption of nutrients due to illness. Thus, when oral feeding is insufficient, oral nutritional supplementation is indicated; specifically, hypercaloric (1.5–2 kcal/mL) and, if necessary, hyperproteic oral supplements (OS) are generally recommended, since they can improve inflammation status, QoL, and survival in HF patients [Interestingly, a previous multicenter clinical trial has suggested that diet optimization, specific nutritional recommendations, and nutritional supplement prescriptions (when necessary) in patients with HF may have a prognostic benefit during and after hospital admission [Interestingly, it has been described that in patients with HF, left ventricular ejection fraction (LVEF) has a positive predictive value for adverse effects [