4. Discussion
muscle mass, nutritional deficits, obesity, HF, skeletal muscle mass, muscle mass gain, cachexia, sarcopenia, adipose tissue reduction, sarcopenic obesity, overweight, Sarcopenia, non-obese, weight loss
OBESITY, OBESE, SARCOPENIA, SARCOPENIA, HEART FAILURE
In the scenario of HF, loss of muscle mass and strength are of special concern, as they may impair overall quality of life and even survival, and interventions that improve muscle mass and strength are therefore desirable. This study showed that, in patients with chronic HF, the use of WPI, even without concomitant exercise training, was associated with positive outcomes in terms of body composition and skeletal muscle mass. The benefits obtained even in the absence of exercise display an especially important opportunity, as HF patients are often unable to exercise, either due to inherent physical limitations or due to reduced access to cardiac rehabilitation services.In this study, a high proportion of the study participants had sarcopenia. This is in line with data showing an elevated prevalence of sarcopenic obesity in HF [Sarcopenia was associated with an increased risk of poor prognosis (mortality and hospitalizations), with a combined hazard ratio of 1.64. Besides these harder outcomes, loss of muscle mass may contribute to frailty and reduction of exercise capacity of patients with HF [Regarding dietary composition, the daily protein intake per kilogram of body weight was found to be below appropriate levels for patients with HF at baseline, even though the percentage of protein intake was within normal limits. This reinforces the importance of routine dietary assessment of patients with HF, as nutritional deficits may go unnoticed, although it has long been demonstrated that patients with chronic stable HF often have an inadequate intake of calories and protein [Results from a 57-patient nitrogen balance study in non-obese patients with HF, compared with 49 control subjects, suggested that a higher protein goal of 1.1 g/kg or greater may be necessary [Interestingly, inadequate consumption of lipids was observed [Some small studies have shown that supplementation of unsaturated fatty acids from dietary sources can have a beneficial effect in patients with HF [Of note, HF patients were frequently overweight or obese at baseline. It is known that sarcopenia can occur earlier than cachexia in the body-wasting process in HF and may not be associated with weight loss [A nutritional solution to minimize the loss of muscle mass in heart failure, even in obese individuals, would be of great relevance in clinical practice. Ideally, it would be interesting for the nutritional supplement not only to stimulate net body protein gain, but also to do so with minimal caloric intake. HF is increasingly being associated with obesity, and a nutritional formulation that significantly increases caloric intake would be undesirable [With WPI, there was a significant increase in skeletal muscle mass (0.6 ± 0.7 kg) after 12 weeks. Prior studies had described the effects of WPI on muscle mass gain, but with associated exercise training [In another report, 23 obese elderly patients with HF with preserved ejection fraction were randomized into three groups: control, whey protein supplementation alone, and whey protein plus light exercise. As in the current study, protein supplementation alone failed to improve physical performance; however, when combined with light exercise, it improved walking speed and quadriceps strength [Overall, WPI supplementation has demonstrated beneficial effects on body composition, with a decrease in body fat mass, BMI, and WC, and an increase in lean body mass [In patients with HF, high-protein diets have also been demonstrated to be advantageous for weight loss and adipose tissue reduction [