4. Discussion
obesity, muscle mass, ankle swelling, fatigue, cardiac cachexia, elevated intra-cardiac pressures, cachexia, inflammation, sarcopenia, reduced cardiac output, cardiac abnormality, HF [, breathlessness, head and neck cancer, malnutrition, Heart Failure
OBESITY, ANKLE SWELLING, MALNOURISHED, PERIPHERAL EDEMA, DISEASE, CLINICAL SYNDROME, SARCOPENIA, INFLAMMATION, MALNOURISHED, HEAD AND NECK CANCER, MALNUTRITION, HEART FAILURE
The European Society of Cardiology defines HF as “a clinical syndrome characterized by typical symptoms (e.g., breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g., elevated jugular venous pressure, pulmonary crackles and peripheral edema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intra-cardiac pressures at rest or during stress” [These patients frequently present malnutrition, within a range of 10–50%, depending on the stage of the disease and according to the parameters used to define malnutrition. In patients with advanced HF, it can progress to cardiac cachexia. Both malnutrition and cachexia have been associated with worse prognosis, period of hospital stay, readmission rate, in-hospital mortality, and overall mortality [Additionally, some patients do not lose weight, despite presenting with overweight or obesity accompanied with sarcopenia. Thus, muscle mass is decreased in quality, quantity, and functionality independently of body weight [A prevalence of sarcopenia of 34% has been previously reported in HF, and is higher in males (37% vs. 33% in females) [According to the Nutritional Intervention Program in Malnourished Patients Admitted for Heart Failure (PICNIC study), individualized nutritional intervention during and after HF admission may have a prognostic benefit. This multicenter clinical trial included 120 malnourished hospitalized patients with acute HF. Patients were randomized to conventional treatment or nutritional intervention (diet optimization, specific recommendations, and nutritional supplement prescriptions if necessary). At the end of the study, all-cause mortality or readmission for worsening of HF was significantly lower in the intervention group (27.1%) compared with the control group (60.7%) [In this context, most experts and cardiology societies recommend a Mediterranean-style diet in these patients, probably due to its anti-inflammatory properties [Generally, it is recommended that hyperproteic OSs could be administered in patients with HF and insufficient oral intake [It is known that patients with HF have elevated circulating levels of pro-inflammatory cytokines; specifically, the innate and adaptive immune systems are activated in HF. Thus, treatment strategies targeting inflammation are a matter of interest in these patients [In clinical nutrition, some nutritional formulas are recommended in specific situations; for example, immunonutrition is currently a standard of care in fast-track abdominal surgery programs, or after surgery in patients with head and neck cancer [This study has some limitations: first the number of participants in each group, which can limit the findings of this study; furthermore, some baseline variables tended to be different in both groups despite there being no statistically significant differences. Ideally, a study with matched controls should be performed, considering that it would not reflect the regular clinical practice. Additionally, we did not supervise the diet daily intake of the patients. Finally, the nutritional intervention was not evaluated alone, which is a frequent limitation in studies regarding nutrition; it was not possible to evaluate the nutritional intervention in an isolated manner, since rehabilitation is currently considered a standard of care in patients with HF [