Last update:
03-Jun-2018

Heart failure is often accompanied by severe malnutrition, which in combination with chronic inflammation, neurohormonal activation and reduced physical activity, is involved in the vicious cycle of heart failure, with progressive deterioration to cardiac cachexia. To date no specific treatment has been found for the cardiac cachexia syndrome. Although several alternative therapeutic trials have been investigated, the main treatment strategy for cardiac cachexia consists of nutritional intervention and exercise training. The main goal of nutritional intervention is maintenance of the body weight (without edema) within the normal range or slightly lower, and the avoidance of further tissue loss with long-term energy substrate restoration. No specific recommendations have been published for macroand micronutrient ingredients. Patients should cover their daily caloric needs according to their activities, with individualized increases in the amount of proteins and sufficient vitamins and electrolytes. Particular attention should be paid to the needs of those patients with renal dysfunction or gut malabsorption and those on chronic diuretic treatment. Prolonged periods of fasting should be avoided. Enteral nutrition is the method of choice, if feasible, but parenteral supplementation may be indicated. Exercise training, and particularly aerobic training and or strength training, are strongly recommended for improving skeletal muscle abnormalities in heart failure with cachexia. Exercise training induces beneficial effects in protein synthesis, with anabolic, anti-inflammatory and anti-oxidative stress effects. Further study is needed to investigate the pathophysiological mechanisms of the cardiac cachexia syndrome and to develop specific preventive and therapeutic strategies.

Key words: Cardiac cachexia, Exercise, Heart failure, Nutritional disorders.