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ARTICLE

Is nutritional intake adequate in chronic heart failure patients?

Roberto Aquilani, MD^*, Cristina Opasich, MD, Manuela Verri, PhD, Federica Boschi, PhD, Oreste Febo, MD, Evasio Pasini, MD^|| and Ornella Pastoris, PhD^,*

^* Servizio di Fisiopatologia Metabolico-Nutrizionale e Nutrizione Clinica, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano-Pavia, Italy
Divisione di Cardiologia, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Pavia, Pavia, Italy
Dipartimento di Scienze Fisio-Farmacologiche, Sezione di Farmacologia, Università degli Studi di Pavia, Pavia, Italy
Divisione di Cardiologia-Unità Scompenso, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano-Pavia, Italy
^|| Centro di Ricerca Cardiovascolare, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Gussago, Brescia, Italy

Manuscript received December 18, 2002; revised manuscript received March 25, 2003, accepted April 17, 2003.

^* Reprint requests and correspondence: Dr. Pastoris Ornella, Sezione di Farmacologia e Biotecnologie Farmacologiche, Facoltà di Scienze MM.FF.NN., Università degli Studi di Pavia-Piazza Botta 11, 27100 Pavia, Italy.
orpast{at}unipv.it

OBJECTIVES: The goal of this study was to investigate the nutrition adequacy and energy availability for physical activity in free-living, clinically stable patients with chronic heart failure (CHF).

BACKGROUND: Little information exists regarding the nutrition adequacy and alimentary habits of patients with clinically stable CHF. We hypothesized that CHF patients have an inadequate intake of calories and protein, leading to a negative calorie and nitrogen balance, an expression of increased tissue breakdown.

METHODS: In 57 non-obese patients with CHF (52 males and 5 females; 52 ± 3 years; body mass index <25 kg/m²) and in 49 healthy subjects (39 males and 10 females) matched for age, body mass index, and sedentary life style we evaluated total energy expenditure (TEE), calorie intake (kcal_I), and nitrogen intake (N_I) from a seven-day food diary, total nitrogen excretion (TNE), and energy availability (EA = kcal_I – resting energy expenditure). A zero calorie balance (CB) occurred when kcal_I = TEE; a nitrogen balance (NB) in equilibrium was set at NB (= N_I – TNE) 0 ± 1 g/day.

RESULTS: In patients and controls kcal_I and N_I were similar. However, in CHF patients the kcal_I was <TEE with a consequent negative CB (–186 ± 305 kcal/day vs. + 104.2 ± 273 kcal/day of controls; p < 0.01). Nitrogen balance resulted negative in CHF (–1.7 ± 3.2 g/24 h vs. + 2.2 ± 3.6 g/24 h in controls; p < 0.01). Energy availability in CHF patients was 41% lower than in controls (p < 0.05).

CONCLUSIONS: Non-obese, free-living patients with clinically stable CHF have an inadequate intake of calories and protein and reduced energy availability for physical activity.

Abbreviations and Acronyms   AMA = arm muscle area   BW = body weight   CB = calorie balance   CHF = chronic heart failure   CHO = carbohydrates   CNB = calorie-nitrogen balance   EA = energy availability   HB = Harris-Benedict equation   kcalI = daily calorie intake   NB = nitrogen balance   NI = daily nitrogen intake   REE = resting energy expenditure   TEE = total energy expenditure   TNL = total nitrogen loss   UNE = urine nitrogen excretion

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