HF: Individualize Energy Intake
➤ For adults with HF (NYHA Classes I–IV/AHA Stages B, C and D), the RDN
should individualize energy intake, meeting total estimated energy needs
(RMR, measured or estimated), which is then multiplied by a physical
activity factor] for weight maintenance, the prevention of further weight
gain or loss, and the prevention of catabolism. Research reports that
MNT resulted in maintenance of body weight (one of the goals of MNT
for HF along with effective management of comorbid conditions, such
as hypertension, disorders of lipid metabolism, diabetes mellitus and
obesity. (Strong, Imperative)
HF: Intentional Weight Loss in Obesity and HF
➤ For adults with HF (NYHA Classes I–IV/AHA Stages B and C) who are also
obese, once the patient is considered weight-stable and euvolemic
(sodium, fluid and medication adherent), the RDN may or may not consider
intentional weight loss. Purposeful weight loss via healthy dietary
intervention or physical activity for improving health-related quality of
life or managing comorbidities such as diabetes mellitus, hypertension
or sleep apnea may be reasonable in obese patients with HF. (Weak,
Conditional)
HF: Individualize Protein Intake
➤ For adults with HF (NYHA Classes I–IV/AHA Stages B, C and D), the RDN
should individualize protein intake, prescribing at least 1.1 g protein per
kg actual body weight to prevent catabolism. Research reports that in
patients with HF who are either normally nourished or malnourished,
reported protein intakes ranging from 1.1–1.4 g per kg actual body weight
per day resulted in positive nitrogen balance, while protein intakes
ranging from 1.0–1.1 g per kg actual body weight per day resulted in
negative nitrogen balance. (Fair, Imperative)
HF: Individualize Sodium and Fluid Intake
➤ For adults with HF (NYHA Classes I–IV/AHA Stages B, C and D), the RDN
should individualize sodium and fluid intake, within the ranges of 2000–
3000 mg sodium per day and 1–2 L fluid per day. Research reports that a
sodium intake of 2000–3000 mg per day and fluid intake of 1–2 L
per day resulted in improvements in quality measures (readmissions rate,
length of stay and mortality rate), renal function and clinical laboratory
measures (blood urea nitrogen, creatinine, BNP and serum sodium),
symptom burden (shortness of breath, difficulty breathing when lying flat,
swelling of legs or ankles, lack of energy, and lack of appetite) and body
weight. (Fair, Imperative)
Nutrition Intervention
