Rehabilitation Nutrition for Acute Heart Failure on Inotropes with Malnutrition, Sarcopenia, and Cachexia: A Case Report

Abstract

M ALNUTRITION COMMONLY occurs in patients with heart failure. In patients with acute heart failure, 23.1% are malnourished and 51.9% are at risk of malnutrition. Malnourished patients with heart failure can experience all causes of adult malnutrition, such as acute illness or injury, chronic illness, and social or environmental circumstances. An association has been demonstrated between heart failure and micronutrient status, such as deficiencies in vitamins A, C, D, and E, thiamine, other B vitamins, selenium, zinc, and copper. Cachexia, a complex metabolic syndrome associated with underlying illness and characterized by muscle loss with or without a loss of fat mass, significantly decreases quality of life and survival in patientswith heart failure. Active screening for malnutrition and individualized dietary interventions may be appropriate in patients with cardiac cachexia. Exercisebased rehabilitation for patients with chronic heart failure confers important improvements in exercise capacity and health-related quality of life, and reduces the risk of hospital admissions. Aerobic exercise training for cardiac cachexia can also recycle and enhance protein expression and enzyme activities, thereby counteracting impairments in metabolism and muscle atrophy. Therefore, nutritional management and rehabilitation are both imperative inpatientswith heart failure. Sarcopenia can be common in patients with heart failure. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Primary sarcopenia is age-related when no other cause is evident. Secondary sarcopenia is considered when one or more other causes are evident, such as inactivity, disease, and/or malnutrition. Muscle wasting has been detected in 19.5% patients with chronic heart failure. Therefore, combating sarcopenia in patients with heart failure is important. Rehabilitation nutrition is a combination of both rehabilitation and nutrition care management with the purpose of maximizing functionality in people with disabilities. Rehabilitation nutrition may improve outcomes in malnourished and disabled patients with heart failure. However, no case of heart failure with malnutrition, sarcopenia, and cachexia treated by rehabilitation nutrition has been reported. In this article, we report a case of rehabilitation nutrition for heart failure complicated with malnutrition, sarcopenia, and cachexia.