Dietary Sodium Restriction in Patients With Heart Failure

Dietary Sodium Restriction in Patients With Heart Failure Posted By:
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There are about 6.2 million adults in the United States living with heart failure (HF), according to the Centers for Disease Control and Prevention. It is well known that in patients with HF, high sodium intake can lead to frequent exacerbations, and, for years, sodium and fluid restrictions to prevent fluid overload and adverse outcomes have been first-line nonpharmacologic strategies recommended for patients with HF by several expert guidelines—even without national consensus. While restricting dietary sodium intake is one of the more common interventions used in these patients, the impact of the amount of dietary sodium restriction on clinical outcomes remains controversial.

A recent trial randomly assigned more than 800 patients with stable HF to a low sodium diet (<1.5 g/day) or usual care. Average sodium intake was 1.658 g/day in the low sodium group compared with 2.073 g/day in the usual care arm. Results demonstrated that rates of all-cause mortality, cardiovascular-related hospitalization, and cardiovascular-related emergency department visits were similar between the treatment groups. Changes in body weight and caloric consumption were also similar between the groups throughout the 12-month study period . The evaluation of sodium-restricted diets on quality of life and physical functioning in other studies has resulted in inconsistent findings.

In a systematic review article exploring the effect of dietary sodium restriction on quality of life in patients with HF, authors speculate why dietary sodium restriction may not be beneficial. When speculating this, the authors cited reasons that included low sodium-induced hyponatremia, activation of antidiuretic and antinatriuretic systems, poor appetite, low caloric intake, and malnutrition. The authors also stressed the importance of considering a patient's quality of life in determining clinical improvements. It was stated that patient's quality of life was often overlooked as a measure of a patient's condition by clinicians because "it cannot reflect more objective indicators of health status."

Patients with HF have various degrees of adherence behaviors toward low-sodium diets—due to a multitude of lifestyle and other factors—which also may play a role in HF exacerbations. Therefore, authors recommended that clinicians should consider all aspects of a patient's life, including quality, when predicting their ability to adhere to low-sodium dietary restrictions.

More research is needed before we can make a definitive statement on what dietary sodium restrictions are most beneficial in HF.

Reference
Zhu C, Cheng M, Su Y, Ma T, Lei X, Hou Y. Effect of dietary sodium restriction on the quality of life of patients with heart failure: a systematic review of randomized controlled trials. J Cardiovasc Nurs. Published online December 23, 2021. doi:10.1097/JCN.0000000000000880

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Filed under: Pulmonary Medicine , Cardiometabolic

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