Ernährung bei Herzinsuffizienz
Abstract
Zusammenfassung. Trotz der Komplexität der Thematik hat die Ernährungsmedizin in den letzten Jahren wichtige Fortschritte gemacht, auch bezüglich kardiovaskulärer Gesundheit und Patient_innen mit Herzinsuffizienz. Dabei gibt es recht gute Evidenz zu spezifischen Ernährungsformen, wie der mediterranen und pflanzenbasierten Kost, aber auch zu einzelnen Mikronährstoffen, wie der intravenösen Eisensubstitution eines Eisenmangels bei Herzinsuffizienz. Bezüglich der empfohlenen Salzmenge bei Herzinsuffizienz können noch keine genauen Mengenangaben gemacht werden, wobei die Aufnahme hoher Salzmengen (>12 g/Tag) vermieden werden sollte. In Anbetracht der Gefahr einer Mangelernährung bei diesem vulnerablen Patientenkollektiv ist bei einigen Betroffenen eine individualisierte Ernährungstherapie sinnvoll. Dies setzt ein gezieltes Screening auf Mangelernährung voraus. Die ernährungsmedizinische Forschung bietet noch grosses Potenzial zur Beantwortung weiterer Fragen bei Herzinsuffizienz. Dazu sind weitere randomisiert kontrollierte Studien und deren Metaanalysen erforderlich. In den vorliegenden Studien wurde z.B. zu wenig auf Unterschiede der Ernährung bei verschiedenen Formen und Stadien der Herzinsuffizienz eingegangen. Voraussetzung zur bestmöglichen Behandlung der Patient_innen mit Herzinsuffizienz ist eine interdisziplinäre Zusammenarbeit zwischen Kardiolog_innen, Internist_innen, Hausärzt_innen und Ernährungstherapeut_innen.
Abstract. Despite the complexity of the subject, nutritional medicine has made important advances in recent years, especially regarding cardiovascular health and for patients with heart failure. There is quite good evidence on specific diets, such as the Mediterranean and plant-based diets, but also on individual micronutrients, such as intravenous iron supplementation of iron deficiency in heart failure. No precise quantities can yet be named when dealing with the recommended amount of salt in heart failure patients, but the intake of high amounts of salt (>12 g/day) should be avoided. Considering the risk of malnutrition in this vulnerable patient population, an individualized nutritional therapy is advisable for some patients. This requires targeted screening for malnutrition. Nutritional medicine research still lacks many answers to further questions regarding heart failure patients. More randomized controlled trials and their meta-analyses are therefore required. Studies available so far have – among other shortcomings – paid too little attention to differences in nutrition in the different types and stages of heart failure. Interdisciplinary collaboration between cardiologists, hospital internists, general practitioners and nutritional therapists is in any case crucial for optimal treatment of patients with heart failure.
Résumé. Malgré la complexité du sujet, la médecine nutritionnelle a fait des progrès importants au cours des dernières an- nées, notamment en ce qui concerne la santé cardiovasculaire et les personnes souffrant d’insuffisance cardiaque. Il existe d’assez bonnes preuves concernant des formes spécifiques d’alimentation, comme le régime méditerranéen et le régime à base de plantes, mais aussi concernant certains micronutriments, comme la substitution intraveineuse de fer en cas de ca- rence en fer chez les insuffisants cardiaques. En ce qui concerne la quantité de sel recommandée en cas d’insuffisance car- diaque, il n’est pas encore possible de donner des indications précises sur les quantités, sachant néanmoins que l’absorption de quantités élevées de sel (>12 g/jour) devrait être évitée. Compte tenu du risque de malnutrition chez ce groupe de patients vulnérables, une thérapie nutritionnelle individualisée s’impose chez certaines personnes concernées. Cela présuppose un dépistage ciblé de la malnutrition. La recherche en médecine nutritionnelle offre encore un grand potentiel pour répondre à d’autres questions en cas d’insuffisance cardiaque. Pour cela, d’autres études randomisées contrôlées et leurs méta-analyses sont nécessaires. Jusqu’à présent, les études disponibles n’ont par exemple pas suf- isamment abordé les différences d’alimentation en fonction des formes et des stades de l’insuffisance cardiaque. La condition préalable au meilleur traitement possible des patients souffrant d’insuffisance cardiaque est une collaboration interdisciplinaire entre cardiologues.
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