Enteral Nutrition in Congestive Heart Failure and Cardiac Cachexia
Condition: Chronic Heart Failure; Cardiac Cachexia
MeSH terms: Heart Failure; Wasting Syndrome; Cachexia
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose of this study was to determine the effects of a high caloric drink on weight and
      several other clinical markers including quality of life in patients with unintentional
      weight loss (cachexia) due to chronic heart failure.
    

Detailed description: 
      Cardiac cachexia has been shown to be powerful independent predictor of mortality in patients
      with congestive heart failure (CHF). Unlike starvation, cachectic CHF patients present with a
      decrease of muscles and/or fat tissue. This probably depends, at least in part, on the level
      of inflammatory activation. Theoretically, it seems clear that nutritional status has to be
      improved in cardiac cachexia. It has been suggested that inflammatory activation in CHF may
      be due to endotoxin translocation through the edematous gut wall. Elevated endotoxin levels
      have been found in patients with acutely decompensated CHF, but these levels normalized with
      diuretic treatment. This finding may be of utmost importance. From one side it underscores
      the need for aggressive diuretic treatment to prevent translocation, from another side
      however, it suggests potential area for enteral treatment. Enteral route of nutrition may be
      highly beneficial by diminishing bacterial translocation from guts and/or endotoxin transfer,
      finally resulting in lower inflammatory activation Numerous experimental studies display that
      enteral feeding reduces bacterial translocation, endotoxin absorption and positively
      modulates function of local immune tissue.

      A search of the literature shows that very little is known about the effectiveness of
      nutritional support on functional performance in cachectic CHF patients and actually no
      reports concern the influence of enteral feeding on immune activation of cachectic CHF
      patients. Recent information of some links existing between leptin, which is increased in
      CHF, and inflammatory activation in this syndrome speculate on a functional role of leptin in
      immune activation in CHF. As leptin is one of the most important hormones in the regulation
      of body energy metabolism, we think it is reasonable to look also into enteral feeding
      -induced changes of leptin and concomitant fluctuations of plasma cytokines.

      During the last 12 months we have been using nutritional support in cachectic patients with
      CHF as an adjunct to standard therapy. We were surprised by a significant functional
      improvement that we observed in many instances. As most of these patients were subjected to
      aggressive multi-drug diuretic therapy as well, it was impossible to appreciate the role of
      enteral nutrition in this respect. We think, these observations are worth verification in
      more controlled prospective studies.
    

Intervention name(s): NutriDrink; Placebo
Intervention type(s): Dietary Supplement; Dietary Supplement
Intervention description(s): Nutritional supplementation that contains 600 kcal/day: protein content 20 g, carbohydrates 72 g, fat 26 g; Nutritional supplementation containing only 12 kcal/day
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Heart failure; cachexia