Diet and ejection fraction
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Diet and Ejection Fraction: Key Insights
Diet and Heart Failure With Preserved Ejection Fraction (HFpEF)
Research shows that diet plays a significant role in the development and management of heart failure with preserved ejection fraction (HFpEF). High-fat diets, especially when combined with other risk factors like hypertension, can lead to obesity, insulin resistance, and diastolic dysfunction while maintaining a normal ejection fraction in animal models. These models closely mimic human HFpEF, showing features such as left ventricular hypertrophy, increased natriuretic peptides, and exercise intolerance. Importantly, dietary interventions and certain medications can improve these outcomes, suggesting that diet is a modifiable factor in HFpEF progression and management 110.
Dietary Patterns, Nutrient Composition, and Cardiac Function
Studies in both humans and animals indicate that the type of fat and sugar in the diet matters. Diets high in unsaturated fatty acids (UFA) and low in sugars are associated with better cardiorespiratory fitness, improved diastolic function, and preserved myocardial function in HFpEF patients and animal models. Conversely, high-sugar and unhealthy fat consumption are linked to worse outcomes. These findings highlight the potential benefit of increasing UFA intake and reducing sugar consumption for patients with HFpEF .
Salt Intake and Diastolic Function
High-salt diets can induce hypertension and HFpEF, as seen in animal studies. Reducing salt intake after HFpEF has developed can improve diastolic function and reduce lung congestion, although it may not significantly lower blood pressure or affect arrhythmia risk. This suggests that salt reduction is beneficial for heart function and congestion, even if some cardiovascular risks remain .
Caloric and Carbohydrate Restriction
Meta-analyses and systematic reviews show that caloric restriction can lead to meaningful improvements in blood pressure, body weight, and functional status in HFpEF patients. Carbohydrate restriction also helps lower blood pressure. However, the quality of evidence is moderate to low, and more rigorous studies are needed to confirm these benefits and develop clear dietary guidelines for HFpEF 47.
Plant-Based Diets and Ejection Fraction in HFrEF
For patients with heart failure with reduced ejection fraction (HFrEF), a defined plant-based diet has been associated with improvements in left ventricular ejection fraction, reduced medication needs, weight loss, and better quality of life. These findings, though based on small case series, suggest that plant-based diets may be a promising adjunct therapy for HFrEF, especially in patients not responding to standard treatments .
Amino Acid Supplementation and Systolic Function
Manipulating dietary amino acids, particularly increasing essential amino acids, has shown preventive and therapeutic effects in animal models of HFrEF. This approach improves glucose metabolism, mitochondrial function, and cardiac energy production, leading to better systolic function. These results suggest that targeted amino acid supplementation could be a useful strategy for managing HFrEF .
Diet, Obesity, and Comorbidities
Obesity and metabolic syndrome, often driven by high-fat diets, are closely linked to the development of HFpEF. Animal models confirm that long-term high-fat feeding leads to diastolic dysfunction, cardiac remodeling, and preserved ejection fraction, mirroring the human condition. These models are valuable for testing new therapies and understanding the impact of diet on heart failure 1109.
Conclusion
Diet has a clear impact on both preserved and reduced ejection fraction in heart failure. High-fat, high-sugar, and high-salt diets contribute to the development and worsening of HFpEF and HFrEF, while dietary interventions—such as caloric restriction, plant-based diets, increased unsaturated fats, and amino acid supplementation—show promise in improving cardiac function and patient outcomes. However, more high-quality, controlled studies are needed to establish definitive dietary recommendations for heart failure patients.
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