Nutrition in Clinical Practice

 

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Nutrition in Clinical Practice, Vol. 23, No. 5, 477-486 (2008)
DOI: 10.1177/0884533608323429

Clinical Dilemma

The Heart Failure and Sodium Restriction Controversy: Challenging Conventional Practice

Katherine R. Beich, MS, RD, LD, CNSD1 and Clyde Yancy, MD, FACC, FAHA, FACP2

From the 1 Baylor Transplant Institute, and2 Baylor University Medical Center, Dallas, Texas.

Address correspondence to: Katherine R. Beich, MS, RD/LD, Baylor Transplant Institute, 3500 Gaston Avenue Dallas, TX 75246; e-mail: ke.beich{at}baylorhealth.edu.

Optimal care of patients with heart failure requires a multifaceted approach that includes guideline-driven, evidence-based therapies, intensive patient education, careful initial and follow-up assessment, and appropriately constructed nutrition prescriptions. Central to the construct of the nutrition prescription is advice regarding sodium consumption. It is intuitively and generally agreed upon that sodium restriction is appropriate for patients with heart failure, despite the lack of evidence-based research studies. Whereas limiting sodium is most appropriate for the hypertensive patient at risk for developing heart failure and the patient who is overtly volume overloaded, less certainty exists regarding the sodium prescription for patients with diagnosed heart failure that is well compensated. Sodium intake is only 1 component of medical nutrition therapy, and prescription must be individualized according to nutrition assessment and priority of needs. However, in the absence of new compelling data, sodium restriction remains the most appropriate dietary intervention in general for patients with heart failure.

Key Words: heart failure • hypertension • diet • diet, sodium-restricted • nutrition therapy • sodium


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