Assessment of the effectiveness of standard diets in treatment of obese patients with chronic heart failure

Diet therapy for obesity complicated by the development of chronic heart failure acquires key importance, since it permits to obtain a significant improvement of haemodynamic parameters, optimize pump function of the heart and even smooth some pathophysiological outcomes. However, studies dealing with metabolic specificities in obese patients with chronic heart failure have not been performed on the territory of the Russian Federation, the question of the correspondence of standard diet therapy to specific clinical-metabolic status, needs for dietary fibers and energy in patients with obesity complicated by the development of chronic heart failure has not been investigated.

The objective. To study the effectiveness of standard diets and their impact on metabolic status of obese patients with chronic heart failure.

Patients and methods. The effectiveness of standard diet therapy (a low-calorie diet and a basic diet variant) in treatment of patients with obesity complicated by chronic heart failure was assessed. We analysed parameters of metabolic status: anthropometric values, body composition and basal metabolism.

Results. As has been shown, standard diets have an ambiguous effect on metabolomic measurements in obese patients with chronic heart failure. For instance, the use of the basic diet variant for 14 days was accompanied by marked loss of fat-free (by 7.2%, р = 0.00008) and muscle body mass (by 16.6%, р = 0.00004) against the background of overall body mass reduction by only 2.3% (р = 0.053), body fat – by 8.5% (р = 0.000017), and total body water – by 7.3% (р = 0.0018). Analysis of energy metabolism showed a significant increase of protein oxidation rates – in the group of grades I-II obesity by +13.8 (4.4; 10.7) g/day (р = 0.02), and in the group of patients with grade III obesity by +14.0 (10.3; 22.9) g/day (р < 0.00001) as a result of the administered course of diet therapy. These findings are of extreme importance, since the intensity of protein catabolism in the body directly correlates with the loss of muscle and active body cell mass. This process determines the reaction of inhibition of overall energy metabolism in the body and lays a pathogenetic foundation for recurrent obesity. On the contrary, reduction of protein oxidation rate correlates with predominance of structural protein anabolism in the body and, consequently, determines increased energy metabolism, enhancing the probability of long-term remission of obesity. 

Conclusion. In order to obtain the maximum clinical effectiveness of diet therapy for obesity complicated by chronic heart failure it would be expedient to modify the chemical composition of standard diets so that to optimize and maximally adjust them to the metabolic needs of patients.

Key words: heart failure, obesity, diet therapy.

For citation: Bogdanov A.R., Derbeneva S.A., Zaletova T.S., Naydenova М.А., Nikityuk D.B., Kaganov B.S. Assessment of the effectiveness of standard diets in treatment of obese patients with chronic heart failure. Vopr. dietol. (Nutrition). 2018; 8(1): 5–10. (In Russian).
DOI: 10.20953/2224-5448-2018-1-5-10