title: Nutritional Interventions in Heart Failure: A Systematic Review of the Literature.
abstract: BACKGROUND
  Heart failure (HF) is a major health care burden and there is a growing need to develop strategies to maintain health and sustain quality of life in persons with HF. The purpose of this review is to critically appraise the components of nutrition interventions and to establish an evidence base for future advances in HF nutrition research and practice.
  
  
  RESULTS
  Cinahl, Pubmed, and Embase were searched to identify articles published from 2005 to 2015. A total of 17 randomized controlled trials were included in this review. Results were divided into 2 categories of nutrition-related interventions: (1) educational and (2) prescriptive. Educational interventions improved patient outcomes such as adherence to dietary restriction in urine sodium levels and self-reported diet recall. Educational and prescriptive interventions resulted in decreased readmission rates and patient deterioration. Adherence measurement was subjective in many studies. Evidence showed that a normal-sodium diet and 1-liter fluid restriction along with high diuretic dosing enhanced B-type natriuretic peptide, aldosterone, tumor necrosis factor α, and interleukin-6 markers.
  
  
  CONCLUSIONS
  Educational nutrition interventions positively affect patient clinical outcomes. Although clinical practice guidelines support a low-sodium diet and fluid restriction, research findings have revealed that a low-sodium diet may be harmful. Future research should examine the role of macronutrients, food quality, and energy balance in HF nutrition.
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland. Electronic address: mabshir1@jhu.edu.
authors.forename: Martha
authors.initials: M
authors.lastname: Abshire
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland; College of Nursing, University of Utah, Salt Lake City, Utah.
authors.forename: Jiayun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Diana
authors.initials: D
authors.lastname: Baptiste
authors.affiliation: Heart Failure Bridge Clinic, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Johana R
authors.initials: JR
authors.lastname: Almansa
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Jingzhi
authors.initials: J
authors.lastname: Xu
authors.affiliation: Heart Failure Bridge Clinic, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Abby
authors.initials: A
authors.lastname: Cummings
authors.affiliation: Academic Affairs, Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Andrews
authors.affiliation: Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dennison Himmelfarb
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004039:Diet, Sodium-Restricted; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000178:diet therapy / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010353:Patient Education as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors
keywords: Diet; fluid restriction; sodium restriction