nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-196-12-62-73nogr-1801Research ArticleОБЗОРREVIEWСовременные аспекты питания при хронической сердечной недостаточностиThe Modern Aspects of Nutrition during Chronic Heart Failurehttps://orcid.org/0000-0003-4839-9578СаликоваС. П.SalikovaS. P.

Саликова Светлана Петровна, д. м. н., доцент, доцент 2 кафедры терапии усовершенствования врачейSPIN: 2012–8481

194044, Санкт-Петербург, улица Академика Лебедева, д. 6

Svetlana P. Salikova, doctor of medical Sciences, associate Professor of 2nd Therapy department of postgraduate educationSPIN: 2012–8481

194044, St. Petersburg, Akademika Lebedev street, 6

https://orcid.org/0000-0002-1095-8787ГриневичВ. Б.GrinevichV. B.

Гриневич Владимир Борисович, д. м. н., профессор, заведующий 2 кафедрой терапии усовершенствования врачейSPIN: 1178–0242Scopus Author ID: 7005167197

194044, Санкт-Петербург, улица Академика Лебедева, д. 6

Vladimir B. Grinevich, doctor of medical Sciences, Professor, Head of 2nd Therapy department of postgraduate educationSPIN: 1178–0242Scopus Author ID: 7005167197

194044, St. Petersburg, Akademika Lebedev street, 6

https://orcid.org/0000-0002-7915-3792ВласовА. А.VlasovA. A.

Власов Андрей Александрович, к. м. н., соискатель 2 кафедры терапии усовершенствования врачейSPIN: 2801–1228

194044, Санкт-Петербург, улица Академика Лебедева, д. 6

Andrey A. Vlasov, candidate of medical SciencesSPIN: 2801–1228

194044, St. Petersburg, Akademika Lebedev street, 6

tuv2@vmeda.orgФГБВОУ ВО «Военно-медицинская академия имени С. М. Кирова» МО РФРоссияMilitary Medical Academy named after S. M. KirovRussian Federation2021150120220126273Copyright © Саликова С.П., Гриневич В.Б., Власов А.А., 20222022Саликова С.П., Гриневич В.Б., Власов А.А.Salikova S.P., Grinevich V.B., Vlasov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1801

Питание занимает одно из важных мест в программах профилактики и немедикаментозной терапии ХСН и ассоциированных с ней заболеваний. При этом обоснованность диетических рекомендаций больным в отношении потребления соли, пищевых привычек и использования отдельных нутрицевтиков вызывает вопросы.

Целью настоящего обзора стало представление современных данных клинических и экспериментальных исследований, касающихся ограничения натрия, использования различных диет, нутрицевтиков, средств для коррекции дисбиоза кишечника при ХСН.

Материалы и методы: поиск статей проводили в базах данных eLIBRARY.RU и Medline по ключевым терминам и их сочетаниям: «сердечная недостаточность», «диета», «питание», «сердечная кахексия», «нутритивная поддержка», «нутрицевтик», «поваренная соль», «ограничение натрия», «биологически активная добавка», «пробиотик», «пребиотик», «энтеральное питание» на русском и английском языках. Отбирали статьи, содержащие результаты клинических и экспериментальных исследований, опубликованные с 1997 по 2021 гг.Данные исследований свидетельствуют, что в основе патогенеза анорексии, мальнутриции и «метаболического ремоделирования» миокарда при ХСН лежат сложные механизмы, определяемые застойными явлениями в печени, нарушением проницаемости отечной кишечной стенки, дисбиозом и хроническим системным воспалением. Обоснованы рекомендации по потреблению натрия от 2 до 2,5 г/сут и поваренной соли от 5 до 6 г/сут пациентами с ХСН. Ограничение потребления жидкости актуально только при декомпенсации ХСН. Использование средиземноморской и антигипертензивной (DASH) диет большинством авторов признано перспективным направлением профилактики и лечения ХСН. Обосновано обогащение рациона питания больных ХСН ω-3 полиненасыщенными жирными кислотами, коэнзимом Q10, пищевыми волокнами, полифенолами и сапонинами. Показана польза энтерального питания и комплексного применения нутрицевтиков с целью замедления прогрессирования потери веса, уменьшения выраженности нейрогормональных и провоспалительных сдвигов. Перспективными направлениями исследований являются создание персонифицированных диет с учетом особенностей течения ХСН, статуса питания, состава кишечной микробиоты и ее метаболитов.

Nutrition occupies one of the important places in the programs of prevention and non-drug therapy of CHF and associated diseases. At the same time, the validity of dietary recommendations to patients regarding salt intake, dietary habits and the use of individual nutraceuticals is questionable. The purpose of this review is to present up-to-date data of clinical and experimental studies concerning sodium restriction, the use of various diets, nutraceuticals, and means for correcting intestinal dysbiosis in CHF. Materials and methods: the articles are searched in the databases eLibraryRU and Medline by key terms and their combinations: “heart failure”, “diet”, “sodium restriction”, “nutraceuticals”, “nutrition”, “cardiac cachexia”, “nutritional support”, “salt”, “dietary supplement”, “probiotic”, “prebiotic”, “enteral nutrition” in Russian and English. We select articles containing the results of clinical and experimental studies published from 1997 to 2021. The research data indicate that the pathogenesis of anorexia, malnutrition and “metabolic remodeling” of the myocardium in CHF is based on complex mechanisms determined by stagnant phenomena in the liver, impaired permeability of the edematous intestinal wall, dysbiosis and chronic systemic infl ammation. The recommendations on the consumption of sodium from 2 to 2.5 g/day and table salt from 5 to 6 g/day in patients with CHF are justified. Limitation of fluid intake is relevant only for decompensation of CHF. The use of the Mediterranean and antihypertensive (DASH) diets is recognized by most authors as a promising direction for the prevention and treatment of CHF. The enrichment of the diet of patients with CHF with ω-3 polyunsaturated fatty acids, coenzyme Q10, dietary fibers, polyphenols and saponins is justified. The benefits of enteral nutrition and the complex use of nutraceuticals in order to slow the progression of weight loss, reduce the severity of neurohormonal and pro-inflammatory shifts are shown. Promising trends of research are the creation of personalized diets taking into account the peculiarities of the course of CHF, the nutritional status, the composition of the intestinal microbiota and its metabolites.

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The authors declare that there are no conflicts of interest present.