• Review: Low-Sodium Diet for HF on Shaky Ground

    Time to 'retreat from an unbridled and potentially harmful insistence' on restriction

    A low-sodium diet has a shaky foundation in heart failure, a systematic review showed.

    Out of more than 2,600 studies on sodium restriction in heart failure, only nine small trials with a total sample of 479 -- none of which were free from bias -- made it into an analysis by a group led by Kamal Mahtani, PhD, of the University of Oxford, England.

    Three studies showed a trend toward limited improvement in chronic stable heart failure outpatients who consumed less salt. And with no solid evidence on harms of cutting dietary salt intake either, they stopped short of calling for a change to current practice for outpatients.

    In contrast, the literature was wholly inconclusive for inpatients admitted with acutely decompensated heart failure, the researchers found.

    "Overall, a paucity of robust high-quality evidence to support or refute current guidance was available. This review suggests that well-designed, adequately powered studies are needed to reduce uncertainty about the use of this intervention," Mahtani and colleagues said.

    "We have long treated the dictum to restrict sodium intake in heart failure as a pillar of best practices and a sacrosanct edict that populates the core database for all physicians treating cardiovascular disease," according to Clyde Yancy, MD, MSc, of Northwestern University Feinberg School of Medicine in Chicago.

    The ongoing SODIUM-HF trial will be helpful, but it's not enough, he suggested.

    "The first step is not a call for more trials but a retreat from an unbridled and potentially harmful insistence on rigorous sodium restriction in those with symptomatic heart failure. To state that we can do better is an understatement; to acknowledge our embarrassment for acting upon uncertain logic is closer to the truth," the editorialist emphasized.

    Sodium restriction in heart failure was a Class I recommendation based on expert consensus in the 2009 guidelines. The 2013 guideline revision downgraded that to a Class IIa (reasonable) recommendation, also based on expert consensus.

    Challenges for researchers include how to gather high-quality evidence in the face of the ubiquity of sodium in westernized diets and the uncertainty that sodium is really "the villain" and not just a surrogate for a more significant nutritional concern, according to Yancy.

     

    Rather than focusing on sodium alone, a whole-diet approach might make more sense, shifting heart failure patients to a Dietary Approaches to Stop Hypertension(DASH) or Mediterranean diet, Yancy suggested.

     

    The study was funded by an award from the U.K. National Health Service National Institute of Health Research School for Primary Care Research.

    Yancy disclosed no relevant conflicts of interest.

    Source:

    JAMA Internal Medicine

    Source Reference: Mahtani KR, et al "Reduced salt intake for heart failure: a systematic review" JAMA Intern Med 2018; DOI: 10.1001/jamainternmed.2018.4673.

     

    JAMA Internal Medicine

    Source Reference: Yancy CW "Sodium restriction in heart failure: too much uncertainty -- do the trials" JAMA Intern Med 2018; DOI: 10.1001/jamainternmed.2018.4653.

     

     

    Read the original article on Medpage Today: Review: Low-Sodium Diet for HF on Shaky Ground

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