NUTRITIONAL INTERVENTIONS AND CLINICAL MANAGEMENT IN THE TREATMENT OF CARDIAC CACHEXIA

Abstract

Cardiac cachexia is a severe and multifactorial complication of heart failure (HF), characterized by malnutrition, severe loss of skeletal muscle mass, catabolic metabolic imbalance, and systemic inflammation, being an independent predictor of morbidity and mortality. This pathological state worsens the progression of HF, leading to reduced functional capacity and increased hospitalizations. This narrative review examines current nutritional interventions and clinical management strategies for this condition, focusing on evidence from the last ten years available in PubMed. Studies highlight Growth Differentiation Factor 15 (GDF15) as a critical biomarker and a promising therapeutic target, whose antagonism may prevent cachexia and delay worsening of cardiac function. Management strategies should be multidisciplinary, focusing on adequate protein supplementation (1.0 to 1.2 g/kg/day), the use of leucine metabolites such as beta-hydroxy-beta-methylbutyrate (HMB), and correction of Vitamin D deficiency to modulate inflammation. Aerobic and resistance exercise constitutes the most robust intervention to attenuate muscle catabolism and reduce myostatin levels and should be integrated with optimized guideline-directed pharmacological therapy. It is concluded that successful management of cardiac cachexia depends on the early and combined application of hyperproteic nutritional support, physical rehabilitation, and optimized pharmacological management.