Potential role of nutritional factors in coronary heart disease and heart failure
Nutritional factors such as magnesium, folic acid, vitamin B12, vitamin B6, L-arginine, polyunsaturated fatty acids (PUFAs) and adequate intake of protein to maintain normal concentrations of plasma albumin are of benefit for patients with coronary heart disease, and heart failure. These nutritional factors (magnesium, folic acid, vitamin B12, vitamin B6, L-arginine, and PUFAs) interact with the metabolism of L-arginine-nitric oxide system, essential fatty acids and eicosanoids to enhance the production of beneficial molecules such as nitric oxide, prostaglandin E1, prostacyclin, prostaglandin I3, lipoxins, resolvins and protectins and suppress the production of harmful pro-inflammatory cytokines. Formation of adequate amounts of nitric oxide, prostaglandin E1, prostacyclin, prostaglandin I3, lipoxins, resolvins and protectins are essential to prevent platelet aggregation, vasoconstriction and induce angiogenesis to prevent coronary heart disease and heart failure. These evidences suggest that adequate intake of these nutrients is necessary for subjects at high risk of coronary heart disease and heart failure so that they are protected against these diseases. In addition, screening for plasma levels of magnesium, folic acid, vitamin B12, vitamin B6, L-arginine, nitric oxide, various PUFAs, lipoxin A4, resolvins, protectins, asymmetrical dimethylarginine (ADMA-an endogenous inhibitor of nitric oxide), albumin, and various eicosanoids and cytokines may help to detect subjects at high risk of coronary heart disease and heart failure and correcting their abnormalities could restore normal physiology.
It is noteworthy that malnutrition is primarily responsible for the high disease burden in developing countries resulting in high morbidity and mortality rates. Malnutrition is reported even in North America, especially in hospitalized patients; it is estimated that about 30-50% of in-patients are malnourished or at risk of malnutrition, especially among elderly (1-4). A close association exists between malnutrition and impaired wound healing, increased post-operative complications and mortality (5-8). Malnutrition is common in chronic diseases such as cancer, infections, chronic kidney disease and chronic heart failure (9-11). It is known that the length of hospital stay and nutritional status are related, i.e., the longer the hospital stay the more severe the undernutrition, and conversely as the malnutrition becomes more prevalent so the hospital stay is prolonged (12, 13). Hence, it is necessary to screen patients for their nutritional status at hospital admission so that they can be offered the optimum nutritional support and minimize the risk for complications. In order to assess the nutritional status, the Nutritional Risk Index (NRI) ...