Evidence related to sodium restriction in patients with heart failure

Sousa, Mailson Marques de; Gouveia, Bernadete de Lourdes André; Almeida, Taciana da Costa Farias; Freire, Maria Eliane Moreira; Melo, Francisco de Assis Brito Pereira de; Oliveira, Simone Helena dos Santos

doi:10.1590/0034-7167-2018-0874

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2018-0874 copy

Evidence related to sodium restriction in patients with heart failure

Pruebas relacionadas con la restricción de sodio en pacientes con insuficiencia cardíaca

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the scientific production about sodium restriction in patients with heart failure.

Methods:

integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases.

Results:

thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet.

Conclusions:

based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

Descriptors:
Evidence-Based Nursing; Cardiac Failure; Diet, Sodium-Restricted; Diet Therapy; Patient Compliance

Reference	Year/Country	Outlining	Objectives	Outcomes	LoE
Colin- Ramirez E et al.⁽¹⁶⁾16 Colin-Ramirez E, McAlister FA, Zheng Y, Sharma S, Armstrong PW, Ezekowitz JA. The long-term effects of dietary sodium restriction on clinical outcomes in patients with heart failure. The SODIUM-HF (Study of Dietary Intervention Under 100 mmol in Heart Failure): a pilot study. Am Heart J [Internet]. 2015 [cited 2018 Jun 19];169(2):274-81. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25641537 https://www.ncbi.nlm.nih.gov/pubmed/2564...	2015 Canada	Randomized clinical trial n = 38	To determine the feasibility of a randomized controlled trial comparing a low sodium diet with a moderate sodium diet.	After six months, sodium intake decreased in both groups. In addition, there was an improvement in the perception of quality of life.	II
Paterna S et al.⁽¹⁷⁾17 Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci (Lond) [Internet]. 2008 [cited 2018 Jul 18];114(3):221-30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17688420 https://www.ncbi.nlm.nih.gov/pubmed/1768...	2008 Italy	Randomized clinical trial n = 232	To assess the effects of a normal sodium diet (120 mmol sodium) compared to a low sodium diet (80 mmol sodium) on HF readmissions.	The group with normal sodium diet had lower incidence of reincarnation. The sodium-restricted diet produced harmful renal and neurohormonal effects in patients with clinically compensated HF.	II
Son YJ et al.⁽¹⁸⁾18 Son YJ, Lee Y, Song EK. Adherence to a sodium-restricted diet is associated with lower symptom burden and longer cardiac event-free survival in patients with heart failure. J Clin Nurs [Internet]. 2011 [cited 2018 Jul 20];20(21-22):3029-38. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21707808 https://www.ncbi.nlm.nih.gov/pubmed/2170...	2011 Korea	Quantitative cohort study n = 232	To determine whether adherence to a sodium-restricted diet affects symptom burden and cardiac event-free survival in Patients with HF.	Patients with ≥3 g sodium intake per day exhibited lower cardiac event-free survival. Limited sodium intake <3 g/day showed improvement in HF symptomatology.	IV
Basuray A et al.⁽¹⁹⁾19 Basuray A, Dolansky M, Josephson R, Sattar A, Grady EM, Vehovec A, et al. Dietary sodium adherence is poor in chronic heart failure patients. J Card Fail [Internet]. 2015 [cited 2018 Jul 20];21(4):323-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25576680 https://www.ncbi.nlm.nih.gov/pubmed/2557...	2015 USA	Quantitative cohort study n = 305	To determine sodium restriction rates and predictors and to assess the reliability of 24-hour urine collection as a tool to estimate dietary sodium intake in Patients with HF.	The mean 24-hour urinary sodium excretion was 3.15 ± 1.58 g/day. Logistic regression analysis showed male gender and high body mass index as predictors associated with non-adherence to sodium restriction.	IV
Welsh D et al.⁽²⁰⁾20 Welsh D, Lennie TA, Marcinek R, Biddle MJ, Abshire D, Bentley B et al. Low-sodium diet self-management intervention in heart failure: pilot study results. Eur J Cardiovasc Nurs [Internet]. 2013 [cited 2018 Jul 20];12(1):87-95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22492785 https://www.ncbi.nlm.nih.gov/pubmed/2249...	2013 USA	Randomized clinical trial n = 52	To examine the effectiveness of an educational intervention (counseling, home visits, and telephone monitoring) in reducing the dietary sodium intake of Patients with HF.	Dietary sodium intake did not differ between the usual care and intervention groups at 6 weeks; however, dietary sodium intake was lower in the intervention group at 6 months.	II
Colin-Ramirez E et al.⁽²¹⁾21 Colin-Ramirez E, McAlister FA, Woo E, Wong N, Ezekowitz JA. Association between self-reported adherence to a low-sodium diet and dietary habits related to sodium intake in heart failure patients. J Cardiovasc Nurs [Internet]. 2015 [cited 2018 Jul 22];30(1):58-65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24598553 https://www.ncbi.nlm.nih.gov/pubmed/2459...	2015 Canada	Quantitative cohort study n = 237	To assess the association between self-reported adherence to a low sodium diet and dietary habits related to sodium intake in Patients with HF.	Self-reported adherence to a low sodium diet was not reliable among Patients with HF. It was found that the self-reported measure was associated with not adding salt in the preparation of meals or at the table. However, there was no reduction in the frequency of ingestion of high sodium foods.	IV
Doukky R et al.⁽²²⁾22 Doukky R, Avery E, Mangla A, Collado FM, Ibrahim Z, Poulin MF et al. Impact of Dietary Sodium Restriction on Heart Failure Outcomes. JACC Heart Fail [Internet]. 2016 [cited 2018 Jul 22];4(1):24-35. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26738949 https://www.ncbi.nlm.nih.gov/pubmed/2673...	2016 USA	Quantitative cohort study n = 902	To assess the impact of sodium restriction on the outcomes of patients with HF.	Results did not show that dietary sodium restriction is associated with lower death or hospitalization rates in Patients with HF. In patients who did not use angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, sodium restriction showed detrimental neurohormonal changes.	IV
Heo S et al.⁽²³⁾23 Heo S, Lennie TA, Moser DK, Okoli C. Heart failure patients' perceptions on nutrition and dietary adherence. Eur J Cardiovasc Nurs [Internet]. 2009 [cited 2018 Jul 23];8(5):323-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19589729 https://www.ncbi.nlm.nih.gov/pubmed/1958...	2009 USA	Qualitative study n = 20	To explore Patients with HF’ perceptions of foods that impact their disease, their understanding of the nutritional recommendations received, and the factors that affect recommendations for following a low sodium diet.	Most patients believed that eating high sodium foods could affect their health. Nevertheless, less than half understood that excessive sodium intake could accentuate the symptoms of HF. Knowledge, social influence, social conditions and diet as a source of pleasure affect the follow-up of a low sodium diet.	VI
Wu JR et al.⁽²⁴⁾24 Wu JR, Lennie TA, Dunbar SB, Pressler SJ, Moser DK. Does the Theory of Planned Behavior predict dietary sodium intake in patients with heart failure? West J Nurs Res [Internet]. 2016 [cited 2018 Jul 23];18. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27756851 https://www.ncbi.nlm.nih.gov/pubmed/2775...	2016 USA	Cross-sectional quantitative study n = 244	To determine which factors were associated with sodium intake in Patients with HF using Theory Planned Behavior.	New York Heart Association subjective standards, gender, and functional class were associated with sodium intake.	VI
Chung ML et al.⁽²⁵⁾25 Chung ML, Park L, Frazier SK, Lennie TA. Long-term adherence to low-sodium diet in patients with heart failure. West J Nurs Res [Internet]. 2016 [cited 2018 Jul 25];30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27903829 https://www.ncbi.nlm.nih.gov/pubmed/2790...	2016 USA	Quantitative cohort study n = 74	To compare sodium intake measured by 24-hour urinary sodium excretion between patients, categorized by self-report, as adherent over 6 months and non-adherent.	The long-term adherent group had lower sodium intake (≤ 3 g) and realized greater benefits from following a low sodium diet (reduced body edema, improved breathing pattern and increased feeling of well-being) compared with the non-adherent group.	IV
Lennie TA et al.⁽²⁶⁾26 Lennie TA, Worrall-Carter L, Hammash M, Odom-Forren J, Roser LP, Smith CS. Relationship of heart failure patients' knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence. Prog Cardiovasc Nurs [Internet]. 2008 [cited 2018 Jul 25];23(1):6-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18326994 https://www.ncbi.nlm.nih.gov/pubmed/1832...	2008 USA and Australia	Cross-sectional quantitative study n = 246	To describe HF patient’s perceptions regarding the instructions received to follow a low sodium diet and the benefits, barriers, ease as well as frequency of following the diet.	Of the patients, 80% reported receiving recommendations to follow a low sodium diet. However, 24-hour urinary sodium excretion showed that only 25% of patients were adherent. Limited information is pointed as barriers to the follow-up of a low sodium diet.	VI
Song EK et al.⁽²⁷⁾27 Song EK, Moser DK, Kang SM, Lennie TA. Self-reported adherence to a low-sodium diet and health outcomes in patients with heart failure. J Cardiovasc Nurs [Internet]. 2016 [cited 2018 Jul 25];31(6):529-34. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26296246 https://www.ncbi.nlm.nih.gov/pubmed/2629...	2016 Korea	Quantitative cohort study n = 119	To determine whether self-reported adherence is consistent with a low sodium diet as measured by food questionnaires and urinary sodium excretion; and whether self-reported adherence to a low sodium diet is a predictor free of cardiac events.	Self-reported adherence was consistent with the measurement of food questionnaires and 24-hour urinary sodium excretion. Patients who reported never or rarely following a low sodium diet were 4.7 times more likely to have cardiac events than those who always followed a low sodium diet.	IV
Lennie TA et al.⁽²⁸⁾28 Lennie TA, Song EK, Wu JR, Chung ML, Dunbar SB, Pressler SJ, et al. Three gram sodium intake is associated with longer event-free survival only in patients with advanced heart failure. J Card Fail [Internet]. 2011 [cited 2018 Jul 28];17(4):325-30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21440871 https://www.ncbi.nlm.nih.gov/pubmed/2144...	2011 USA	Quantitative cohort study n = 302	To compare differences in cardiac event-free survival between patients with sodium intake above and below 3 g.	Results showed that 3 g/day of sodium in dietary restriction may be more appropriate for Patients with HF with marked symptomatology.	IV

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[1] Corresponding author: Mailson Marques de Sousa. E-mail: mailson_ms@hotmail.com