Nutrological and metabolic approaches to the action of the some special micronutrients in heart failure and metabolic syndrome: a systematic review

Abstract

Introduction: In the heart disease scenario, heart failure (HF) is the leading cause of hospitalizations in the United States in patients over 65 years of age, and there is evidence that this pathology affects 26 million people worldwide. Dietary guidance for patients with HF has focused on sodium restriction and fluid intake, but diet quality is often poor in HF patients and can contribute to morbidity and mortality. Restrictive diets can lead to inadequate intake of macro and micronutrients by patients with HF, highlighting deficiencies in calcium, magnesium, coenzyme Q10, zinc, iron, thiamine, vitamins D, E, and K, and folate. Objective: Through a systematic literature review, the main nutrological approaches to the action of the micronutrients magnesium, coenzyme Q10, and vitamin D in heart failure and metabolic syndrome were evidenced. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from August 2022 to September 2022 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 1998 to 2022. The low quality of evidence was attributed to reports of cases, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: The total of 136 studies were found for eligibility analysis, and then 75 of the 84 total studies were selected for this systematic review. According to the GRADE instrument, most studies showed homogeneity in their results, with I2 =98.7% >50%. The Funnel Plot showed a symmetrical behavior, not suggesting a significant risk of bias in studies with smaller sample sizes. Studies have shown that magnesium deficiency or changes in its metabolism are related to the pathophysiology of heart failure, hypertension, arrhythmias, preeclampsia, insulin resistance, and diabetes. Vitamin D plays an important role in innate and adaptive immune responses, cell cycle, and metabolic processes, evidenced by the reported relationship between its deficiency and the prevalence of immunity-mediated disorders, cancer, and cardiometabolic diseases. The VDR results in β cells, endothelium, cardiac myocytes, and renin production suggesting a role for vitamin D in these diseases. Coenzyme Q10 is part of the electron transport chain and is found in large concentrations in the mitochondrial, especially in the muscles, brain, and heart. Clinical studies have shown that pathologies such as acute myocardial infarction, arterial hypertension, and myopathies induced by statins, physical fatigue inherent in physical exercise, male infertility, preeclampsia, Parkinson's disease, periodontal disease, and migraine had low plasma concentrations of coenzyme Q10.