Table II.
Recommendations on potential utility of selected nutraceuticals in heart failure muscle wasting
| Nutraceutical | Tested dose ranges [daily] | Potential utility in heart failure muscle wasting | Recommendation | References |
|---|---|---|---|---|
| Omega-3 fatty acids | From 720 mg EPA + 480 mg DHA to 8 g of mixed n-3 fatty acids | Safe but has no confirmed effect on muscle mass in HF | ++OO | 19, 29 |
| Protein or amino acids supplementation | From 13 g to 45 g of dietary protein; from 3.2 to 15 g of EAA | May improve hand grip strength, enhance muscle function | ++++ | 45, 46, 47, 48, 55, 56, 57, 84, 160 |
| Leucine (∼2.5 g daily) | From 1.2 to 6 g | Improvement in muscle outcomes by improving lean muscle-mass content and functional performance measured by walking time | +++O | 37, 42, 49, 50, 54 |
| HMB (∼3 g daily) | From 2 to 3 g | Increase of muscle mass gain and potential improvement in muscle strength | +++O | 37, 38, 39, 40, 41, 51, 52, 53 |
| Alpha lipoic acid (∼150 mg daily) | From 150 to 1200 mg | Possible protective effects with respect to muscle damage, more studies in vivo are needed | ++OO | 59, 68, 69 |
| Vitamin D (400–5000 UI/day) | From 400 to 5000 IU | May improve muscle strength in people presenting a serum 25-(OH)D level < 30 nmol/l | +++O | 78, 79, 80, 81, 82, 83, 84, 87 |
| Creatine (∼20 g/day) | From 3 to 20 g | Increase body weight, improve muscle strength and endurance. However, the effects of long-lasting supplementation have not yet been assessed | ++OO | 96, 99, 115, 116, 117, 118 |
| Curcumin (∼1–1.5 g/day) | From 0.5 to 1.5 g | May play a significant role in the management of sarcopenia by anti-inflammatory action, increased hand grip strength, antifatigue effects, and muscle protein management | +++O | 127, 128, 129 |
| Beetroot and inorganic nitrates | From 11.2 to 13.4 mmol NO3– | Potential improvement in muscle contractile function but there is not enough evidence to recommend, and no potential dose is established | ++OO | 18, 131 |
| Coffee | No dose tested | Potential preventing role in sarcopenia, no clinical trials to date, no potential dose established | ++OO | 143, 149 |
| Vitamin C | No dose tested | It is still unclear whether vitamin C dietary intake is beneficial for decreasing sarcopenia, it is not recommended | +OOO | 153, 154, 155, 157 |
*Consider protein supplementation in patients with sarcopenia who are unsuccessful in meeting protein needs through diet modifications alone and where there are no medical contraindications.