Nutritional intervention in pulmonary arterial hypertension
Pulmonary arterial hypertension (PAH) is a progressive disease primarily affecting the pulmonary vasculature and heart. PAH patients suffer from
exercise intolerance and fatigue, negatively affecting their quality of life.
In a recent review (Vinke et al. 2018), current insights were summarized in the pathophysiological mechanisms underlying PAH. The review zoomed
in on the potential involvement of nutritional status and micronutrient deficiencies exercise intolerance and fatigue in PAH patients.
Pathophysiological processes that contribute to exercise intolerance and impaired quality of life of PAH patients include right ventricular
dysfunction, inflammation, skeletal muscle alterations, and dysfunctional energy metabolism. PAH-related nutritional deficiencies and metabolic
alterations have been linked to fatigue, exercise intolerance, and endothelial dysfunction. Available evidence suggests that exercise interventions
can be effective in PAH patients to improve exercise tolerance and decrease fatigue. By contrast, knowledge on the prevalence of micronutrient
deficiencies and the possible effects of nutritional interventions in PAH patients is limited. Although data on nutritional status and micronutrient
deficiencies in PAH are scarce, the available knowledge, including that from adjacent fields, suggests that nutritional intervention to correct
deficiencies and metabolic alterations may contribute to a reduction of disease burden.
Patients have an increased interest in the use of nutritional supplements, but there is a lack of scientific knowledge and guidelines on this field.
Future research is therefore focusing on studying micronutrient deficiencies in PAH patients and the effect of correcting deficiencies by nutritional
supplementation.
This is a collaborative study between the University Clinic of Cardiology, Heart Center Leipzig (Germany), the Erasmus Medical Center, Rotterdam (the
Netherlands), Actelion Pharmaceuticals (the Netherlands) and Wageningen University (the Netherlands).
Nutritional intervention in a mouse model of pulmonary hypertension and cardiac cachexia Cardiac cachexia is characterized by ventricular remodeling
that is associated with skeletal muscle wasting. Cardiac cachexia is occurring as a consequence of pulmonary hypertension. However, therapeutic
strategies that target both cardiac and skeletal muscle in order to prevent maladaptations remain sparse. In recent studies, we supplied a standard
chow supplemented with high protein, leucine, fish oil and oligosaccharides, to determine whether cardiac and skeletal muscle remodeling could be
attenuated during cardiac cachexia in a mouse model of pulmonary hypertension. The results showed that this multi-target nutritional intervention
significantly attenuated both right ventricular and skeletal muscle maladaptations.
Future studies are focusing on the effect of nutritional intervention with and without exercise training on cardiac and skeletal muscle in the same
animal model.
This is a collaborative study between the University Clinic of Cardiology, Heart Center Leipzig (Germany) and Wageningen University (the Netherlands).
