• Cardiac cachexia, defined as weight loss of 6% or more (in the absence of edema) in at least 6 months, occurs in about 12–15% in patients in NYHA classes II–IV.
• The aetiology of cardiac cachexia is complex; however loss of appetite has a significant role in only 10-20% of all cases.
• Wt loss do not adversely affect the cardiac function but pts with cardiac cachexia have a 2-3 times higher mortality than non cachectic CCF pts.
• EN is recommended to stop or reverse weight loss, although there is no evidence available from studies.

Discuss parenteral nutrition in chronic heart failure?

• PN is reserved for patients in whom malabsorption occurs and in those in whom enteral nutrition has failed.
• Is gut function impaired in CCF?
• There is limited evidence that gut function is impaired in CCF. However decreased cardiac function can reduce bowel perfusion and lead to bowel edema, resulting in malabsorption
• In view of decreased cardiac function and water retention, it is recommended that PN should be avoided, other than in patients with evidence of malabsorption in which enteral nutrition has been shown, or is strongly expected, to be ineffective.

Ref

1. ESPEN guidelines