Nutrition in pediatric cardiomyopathy - Children's Cardiomyopathy ...

T.L. Miller et al. / Progress in Pediatric Cardiology 24 (2007) 59–7165Table 1 (continued)Roles Recommended daily intake Dietary sourcesSelenium (μg/d) Antioxidant protection in concert with vitamin E. Children Cereals, meat, eggs, dairy products,1–3 y:204–8: 30Males and females9–13 y: 4014–18 y: 55human milk, and infant formula, whichare good sources of highly available Seand are of low risk of providing excessamounts of Se.Sodium (g/d)Sodium restriction prevents exacerbations of heartfailure and can reduce the dose of diuretic therapy.Other nutrition supplementsCarnitine Essential for the transport oflong-chain fatty acids from cytoplasminto the sites of β-oxidation within themitochondrial matrix.TaurineNonessential amino acid that participates incontrolling cellular calcium levels.Creatine Primary high-energy phosphate reservoirphosphate of the heart and skeletal muscle.Coenzyme Q10 Critically necessary for oxidative energyproduction and cardiac function.Role as a rate-limiting carrier for the flowof electrons through complexes I, II and IIIof the mitochondrial respiratory chain.Children1–3 y: 1.04–8: 1.2Males9–13 y: 1.514–18 y: 1.5Females9–18 y: 1.5No DRI or RDA established.Conditionally essential nutrients.Processed foods to which sodiumchloride (salt)/benzoate/phosphate havebeen added; salted meats, nuts, cold cuts;margarine; butter; salt added to foods incooking or at the table.Animal products like meat, fish, poultry,and milk.Meat and fish.Meat and fish.Widespread throughout all food groups.BMR = Basal Metabolic Rate.EER = Estimated Energy Requirement.FTT = Failure to Thrive.DRI = Dietary Reference Intake.AMDR = Acceptable Macronutrient Distribution Range — is the range of intake for a particular energy source that is associated with reduced risk of chronic diseasewhile providing intakes of essential nutrients.⁎ Food and Nutrition Board, Institute of Medicine, National Academies of Sciences. Retrieved June 20, 2007 from http://www.nap.edu.reasons including a proinflammatory state (cachexia) or delayedgastric emptying secondary to increased edema may be a factorthat contributes to suboptimal dietary intake. Physical activitylevel also has to be accounted for, with physical activity beingindirectly related to the level of congestive heart failure [31].However, physical inactivity may contribute the digression inheart function leading to worsening heart failure.There is little information regarding the role of dietarymacronutrients in the development or prevention of leftventricular hypertrophy or heart failure in children withcardiomyopathy. Dietary guidelines aimed at prevention ofcardiovascular disease emphasize the importance of consuminga low-fat/high carbohydrate diet; however recent findingssuggest that reducing fat intake and increasing carbohydrateconsumption does not lower the risk of heart disease [32] inadults. Little information is available for children, yet it isbecoming increasingly recognized that the root of adultcardiovascular disease may begin in childhood.Studies of animal models have shown that a high-fat dietattenuated the hypertension-induced increase in left ventricularmass, cardiomyocyte hypertrophy, left ventricular chambermarkers of cardiac dysfunction, and induction of molecularmarkers of cardiac hypertrophy and dysfunction [33–35].Fig. 2. Metabolic pathways with increased nutritional requirements in thedecompensating myocyte. Figure reproduced from Sole MJ, Jeejeebhoy KN.Conditioned nutritional requirements and the pathogenesis and treatment ofmyocardial failure. Curr Opin Clin Nutr Metab Care. 2000 Nov;3(6):417–24.Permission granted by Lippincott Williams & Wilkins, Inc.