A Focus on Heart Failure Management through Diet and Nutrition: A Comprehensive Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In this article "A Focus on Heart Failure Management through Diet and Nutrition: A Comprehensive Review" by Liao et al, a synopsis of the available data on the nutritional recommendations to HF patients is given.

I would like to have seen information about food (nutritional) supplements that is an emerging and challenging field in this context. E.g. resveratrol supplements have been shown to be promising for metabolic syndrome and dyslipidemia pts, not reaching their goals through pharmacotherapy. Also substitute of NaCl that can be found in the pharmacy. In most countries these supplements can be found over the counter, so it is important that pts have a guidance about their indications and interactions with grugs or specific diets.

Also one must give highlight to the importance of nutrition concerning residual risk factors in HF pts with comorbidities  and underline the importance of reversing frailty through these interventions.

Comments on the Quality of English Language

I think that English language used in the article is of good level and needs only minor revisions, if any.

Author Response

• Comment 1: I would like to have seen information about food (nutritional) supplements that is an emerging and challenging field in this context. E.g. resveratrol supplements have been shown to be promising for metabolic syndrome and dyslipidemia pts, not reaching their goals through pharmacotherapy. Also substitute of NaCl that can be found in the pharmacy. In most countries these supplements can be found over the counter, so it is important that pts have a guidance about their indications and interactions with grugs or specific diets.

Response: Thank you for this suggestion. We have added resveratrol supplements to our section on dietary supplements (see Section 3.2.5, page 5, lines 211 – 223). In addition, we have added a mention of salt replacements (ie potassium-enriched salt) to our discussion about salt restriction (page 5, lines 139 – 146).

• Comment 2: Also one must give highlight to the importance of nutrition concerning residual risk factors in HF pts with comorbidities  and underline the importance of reversing frailty through these interventions.

Response: Thank you, we agree that this is highly important and we had dedicated a section to the discussion about comorbidities in people with HF, as well as HF related cachexia and frailty, which necessitates alterations to diet (see existing Sections 5 and 6, pages 7 - 9)

All new changes are highlighted in grey

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

While I am perfectly fine with the work and the conclusions offered by the authors, I have a couple (indeed only three) of concerns.

1) Figure 1 shows, among others, the directory of the actual pharmacologic treatment for HF. I believe diuretics are lacking and should be added;

2) row 74: the authors report "emaglifozin" while the correct name should be "empaglifozin";

3) in section 3.1 a paragraph is due about the "salt wars" debate, with a note showing how and why some authors avoid 24h urinary sodium (see for instance Cappuccio, Campbell et al. Curr Nutr Rep. 2022; 11(2): 172–184).

Author Response

Comment 1: Figure 1 shows, among others, the directory of the actual pharmacologic treatment for HF. I believe diuretics are lacking and should be added

Response: Thank you for this suggestion. “Diuretics” has been added to current pharmacological treatment in Figure 1.  

Comment 2: row 74: the authors report "emaglifozin" while the correct name should be "empaglifozin";

 Response: This has been amended. Please see line 74, page 3.

Comment 3: in section 3.1 a paragraph is due about the "salt wars" debate, with a note showing how and why some authors avoid 24h urinary sodium (see for instance Cappuccio, Campbell et al. Curr Nutr Rep. 2022; 11(2): 172–184).

Response: Thank you for this suggestion. We have added a paragraph in Section 3.1 (page 3, lines 113 – 121) addressing the controversy over sodium restrictions and inaccuracies with measurement. 

All new changes are in grey (Empagliflozin ammended accordingly not highlighted on manuscript)

Author Response File: Author Response.pdf