The Need for ib r ddition in ymp omatic eart ailure (FEAST-HF): A Randomized Controlled Pilot Trial

BackgroundPre-clinical and observational studies suggest a role for the gut microbiome in the pathogenesis of heart failure (HF); the gut microbiome may be modified by fermentable dietary fiber (FDF). The Need for FibEr Addition in SympTomatic Heart Failure: A randomized controlled pilot trial (FEAST-HF) evaluated feasibility of recruitment and supplementation with FDF in HF and whether FDF (acacia), compared to control, reduced the level of N-terminal pro–b-type natriuretic peptide (NT-proBNP) and growth stimulation expressed gene 2 (ST2), and changes in the gut microbiome.MethodsParticipants were randomly allocated 1:1:1 to either of the intervention arms (5g /day or 10g/day acacia) or control arm (10g/day microcrystalline cellulose (MCC, non-fermentable active control). Adherence and tolerance was assessed, and clinical events were monitored for safety. All outcomes (NT-proBNP, ST2, New York Heart Association (NYHA) class, Kansas City Cardiomyopathy Questionnaire (KCCQ), 6-minute walk test, gut microbiome) were measured at baseline, 6 and 12 weeks.ResultsBetween September 13, 2018, and December 16, 2021, 51 patients were randomly allocated to either MCC (n=18), acacia 5g daily (n=13) or acacia 10g daily (n=18). There were no differences between either dose of acacia and MCC in NT-proBNP, ST2, NYHA class or KCCQ over 12 weeks. Dietary treatment arms had a negligible impact on microbial communities. No safety, tolerability or adherence issues were observed.ConclusionsDietary supplementation with acacia gum was safe and well tolerated in ambulatory patients with HF; however, it did not change NT-proBNP, ST2, or the composition of the gut microbiome.