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Li RM, Dai GH, Guan H, Gao WL, Ren LL, Wang XM, Qu HW. Association between handgrip strength and heart failure in adults aged 45 years and older from NHANES 2011-2014. Sci Rep 2023; 13:4551. [PMID: 36941323 PMCID: PMC10027666 DOI: 10.1038/s41598-023-31578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
Growing evidence indicates that handgrip strength (HGS) is a conspicuous marker for assessing some diseases affecting middle-aged and elderly individuals. However, research regarding HGS and heart failure (HF) is sparse and controversial. Hence, we aimed to investigate the association between HGS and HF among adults aged 45 years and older in the United States. In this cross-sectional study, we included 4524 adults older than 45 years who were part of the National Health and Nutrition Examination Survey. A generalized additive model was used to estimate the association between HGS and HF. Age, gender, race, income, education, body mass index, smoking status, drinking status, diabetes, hypertension, stroke, vigorous physical activity, total energy intake, total protein intake, total sugars intake, and total fat intake covariates were adjusted using multiple regression models. And further subgroup analysis was conducted. We documented 189 cases of HF, including 106 men and 83 women. HGS was negatively associated with HF after adjusting for all the covariates (odds ratio = 0.97, 95% confidence interval = 0.96-0.99; P < 0.001). Compared with the lowest quintile, the highest quintile was associated with an 82% lower incidence of HF (odds ratio = 0.18, 95% confidence interval = 0.08-0.43; P < 0.001). Subgroup analysis showed that the results remained stable. In US adults older than 45, HGS was negatively associated with HF after adjusting for covariates. This finding had the potential to draw attention to the physiological and pathological effects of decreased muscle function on HF and may influence further prospective studies with intervention trials.
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Affiliation(s)
- Run-Min Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guo-Hua Dai
- Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jing-Shi Road, Jinan, 250014, China.
| | - Hui Guan
- Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jing-Shi Road, Jinan, 250014, China
| | - Wu-Lin Gao
- Department of Geriatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jing-Shi Road, Jinan, 250014, China
| | - Li-Li Ren
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xing-Meng Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hui-Wen Qu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Chae S, Song J, Ojo M, Bowles KH, McDonald MV, Barrón Y, Hobensack M, Kennedy E, Sridharan S, Evans L, Topaz M. Factors associated with poor self-management documented in home health care narrative notes for patients with heart failure. Heart Lung 2022; 55:148-154. [PMID: 35597164 PMCID: PMC11021173 DOI: 10.1016/j.hrtlng.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with heart failure (HF) who actively engage in their own self-management have better outcomes. Extracting data through natural language processing (NLP) holds great promise for identifying patients with or at risk of poor self-management. OBJECTIVE To identify home health care (HHC) patients with HF who have poor self-management using NLP of narrative notes, and to examine patient factors associated with poor self-management. METHODS An NLP algorithm was applied to extract poor self-management documentation using 353,718 HHC narrative notes of 9,710 patients with HF. Sociodemographic and structured clinical data were incorporated into multivariate logistic regression models to identify factors associated with poor self-management. RESULTS There were 758 (7.8%) patients in this sample identified as having notes with language describing poor HF self-management. Younger age (OR 0.982, 95% CI 0.976-0.987, p < .001), longer length of stay in HHC (OR 1.036, 95% CI 1.029- 1.043, p < .001), diagnosis of diabetes (OR 1.47, 95% CI 1.3-1.67, p < .001) and depression (OR 1.36, 95% CI 1.09-1.68, p < .01), impaired decision-making (OR 1.64, 95% CI 1.37-1.95, p < .001), smoking (OR 1.7, 95% CI 1.4-2.04, p < .001), and shortness of breath with exertion (OR 1.25, 95% CI 1.1-1.42, p < .01) were associated with poor self-management. CONCLUSIONS Patients with HF who have poor self-management can be identified from the narrative notes in HHC using novel NLP methods. Meaningful information about the self-management of patients with HF can support HHC clinicians in developing individualized care plans to improve self-management and clinical outcomes.
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Affiliation(s)
- Sena Chae
- College of Nursing, University of Iowa, 50 Newton Rd, Iowa City, IA 52242, United States.
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, United States
| | - Marietta Ojo
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences Philadelphia PA, Center for Home Care Policy & Research, University of Pennsylvania School of Nursing, Visiting Nurse Service of New York, New York, NY, United States
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Mollie Hobensack
- Columbia University School of Nursing, New York, NY, United States
| | - Erin Kennedy
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Lauren Evans
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Maxim Topaz
- Center for Home Care Policy & Research, Columbia University School of Nursing, Data Science Institute, Columbia University, Visiting Nurse Service of New York, New York, NY, United States
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Singh RB, Fedacko J, Pella D, Fatima G, Elkilany G, Moshiri M, Hristova K, Jakabcin P, Vaňova N. High Exogenous Antioxidant, Restorative Treatment (Heart) for Prevention of the Six Stages of Heart Failure: The Heart Diet. Antioxidants (Basel) 2022; 11:antiox11081464. [PMID: 36009183 PMCID: PMC9404840 DOI: 10.3390/antiox11081464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/06/2023] Open
Abstract
The exact pathophysiology of heart failure (HF) is not yet known. Western diet, characterized by highly sweetened foods, as well as being rich in fat, fried foods, red meat and processed meat, eggs, and sweet beverages, may cause inflammation, leading to oxidative dysfunction in the cardiac ultra-structure. Oxidative function of the myocardium and how oxidative dysfunction causes physio-pathological remodeling, leading to HF, is not well known. Antioxidants, such as polyphenolics and flavonoids, omega-3 fatty acids, and other micronutrients that are rich in Indo-Mediterranean-type diets, could be protective in sustaining the oxidative functions of the heart. The cardiomyocytes use glucose and fatty acids for the physiological functions depending upon the metabolic requirements of the heart. Apart from toxicity due to glucose, lipotoxicity also adversely affects the cardiomyocytes, which worsen in the presence of deficiency of endogenous antioxidants and deficiency of exogenous antioxidant nutrients in the diet. The high-sugar-and-high-fat-induced production of ceramide, advanced glycation end products (AGE) and triamino-methyl-N-oxide (TMAO) can predispose individuals to oxidative dysfunction and Ca-overloading. The alteration in the biology may start with normal cardiac cell remodeling to biological remodeling due to inflammation. An increase in the fat content of a diet in combination with inducible nitric oxide synthase (NOSi) via N-arginine methyl ester has been found to preserve the ejection fraction in HF. It is proposed that a greater intake of high exogenous antioxidant restorative treatment (HEART) diet, polyphenolics and flavonoids, as well as cessation of red meat intake and egg, can cause improvement in the oxidative function of the heart, by inhibiting oxidative damage to lipids, proteins and DNA in the cell, resulting in beneficial effects in the early stage of the Six Stages of HF. There is an unmet need to conduct cohort studies and randomized, controlled studies to demonstrate the role of the HEART diet in the treatment of HF.
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Affiliation(s)
- Ram B. Singh
- Halberg Hospital and Research Institute, Moradabad 244001, India;
| | - Jan Fedacko
- Department of Gerontology and Geriatric, Medipark, University Research Park, PJ Safarik University, 040-11 Kosice, Slovakia
- Correspondence:
| | - Dominik Pella
- Department of Cardiology, Faculty of Medicine and East Slovak, Institute for Cardiovascular Disease, PJ Safarik University, 040-11 Kosice, Slovakia;
| | - Ghizal Fatima
- Department of Biotechnology, Era University, Lucknow 226001, India;
| | - Galal Elkilany
- International College of Cardiology, Laplace, LA 90001, USA;
| | - Mahmood Moshiri
- International College of Cardiology, Richmond Hill, ON LL-9955, Canada;
| | - Krasimira Hristova
- Department of Cardiology, National University Hospital, 1000 Sofia, Bulgaria;
| | - Patrik Jakabcin
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, 10000 Prague, Czech Republic;
| | - Natalia Vaňova
- Department of Internal Medicine UPJS MF and AGEL Hospital, Research Park, PJ Safaric University, 040-11 Kosice, Slovakia;
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Celano CM, Golden J, Healy BC, Longley RM, Huffman JC. Predictors of completion and response to a psychological intervention to promote health behavior adherence in heart failure. Int J Psychiatry Med 2022; 57:21-34. [PMID: 33461359 PMCID: PMC8300859 DOI: 10.1177/0091217421989830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Most individuals with heart failure (HF) struggle to adhere to one or more health behaviors, and interventions to promote adherence are time-intensive and costly. In this analysis, we examined the predictors of engagement and response related to a telephone-delivered health behavior intervention for individuals with HF. METHOD Using data from two pilot trials (N = 25) of a behavioral intervention for individuals with New York Heart Association (NYHA) class I-II HF, we examined predictors of intervention engagement and response using linear and mixed effects regression analyses. Predictors included medical (NYHA class, physical health-related quality of life [HRQoL], and HF symptoms) and intervention (ease and usefulness/utility ratings of the first intervention exercise) characteristics. Outcomes included percentage of sessions completed, accelerometer-measured physical activity, and sodium intake. RESULTS Lower physical HRQoL and more frequent HF symptoms were associated with completion of more sessions. In contrast, more frequent HF symptoms and higher NYHA class were associated with less physical activity improvement. Finally, participants' ratings of the first session's utility were associated with greater improvements in physical activity at follow-up. CONCLUSIONS These findings suggest that while individuals with greater functional impairment are more engaged in a behavioral intervention, they may be less able to increase physical activity in response to the program. Furthermore, the perceived utility of an initial session may predict longer-term behavior change. Larger studies are needed to clarify the presence of additional predictors and determine how they can be used to better tailor health behavior interventions.
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Affiliation(s)
- Christopher M. Celano
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Julia Golden
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Brian C. Healy
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA,Departments of Neurology and Biostatistics, Harvard Medical School, Boston, MA, USA
| | - Regina M. Longley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Gorący I, Rębacz-Maron E, Korbecki J, Gorący J. Concentrations of Mg, Ca, Fe, Cu, Zn, P and anthropometric and biochemical parameters in adults with chronic heart failure. PeerJ 2021; 9:e12207. [PMID: 34760349 PMCID: PMC8567860 DOI: 10.7717/peerj.12207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background The study investigated the relationship between the concentrations of Mg, Ca, Fe, Cu, Zn, P and anthropometric and biochemical parameters in the blood serum of patients with heart failure (HF) and the potential influence on the development and progression of HF. Material & methods The study included 214 patients (155 men and 59 women), aged 40–87 years, presenting symptoms or signs typical of HF (according to the NYHA functional classification). Serum concentrations were determined for Mg, Ca, Fe, Cu, Zn, P, C-reactive protein (CRP), creatinine, urea, triglyceride levels (TG), total cholesterol (CH), high density protein (HDL), low density protein (LDL). The levels of macro-and microminerals were analysed using inductively coupled serum optical emission spectrometry (ICP-OES). Results Our study confirmed the role of known risk factors in the development of heart failure, including: overweight, diabetes, hypertension, high triglycerides (TG), high total cholesterol (CH), high levels of low density protein (LDL) and reduced levels of high density protein (HDL), high CRP, high creatinine. Moreover, deficient serum concentrations of Mg (47% of the studied men and 54% of the women) and Cu (in 44% of men and more than 30% of women) were observed, as well as subnormal serum Fe (2% of women) and Zn (1% of men). Elevated serum Ca was found in 50% of men and 49% of women. In 44% of the studied men and 52% of the studied women, P levels in serum were also above-average. The study revealed a significant positive correlation between serum levels of Ca and Mg, and also Ca and Cu in women. In men, serum Cu was positively correlated with Mg and Ca concentrations. In patients from group 1 (NYHA I–II), Mg content was positively correlated with Ca and Cu. In this patient group, Ca was also positively associated with Cu content in serum. In group 2 (NYHA III-IV), serum Mg concentration was significantly positively correlated with that of Cu and Ca. Conclusions Changes in the serum concentrations of macro-and microminerals may significantly affect the severity of HF in Polish patients.
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Affiliation(s)
- Iwona Gorący
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Rębacz-Maron
- Institute of Biology, Department of Ecology and Anthropology, University of Szczecin, Szczecin, Poland
| | - Jan Korbecki
- Department of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Wrocław, Poland
| | - Jarosław Gorący
- Clinic of Cardiology, Pomeranian Medical University, Szczecin, Poland
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6
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Abstract
BACKGROUND Men with heart failure are reported to be less adherent to low-sodium diets than women are. One potential reason may be that men consume more food and, consequently, more sodium than women do. OBJECTIVES The aims of this study were to compare dietary sodium intake, urine sodium excretion, and sodium density of diet consumed between men and women with heart failure and to determine whether sex moderated the relationship of kilocalories (kcals) consumed with dietary and urine sodium. METHODS A total of 223 patients with heart failure (mean age, 62 ± 12 years; 70% men, 46% New York Heart Association class III-IV) completed detailed 4-day food diaries and provided 24-hour urine sodium samples. To account for sodium density of food, dietary sodium and urine sodium were referenced to sodium per 1000 kcal. RESULTS On an absolute basis, men consumed 23% more kcals and 28% more sodium than women did; 24-hour sodium excretion was 16% higher in men than in women. There were no differences between men and women when dietary sodium and urinary sodium were referenced to 1000 kcal, indicating they consumed foods with similar sodium density. However, both moderation analyses showed that the dietary sodium intake of men and women with lower kcal intake was similar, whereas men with higher kcal intake consumed more sodium-dense foods than women did. CONCLUSION The results suggest that the men with higher sodium intake than women had 2 reasons for nonadherence. They consumed more food and foods with higher sodium density than women did.
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7
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Cosiano MF, Jannat-Khah D, Lin FR, Goyal P, McKee M, Sterling MR. Hearing Loss and Physical Functioning Among Adults with Heart Failure: Data from NHANES. Clin Interv Aging 2020; 15:635-643. [PMID: 32440106 PMCID: PMC7211960 DOI: 10.2147/cia.s246662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/09/2020] [Indexed: 01/14/2023] Open
Abstract
Background Hearing loss (HL) is associated with poor physical functioning among older adults, yet this association has not been examined in heart failure (HF), a disease in which both hearing loss and poor physical functioning are highly prevalent. We investigated whether this association exists in HF since HL represents a potentially modifiable risk factor for poor physical functioning. Methods We studied adults aged ≥70 years with self-reported HF in the National Health and Nutrition Examination Survey (NHANES). HL was assessed and categorized using pure-tone averages. Activities of daily living (ADLs), instrumental ADLs (IADLs), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activity (GPA) were assessed. Negative binomial regression was used to examine the association between HL and physical functioning Results One hundred eighty-one participants comprised our population. Those with ≥ moderate HL had more difficulty with ADLs (37.0% vs 24.0%, p=0.02), IADLs (36.0% vs 23.0%, p=0.05), and LEM (37.3% vs 20.0%, p=0.009), compared to participants with none or mild HL. In multivariable models, ≥ moderate HL was significantly associated with difficulty in physical functioning across four of the five domains: ADLs: PR: 1.71 (95% CI: 1.07-2.72); IADLs: PR: 1.71 (1.24-2.34); LEM: PR: 1.51 (1.01-2.26); and GPA: PR: 1.19 (1.00-1.41). Conclusion Among older adults with HF, moderate or greater HL was associated with a higher prevalence of difficulty with ADLs, IADLs, and LEM, compared to mild or no HL.
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Affiliation(s)
- Michael F Cosiano
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | | | - Frank R Lin
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Celano CM, Beale EE, Freedman ME, Mastromauro CA, Feig EH, Park ER, Huffman JC. Positive psychological constructs and health behavior adherence in heart failure: A qualitative research study. Nurs Health Sci 2020; 22:620-628. [PMID: 32125066 DOI: 10.1111/nhs.12704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022]
Abstract
Psychological well-being may play an important role in health behavior adherence and cardiovascular health, but there has been limited study of well-being in patients with heart failure. In this descriptive qualitative research study, we interviewed 30 patients with heart failure to explore their psychological experiences with heart failure and the perceived associations between positive psychological constructs and adherence to physical activity, diet, and medication recommendations. Interviews were transcribed, then coded in NVivo using directed and conventional content analysis, and the Consolidated Criteria for Reporting Qualitative Research checklist was applied to report our findings. Participants spontaneously reported positive psychological constructs both during an acute phase of illness and 3 months later. Participants most commonly experienced gratitude, acceptance, connectedness, and faith in the setting of heart failure. In contrast, pride, determination, and hope were identified most frequently as playing a role in health behavior adherence. Finally, participants reported a reinforcing relationship between positive constructs and health behavior engagement. These findings suggest that interventions to boost positive constructs have the potential to improve well-being and health behavior adherence in patients with heart failure.
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Affiliation(s)
- Christopher M Celano
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eleanor E Beale
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Melanie E Freedman
- Department of Psychology, Northwestern University, Chicago, Illinois, USA
| | - Carol A Mastromauro
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily H Feig
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeff C Huffman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
BACKGROUND Patients with heart failure (HF) and their family caregivers usually consume similar diets, but there is a lack of evidence about diet quality of patients with HF and their family caregivers. OBJECTIVE The specific aim of this study was to compare diet quality of patients with HF with that of their family caregivers. METHODS In this cross-sectional study, 40 patients with HF and their 40 family caregivers completed a VioScreen Food Frequency Questionnaire from which Healthy Eating Index-2010 (HEI) diet quality scores (consisting of the total HEI score and 12 component scores) were calculated. RESULTS None of the 40 patient-caregiver dyads had a high diet quality score (ie, total HEI > 80), whereas 21% of participants had poor diet scores (ie, total HEI ≤ 50). There were no differences in total HEI scores (58.5 vs 59.4, P = .58) or the 12 component scores of the HEI within dyad members. Mean scores of 6 of the 12 components (ie, total fruit, greens and beans, total protein foods, seafood and plant proteins, fatty acids, empty calories) for both members of the HF dyad were lower than the national average. Interestingly, scores for the sodium component were similarly low in patients and caregivers (4.1 vs 3.4, P = .24), indicating high sodium intake. CONCLUSION Both patients and caregivers consume poor-quality diets that are high in sodium. These findings suggest that nutrition interventions to improve diet quality for patients with HF need to be targeted at the family as a unit.
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10
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Association between the Prognostic Nutritional Index and Dietary Intake in Community-Dwelling Older Adults with Heart Failure: Findings from NHANES III. Nutrients 2019; 11:nu11112608. [PMID: 31683657 PMCID: PMC6893765 DOI: 10.3390/nu11112608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to examine the association between nutritional status and dietary intake in community-dwelling older adults with heart failure (HF). A cross-sectional analysis of NHANES III data was conducted. The analytic sample was comprised of n = 445 individuals aged 50+ years with congestive HF (54.4% male, 22.9% non-Hispanic Black, 43.8% low-income). Nutritional status was measured using the Prognostic Nutritional Index (PNI). Participants were classified by PNI quintiles with lower PNI scores indicating lower nutritional status. Participants in quintile 5 showed significantly greater intakes of energy, protein, vegetables, magnesium, zinc, copper, potassium, red meat, saturated fat, and sodium. In multivariate analyses, increased intake of red meat (β = 0.253, p = 0.040) and vegetables (β = 0.255, p = 0.038) was associated with significantly better nutritional status. In the absence of comprehensive nutritional guidance for HF patients, it appears that small increases in energy, protein (red meat), and vegetable consumption are associated with improved nutritional status.
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11
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Goyal P, Bryan J, Kneifati-Hayek J, Sterling MR, Banerjee S, Maurer MS, Lachs MS, Safford MM. Association Between Functional Impairment and Medication Burden in Adults with Heart Failure. J Am Geriatr Soc 2018; 67:284-291. [PMID: 30488944 DOI: 10.1111/jgs.15654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether the number of medications taken by adults with heart failure (HF) and impairment in activities of daily living (ADL)-a subpopulation in whom the risks of a high medication burden may outweigh the benefits-differs from the number taken by those without impairment in ADLs. DESIGN Cross-sectional. SETTING National Health and Nutrition Examination Survey (NHANES; 2003-2014), a cross-sectional survey that produces national estimates of adults in the United States. PARTICIPANTS Adults aged 50 and older (mean 70) with self-reported HF (N= 947; representing 4.6 million adults with HF in the United States. MEASURMENTS We assessed ADL impairment and medication count based on self-report. ADL impairment was defined as having difficulty with or being unable to dress, feed oneself, or get in and out of bed. To determine the independent association between ADL impairment and medication count, we performed sequential Poisson multivariable regression analyses. All analyses were cross-sectional in nature and accounted for the complex survey design of NHANES. RESULTS Mean medication count was 7.2, and 74% of participants were taking 5 or more medications (polypharmacy). In a multivariable model, ADL impairment was not independently associated with medication count. These findings were similar for those with 3 or more hospitalizations in the prior year, declining health status, and cognitive impairment. CONCLUSION After adjusting for confounders including comorbidity, we found that adults with HF and ADL impairment take as many medications as those without ADL impairment. This suggests that providers may not sufficiently consider functional impairment when prescribing medications to adults with HF and thus may unnecessarily expose individuals to risk of adverse outcomes. J Am Geriatr Soc 67:284-291, 2019.
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Affiliation(s)
- Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York.,Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna Bryan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jerard Kneifati-Hayek
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Samprit Banerjee
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York
| | - Mark S Lachs
- Division of Geriatrics, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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12
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Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, Ostfeld RJ, Barnard ND, Gaggin H, Freeman AM, Allen K, Madan S, Massera D, Litwin SE. Lifestyle Modifications for Preventing and Treating Heart Failure. J Am Coll Cardiol 2018; 72:2391-2405. [DOI: 10.1016/j.jacc.2018.08.2160] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 08/07/2018] [Accepted: 08/12/2018] [Indexed: 12/11/2022]
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Abstract
UNLABELLED Patients with heart failure (HF) frequently struggle to adhere to health behaviors, and psychological factors may contribute to nonadherence. We examined the feasibility and acceptability of a 10-week, positive psychology (PP)-based intervention to promote health behavior adherence in patients (N = 10) with mild to moderate HF and suboptimal health behavior adherence. Participants engaged in weekly phone sessions, completed PP exercises (e.g., writing a gratitude letter, using a personal strength), and set goals related to diet, medication adherence, and physical activity. Feasibility was assessed by the number of sessions completed, and acceptability by participant ratings of ease and utility. Preliminary efficacy was measured by changes in psychological and adherence outcomes. The intervention was feasible (87% of exercises completed) and acceptable. Furthermore, in exploratory analyses, the intervention was associated with improvements in psychological and health behavior adherence outcomes. Larger, randomized trials are needed to further investigate the utility of this intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02938052.
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Lennie TA, Andreae C, Rayens MK, Song EK, Dunbar SB, Pressler SJ, Heo S, Kim J, Moser DK. Micronutrient Deficiency Independently Predicts Time to Event in Patients With Heart Failure. J Am Heart Assoc 2018; 7:e007251. [PMID: 30371170 PMCID: PMC6201427 DOI: 10.1161/jaha.117.007251] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/09/2018] [Indexed: 12/03/2022]
Abstract
Background Dietary micronutrient deficiencies have been shown to predict event-free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event-free survival, defined as a combined end point of all-cause hospitalization and death. Methods and Results Four-day food diaries were collected from 246 patients with heart failure (age: 61.5±12 years; 67% male; 73% white; 45% New York Heart Association [NYHA] class III / IV ) and analyzed using Nutrition Data Systems for Research. Micronutrient deficiencies were determined according to methods recommended by the Institute of Medicine. Patients were followed for 1 year to collect data on all-cause hospitalization or death. Patients were divided according to number of dietary micronutrient deficiencies at a cut point of ≥7 for the high deficiency category versus <7 for the no to moderate deficiency category. In the full sample, 29.8% of patients experienced hospitalization or death during the year, including 44.3% in the high-deficiency group and 25.1% in the no/moderate group. The difference in survival distribution was significant (log rank, P=0.0065). In a Cox regression, micronutrient deficiency category predicted time to event with depression, NYHA classification, comorbidity burden, body mass index, calorie and sodium intake, and prescribed angiotensin-converting enzyme inhibitors, diuretics, or β-blockers included as covariates. Conclusions This study provides additional convincing evidence that diet quality of patients with heart failure plays an important role in heart failure outcomes.
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Affiliation(s)
| | - Christina Andreae
- Division of Nursing ScienceDepartment of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | | | - Eun Kyeung Song
- Department of NursingCollege of MedicineUniversity of UlsanKorea
| | | | | | - Seongkum Heo
- College of NursingUniversity of Arkansas for Medical SciencesLittle RockAR
| | - JinShil Kim
- Gachon University College of NursingIncheonKorea
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15
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Sterling MR, Jannat-Khah D, Vitale S, Safford MM. Can your patients with heart failure see? The prevalence of visual impairment among adults with heart failure. J Gen Intern Med 2018; 33:605-607. [PMID: 29464476 PMCID: PMC5910364 DOI: 10.1007/s11606-018-4366-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Deanna Jannat-Khah
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Susan Vitale
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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16
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Micronutrient Deficiency Independently Predicts Adverse Health Outcomes in Patients With Heart Failure. J Cardiovasc Nurs 2018; 32:47-53. [PMID: 26544174 DOI: 10.1097/jcn.0000000000000304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite growing evidence on the important role of micronutrients in prognosis of heart failure (HF), there has been limited research that micronutrient deficiency predicts health outcomes in patients with HF. PURPOSE The aim of this study was to determine whether micronutrient deficiency independently predicts adverse health outcomes. METHODS A total of 113 consecutive outpatients with HF completed a 3-day food diary to measure intake of 15 micronutrients. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary micronutrient deficiencies. Patients completed the Minnesota Living With HF Questionnaire to assess health-related quality of life (HRQoL) and were followed up for 1 year to determine cardiac-related hospitalization or cardiac death. Hierarchical multiple linear regressions and Cox proportional hazard regressions were used to determine whether micronutrient deficiencies predicted health outcomes. RESULTS Fifty-eight patients (51%) had at least 3 micronutrient deficiencies (range, 0-14). Calcium, magnesium, and vitamin D were the most common micronutrient deficiencies. Micronutrient deficiency was independently associated with worse HRQoL (β = .187, P = .025) in hierarchical multiple linear regression. Thirty-nine patients were hospitalized or died during 1-year follow-up because of cardiac problems. The number of micronutrient deficiencies independently predicted cardiac event-free survival (hazard ratio, 1.14; 95% confidence interval, 1.02-1.28). CONCLUSIONS These findings show that micronutrient deficiency independently predicted poor HRQoL and earlier cardiac event-free survival in patients with HF. Further research is needed to provide for specific dietary guidelines for better health outcomes in HF patients.
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Dietary Micronutrient Intake and Micronutrient Status in Patients With Chronic Stable Heart Failure. J Cardiovasc Nurs 2017; 32:148-155. [DOI: 10.1097/jcn.0000000000000322] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu JR, Lennie TA, Dunbar SB, Pressler SJ, Moser DK. Does the Theory of Planned Behavior Predict Dietary Sodium Intake in Patients With Heart Failure? West J Nurs Res 2016; 39:568-581. [DOI: 10.1177/0193945916672661] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sodium intake in heart failure (HF) is a crucial but poorly understood phenomenon. Theoretical models promote understanding and provide a context for rational appraisal of complex situations. The purpose of this study was to determine which factors were associated with sodium intake in HF patients using theory of planned behavior (TPB). In this study, patients’ ( N = 244) attitudes, subjective norms, and perceived behavioral control (tenets of the TPB) were assessed using the Dietary Sodium Restriction Questionnaire. Sodium intake was estimated objectively by 24-hr urinary sodium excretion (UNa). The average UNa was 3,811 mg. Subjective norms, gender, and New York Heart Association functional class were associated with sodium intake ( p < .001). Thus, it is important for health care providers to clearly express their approval of following low-sodium diet to their HF patients, and include significant others in interventions to help patients develop/maintain a positive subjective norm to decrease sodium intake and reduce HF exacerbations.
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Affiliation(s)
- Jia-Rong Wu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Colin-Ramirez E, McAlister FA, Zheng Y, Sharma S, Ezekowitz JA. Changes in dietary intake and nutritional status associated with a significant reduction in sodium intake in patients with heart failure. A sub-analysis of the SODIUM-HF pilot study. Clin Nutr ESPEN 2015; 11:e26-e32. [PMID: 28531423 DOI: 10.1016/j.clnesp.2015.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/22/2015] [Accepted: 11/02/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND & AIMS Concerns have been raised about the impact of dietary sodium restriction on the overall dietary intake and nutritional status in patients with heart failure (HF). The objective of this study was to evaluate the association between a significant reduction in sodium intake and dietary changes and nutritional status in patients with chronic HF. METHODS This is a secondary analysis of 38 patients enrolled in a pilot study of dietary sodium reduction. Patients were classified into two groups according to a level of sodium reduction achieved (≥25% [n = 21 patients] and <25% [n = 14 patients]) at 6 months. Between group changes in energy, nutrient intake, weight loss, and hand grip strength from baseline to 6 months were compared. RESULTS Patients had a median age of 65 years, 51% were male, median body mass index was 30.7 kg/m2 and median ejection fraction was 39%. Over 6 months, the group with ≥25% sodium reduction exhibited a greater increase in folate intake [median change 50 mcg/day (25th-75th percentiles: -101, 167) vs. -31 mcg/day (25th-75th percentiles: -221, 51), p = 0.04 between groups] and a larger reduction in calcium intake [median change -262 (25th-75th percentiles: -585, -9) vs. 91 (25th-75th percentiles: -114, 210), p = 0.01 between groups], and were more likely to meet the parameters of the DASH diet compared to the <25% sodium reduction group. No significant differences between groups were seen for caloric intake and other relevant nutrients and no significant weight loss was found in either group. CONCLUSIONS Dietary sodium reduction may be achieved without compromising overall dietary intake and nutritional status in patients with HF when an individualized and comprehensive dietary approached is used. CLINICAL TRIAL IDENTIFIER Clinicaltrials.gov identifier: NCT01480401.
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Affiliation(s)
| | - Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Centre at the University of Alberta, Edmonton, Canada
| | - Sangita Sharma
- Medicine Department, University of Alberta, Edmonton, Canada
| | - Justin A Ezekowitz
- Medicine Department, University of Alberta, Edmonton, Canada; Canadian VIGOUR Centre at the University of Alberta, Edmonton, Canada; Heart Function Clinic, Division of Cardiology, University of Alberta, Edmonton, Canada.
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Rifai L, Silver MA. A Review of the DASH Diet as an Optimal Dietary Plan for Symptomatic Heart Failure. Prog Cardiovasc Dis 2015; 58:548-54. [PMID: 26545444 DOI: 10.1016/j.pcad.2015.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
Abstract
Despite tremendous focus, effort, drug and device development and resources dedicated to the care of patients at risk for and with heart failure (HF), the epidemic continues. The HF patient presents with a widely deranged physiology and typically at the same time is malnourished adding to the disease complexity and therapeutic challenges. Most nutritional approaches for patients with HF focus on dietary restrictions (of salt and water) and lack uniformity or clarity or focus on meeting nutritional needs, barriers and deficits of the patient with HF. Finally, it seems reasonable to anticipate that any dietary program recommendation should contribute in a positive way toward HF management goals and at its foundation positively contribute to the deranged physiology. In many ways the "Dietary Approaches to Stop Hypertension" (DASH) dietary program fulfills these needs and early evidence supports the notion that the DASH diet may be optimal for patients with HF. This brief review examines some of this evidence and provides recommendations for the HF community.
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Affiliation(s)
- Luay Rifai
- Section of Cardiology, Advocate Lutheran Hospital, Park Ridge, IL, United States.
| | - Marc A Silver
- Heart Failure Institute and the Division of Medical Services, Advocate Christ Medical Center, Oak Lawn, IL, United States
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21
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Levitan EB, Lewis CE, Tinker LF, Eaton CB, Ahmed A, Manson JE, Snetselaar LG, Martin LW, Trevisan M, Howard BV, Shikany JM. Mediterranean and DASH diet scores and mortality in women with heart failure: The Women's Health Initiative. Circ Heart Fail 2013; 6:1116-23. [PMID: 24107587 PMCID: PMC4564006 DOI: 10.1161/circheartfailure.113.000495] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current dietary recommendations for patients with heart failure (HF) are largely based on data from non-HF populations; evidence on associations of dietary patterns with outcomes in HF is limited. We therefore evaluated associations of Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diet scores with mortality among postmenopausal women with HF. METHODS AND RESULTS Women's Health Initiative participants were followed up from the date of HF hospitalization through the date of death or last participant contact before August 2009. Mediterranean and DASH diet scores were calculated from food-frequency questionnaires. Cox proportional hazards models adjusted for demographics, health behaviors, and health status were used to calculate hazard ratios and 95% confidence intervals (CI). For a median of 4.6 years of follow-up, 1385 of 3215 (43.1%) participants who experienced a HF hospitalization died. Multivariable-adjusted hazard ratios were 1 (reference), 1.05 (95% CI, 0.89-1.24), 0.97 (95% CI, 0.81-1.17), and 0.85 (95% CI, 0.70-1.02) across quartiles of the Mediterranean diet score (P trend=0.08) and 1 (reference), 1.04 (95% CI, 0.89-1.21), 0.83 (95% CI, 0.70-0.98), and 0.84 (95% CI, 0.70-1.00) across quartiles of the DASH diet score (P trend=0.01). Diet score components, vegetables, nuts, and whole grain intake, were inversely associated with mortality. CONCLUSIONS Higher DASH diet scores were associated with modestly lower mortality in women with HF, and there was a nonsignificant trend toward an inverse association with Mediterranean diet scores. These data provide support for the concept that dietary recommendations developed for other cardiovascular conditions or general populations may also be appropriate in patients with HF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Ribeiro RF, Dabkowski ER, O'Connell KA, Xu W, Galvao TDF, Hecker PA, Shekar KC, Stefanon I, Stanley WC. Effect of a high-protein diet on development of heart failure in response to pressure overload. Appl Physiol Nutr Metab 2013; 39:238-47. [PMID: 24476481 DOI: 10.1139/apnm-2013-0274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Heart failure treatment guidelines provide no recommendations regarding the intake of protein, though it has been proposed that increasing protein intake may result in clinical improvement. High-protein intake might improve protein synthesis and cell function, and prevent deterioration in mitochondrial and left ventricular function. We assessed the effects of a high-protein diet on the development of heart failure characterized by cardiac hypertrophy, impaired mitochondrial oxidative metabolism and contractile dysfunction induced by transverse aortic constriction in rats. A standard diet with 18% of energy intake from protein was compared with a high-protein diet (30% of energy intake). First, we evaluated the effects of protein intake on the development of heart failure during 14 weeks of aortic constriction, and found similar cardiac hypertrophy, contractile dysfunction, ventricular dilation, and decreased cardiac mitochondrial oxidative capacity with both 18% and 30% protein. We then assessed more advanced heart failure, with 22 weeks of aortic constriction. We again saw no difference in cardiac mass, left ventricular volume, mitochondrial oxidative capacity or resistance to permeability transition between the 18% and 30% protein diets. There was a modest but significant decrease in survival with heart failure with the 30% protein diet compared with 18% protein (p < 0.003). In conclusion, consumption of a high-protein diet did not affect cardiac mass, left ventricular volumes or ejection fraction, or myocardial mitochondrial oxidative capacity in rats with pressure overload induced heart failure, but significantly decreased survival.
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Affiliation(s)
- Rogerio F Ribeiro
- a Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, MD 21231, USA
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24
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Alosco ML, Spitznagel MB, Raz N, Cohen R, Sweet LH, Colbert LH, Josephson R, van Dulmen M, Hughes J, Rosneck J, Gunstad J. Dietary habits moderate the association between heart failure and cognitive impairment. J Nutr Gerontol Geriatr 2013; 32:106-21. [PMID: 23663211 PMCID: PMC5022366 DOI: 10.1080/21551197.2013.781408] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cognitive impairment is common in heart failure patients. Poor dietary habits are associated with reduced neurocognitive function in other medical populations, including diabetes and Alzheimer's disease. This study examined whether dietary habits help moderate the relationship between heart failure severity and cognitive function. A total of 152 persons with heart failure completed neuropsychological testing and a fitness assessment. Dietary habits were assessed using the Starting the Conversation-Diet questionnaire, a nutrition measure suggested for use in primary care settings. Moderation analyses showed that better dietary habits attenuated the adverse impact of heart failure severity on frontal functioning (b = 1.28, p < 0.05). Follow-up analyses revealed consumption of foods high in sodium was associated with reduced cognitive function (p < 0.05). This study suggests dietary habits can moderate the association between heart failure and performance on tests of attention and executive function. Longitudinal studies are needed to confirm and clarify the mechanisms for our findings.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, OH 44242, USA.
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25
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A qualitative analysis of coronary heart disease patient views of dietary adherence and web-based and mobile-based nutrition tools. J Cardiopulm Rehabil Prev 2012; 32:203-9. [PMID: 22760245 DOI: 10.1097/hcr.0b013e31825b4e6a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Dietary adherence can be challenging for patients with coronary heart disease (CHD), as they may require multiple dietary changes. Choosing appropriate food items may be difficult or take extensive amounts of time without the aid of technology. The objective of this project was to (1) examine the dietary challenges faced by patients with CHD, (2) examine methods of coping with dietary challenges, (3) explore the feasibility of a Web-based food decision support system, and (4) explore the feasibility of a mobile-based food decision support system. METHODS Food for the Heart (FFH), a Web site-based food decision support system, and Mobile Magic Lens (MML), a mobile-based system, were developed to aid in daily dietary choices. Three CHD patient focus groups were conducted and focused on CHD-associated dietary changes as well as the FFH and MML prototypes. A total of 20 CHD patients and 7 informal caregivers participated. Qualitative, content analysis was performed to find themes grounded in the responses. RESULTS Five predominant themes emerged: (1) decreasing carbohydrate intake and portion control are common dietary challenges, (2) clinician and social support makes dietary adherence easier, (3) FFH could make meal-planning and dietary adherence less complicated, (4) MML could save time and assist with healthy choices, and (5) additional features need to be added to make both tools more comprehensive. CONCLUSION Food for the Heart and MML may be tools that CHD patients would value in making food choices and adhering to dietary recommendations, especially if additional features are added to assist patients with changes.
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Hernández MA, Patiño AF. Consideraciones nutricionales en el paciente con falla cardíaca crónica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70152-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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McKeag NA, McKinley MC, Woodside JV, Harbinson MT, McKeown PP. The role of micronutrients in heart failure. J Acad Nutr Diet 2012; 112:870-86. [PMID: 22709814 DOI: 10.1016/j.jand.2012.01.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 01/19/2012] [Indexed: 02/07/2023]
Abstract
Heart failure is a common condition in the Western world, particularly among elderly persons and with an ever-aging population, the incidence is expected to increase. Diet in the setting of heart failure is important--patients with this condition are advised to consume a low-salt diet and monitor their weight closely. Nutritional status of patients with heart failure also is important--those with poor nutritional status tend to have a poor long-term prognosis. A growing body of evidence suggests an association between heart failure and micronutrient status. Reversible heart failure has been described as a consequence of severe thiamine and selenium deficiency. However, contemporary studies suggest that a more subtle relationship may exist between micronutrients and heart failure. This article reviews the existing literature linking heart failure and micronutrients, examining studies that investigated micronutrient intake, micronutrient status, and the effect of micronutrient supplementation in patients with heart failure, and focusing particularly on vitamin A, vitamin C, vitamin E, thiamine, other B vitamins, vitamin D, selenium, zinc, and copper.
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Affiliation(s)
- Nicholas A McKeag
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Belfast, United Kingdom.
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Son YJ, Song EK. High nutritional risk is associated with worse health-related quality of life in patients with heart failure beyond sodium intake. Eur J Cardiovasc Nurs 2012; 12:184-92. [PMID: 22653090 DOI: 10.1177/1474515112443439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The most desirable outcome in heart failure (HF) management is to improve health-related quality of life (HRQoL) as a patient-centred health outcome. Nutrition is assumed to be important in HF management, whereas there is little evidence that nutritional risk affects HRQoL, except for sodium. PURPOSE We aimed to determine whether nutritional risk is associated with worse HRQoL after controlling for daily sodium intake. METHODS A total of 134 consecutive patients with HF [age 63 ± 11 years, 35% female, 45% New York Heart Association (NYHA) class III/IV, ejection fraction (EF) 33 ± 13%] completed the Nutrition Screening Initiative (NSI) to assess nutritional risk and a 24-h urine sodium excretion assessment to estimate daily sodium intake at baseline. The Minnesota Living with HF Questionnaire was used to evaluate HRQoL at baseline and 6 months later. Hierarchical linear regressions were used to determine whether nutritional risk predicted HRQoL at baseline and 6 months later. RESULTS Seventy-eight (58.2%) patients had high nutritional risk as indicated by a total NSI score ≥ 6. Increased nutritional risk was independently associated with worse HRQoL at baseline and 6 months later (β = 0.33, p < 0.001; β = 0.35, p < 0.001, respectively), after controlling for age, gender, aetiology, body mass index, NYHA class, EF, total comorbidity score, prescribed medications, and daily sodium intake. CONCLUSION These findings show that higher nutritional risk beyond sodium intake affects worse HRQoL in patients with HF. Further work is required to provide specific dietary guidelines to improve health outcomes for patients with HF.
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Affiliation(s)
- Youn-Jung Son
- Department of Nursing, College of Medicine, Soonchunhyang University, Cheonan, South Korea
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Azizi-Namini P, Ahmed M, Yan AT, Keith M. The role of B vitamins in the management of heart failure. Nutr Clin Pract 2012; 27:363-74. [PMID: 22516940 DOI: 10.1177/0884533612444539] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Heart failure (HF) is the leading cause of morbidity and mortality in industrialized countries, creating a significant burden on both the healthcare system and quality of life. Research efforts continue to explore new pharmaceutical or surgically based approaches to HF management, but the role of nutrition as an adjunct therapy has been largely ignored. Elderly age, anorexia, malabsorption, premature satiety, and disease severity are among the factors identified as contributing to reduced nutrient intakes in patients with HF. These factors suggest that patients with HF are at increased risk of multiple-nutrient deficiencies, including B vitamins. B vitamins may be of particular therapeutic interest because of their key roles as cofactors in energy-producing pathways. Recently, impaired stores of high-energy compounds have been linked with myocardial dysfunction and prognosis in patients with HF. Therefore, deficiencies of B vitamins might contribute to reduced energy stores and disease progression. This review summarizes the existing literature both with respect to the prevalence of B vitamin deficiency as well as evidence from supplementation trials in patients with HF. The findings suggest that most of the literature in this area has focused on thiamin deficiency in patients with HF, whereas other B vitamins remain largely unstudied. Although few sporadic trials suggest a role for B vitamins in the management of HF, none are conclusive. Therefore, there is a need for larger, more robust trials to assist in defining the B vitamin requirements as well as the impact of supplementation on both morbidity and mortality in patients with HF.
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Affiliation(s)
- Parastoo Azizi-Namini
- Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Pritchett AM, Deswal A, Aguilar D, Foreyt JP, Chan W, Mann DL, Ballantyne C, Bozkurt B. Lifestyle Modification with Diet and Exercise in Obese Patients with Heart Failure - A Pilot Study. ACTA ACUST UNITED AC 2012; 2:1-8. [PMID: 23125955 DOI: 10.4172/2165-7904.1000118] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE: There is a paucity of data regarding intentional weight loss in obese heart failure patients. This study sought to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic heart failure and metabolic syndrome. METHODS: Patients (n=20) with systolic heart failure (ejection fraction < 50%) and metabolic syndrome were randomized to standard medical therapy (Control) versus medical therapy and lifestyle modification (Lifestyle) and followed prospectively for 3 months. Lifestyle modification involved a walking program and reduced calorie diet with 2 meal replacement products (Slim Fast®) daily. Patients attended weekly meetings with a dietitian for 12 weeks. Endpoints were obtained at baseline and 3 months and included physical exam, laboratory values, quality of life questionnaire, 6 minute walk, and brachial ultrasound. RESULTS: At 3 months, 5 patients in each group had lost weight. Excluding 1 patient in each group who had increased diuretic dosing, the overall change in weight was -0.84 ± 3.82 and -0.50 ± 3.64 kg (p=0.85) in the control versus lifestyle groups respectively. No significant differences in the defined endpoints were noted. None of the patients had an adverse event that was related to weight loss or exercise. CONCLUSIONS: This study is the first to assess the effects of a comprehensive program of dietary, behavioral, and exercise modifications in this population. Institution of lifestyle modification in patients with systolic heart failure and metabolic syndrome was well tolerated, but did not result in significant weight loss.
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Affiliation(s)
- Allison M Pritchett
- Winters Center for Heart Failure Research and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA ; Section of Cardiology, Ben Taub General Hospital, Harris County Hospital District, Houston, Texas, USA
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Stanley WC, Dabkowski ER, Ribeiro RF, O'Connell KA. Dietary fat and heart failure: moving from lipotoxicity to lipoprotection. Circ Res 2012; 110:764-76. [PMID: 22383711 PMCID: PMC3356700 DOI: 10.1161/circresaha.111.253104] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 01/27/2011] [Indexed: 02/07/2023]
Abstract
There is growing evidence suggesting that dietary fat intake affects the development and progression of heart failure. Studies in rodents show that in the absence of obesity, replacing refined carbohydrate with fat can attenuate or prevent ventricular expansion and contractile dysfunction in response to hypertension, infarction, or genetic cardiomyopathy. Relatively low intake of n-3 polyunsaturated fatty acids from marine sources alters cardiac membrane phospholipid fatty acid composition, decreases the onset of new heart failure, and slows the progression of established heart failure. This effect is associated with decreased inflammation and improved resistance to mitochondrial permeability transition. High intake of saturated, monounsaturated, or n-6 polyunsaturated fatty acids has also shown beneficial effects in rodent studies. The underlying mechanisms are complex, and a more thorough understanding is needed of the effects on cardiac phospholipids, lipid metabolites, and metabolic flux in the normal and failing heart. In summary, manipulation of dietary fat intake shows promise in the prevention and treatment of heart failure. Clinical studies generally support high intake of n-3 polyunsaturated fatty acids from marine sources to prevent and treat heart failure. Additional clinical and animals studies are needed to determine the optimal diet in terms of saturated, monounsaturated, and n-6 polyunsaturated fatty acids intake for this vulnerable patient population.
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Affiliation(s)
- William C Stanley
- Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, MD 21201, USA.
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Short-term effects of hypertonic saline solution in acute heart failure and long-term effects of a moderate sodium restriction in patients with compensated heart failure with New York Heart Association class III (Class C) (SMAC-HF Study). Am J Med Sci 2011; 342:27-37. [PMID: 21701268 DOI: 10.1097/maj.0b013e31820f10ad] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Hypertonic saline solution (HSS) and a moderate Na restriction plus high furosemide dose showed beneficial effects in compensated heart failure (HF), in short and long terms. The study was aimed to verify the effects of this combination on hospitalization time, readmissions and mortality in patients in New York Heart Association (NYHA) class III. METHOD Chronic ischemic or nonischemic cardiomyopathy uncompensated patients with HF in NYHA III functional class with ejection fraction <40%, serum creatinine <2.5 mg/dL, blood urea nitrogen <60 mg/dL and reduced urinary volume were single-blind randomized in 2 groups: the first group received a 30-minute intravenous infusion of furosemide (250 mg) plus HSS (150 mL) twice daily and a moderate Na restriction (120 mmol); the second group received furosemide intravenous bolus (250 mg) twice a day, without HSS and a low Na diet (80 mmol); both groups received a fluid intake of 1000 mL/d. After discharge, the HSS group continued with 120 mmol Na/d; the second group continued with 80 mmol Na/d. RESULTS A total of 1771 patients (881 HSS group and 890 without HSS group) met inclusion criteria: the first group (881 patients), compared with the second (890 patients), showed an increase in diuresis and serum Na levels, a reduction in hospitalization time (3.5 + 1 versus 5.5 + 1 days, P < 0.0001) and, during follow-up (57 + 15 months), a lower rate in readmissions (18.5% versus 34.2%, P < 0.0001) and mortality (12.9% versus 23.8%, P < 0.0001); the second group also showed a significant increase in blood urea nitrogen and serum creatinine. CONCLUSION This study suggests that in-hospital HSS administration, combined with moderate Na restriction, reduces hospitalization time and that a moderate sodium diet restriction determines long-term benefit in patients with NYHA class III HF.
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Gardetto NJ. Self-management in heart failure: where have we been and where should we go? J Multidiscip Healthc 2011; 4:39-51. [PMID: 21544247 PMCID: PMC3084307 DOI: 10.2147/jmdh.s8174] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 01/09/2023] Open
Abstract
Chronic conditions such as heart failure (HF) place a tremendous strain on patients, their families, the community, and the health care system because there are no real “cures”. Adding to the burden are longer life expectancies and increased numbers of people living with multiple chronic conditions. Today, whether engaging in a health-promoting activity, such as exercise, or living with a chronic disease such as HF, the individual is responsible for actively managing day-to-day activities, a concept referred to as self-management. Self-management emerged as the cornerstone for chronic care models and multidisciplinary disease-management strategies in chronic illness care. Moreover, self-management has been prioritized as a central pathway for improving the quality and effectiveness of most chronic HF care. Adherence to self-management is vital to optimize the treatment outcomes in HF patients, but implementing chronic disease self-management (CDSM) strategies and identifying the difficulties in self-management has proved to be a challenge. Understanding both where we have been and the future direction of self-management in HF care is not only timely, but a crucial aspect of improving long-term outcomes for people with HF and other chronic diseases.
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Affiliation(s)
- Michael B. Rothberg
- Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199 USA
- Tufts University School of Medicine, Boston, MA USA
| | - Senthil K. Sivalingam
- Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199 USA
- Tufts University School of Medicine, Boston, MA USA
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