Micronutrient deficiency independently predicts time to event in patients with heart failure

• Type of Material: Article
• Authors: Terry A. Lennie, University of Kentucky; Christina Andreae, Linköping University; Mary Kay Rayens, University of Kentucky; Eun Kyeung Song, Ulsan University; Sandra B Dunbar, Emory University; Susan J. Pressler, Indiana University; Seongkum Heo, University of Arkansas; JinShil Kim, Gachon University; Debra K. Moser, University of Kentucky
• Language: English
• Date: 2018-09-01
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.117.007251
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 7
• Issue: 17
• Start Page: e007251
• End Page: e007251
• Grant/Funding Information: This work was supported by National Institute of Nursing Research NIH RO1NR009280, National Institute of Nursing Research NIH P20NR0106791, American Heart Association, Great Rivers Affiliate Postdoctoral Fellowship, National Center for Research Resources, NIH UL1 RR025008, National Center for Advancing Translational Sciences, NIH UL1TR000117, General Clinical Research Centers NIH: Indiana University M01RR000750, Atlanta Veterans Administration Medical Center, and Clarian Health Partners (Indiana).
• Keywords: risk factor; nutrition; survival analysis; heart failure; diet
• Research Categories: Health Sciences, General; Health Sciences, Nursing

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 tomoderate 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 b-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.