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Terry A. Lennie - One of the best experts on this subject based on the ideXlab platform.
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association of depressive symptoms and Micronutrient Deficiency with cardiac event free survival in patients with heart failure
Journal of Cardiac Failure, 2015Co-Authors: Eun Kyeung Song, Seokmin Kang, Debra K. Moser, Terry A. LennieAbstract:Abstract Background Depressive symptoms and malnutrition independently predict cardiac events in heart failure (HF) patients. However, the relationships among depressive symptoms, nutritional intake, and cardiac event–free survival have not been examined. Methods and Results A total of 232 patients with HF completed the Patient Health Questionnaire 9 (PHQ-9) to measure depressive symptoms and a 3-day food diary to determine the number of Micronutrient deficiencies. Patients were followed for 2 years to collect data on cardiac event–free survival. Patients were divided into 4 groups by a PHQ-9 score of 10 and the median value of Micronutrient deficiencies. Cox regressions were used to determine the relationships among depressive symptoms, Micronutrient Deficiency, and cardiac event–free survival. Depressive symptoms conferred greater risk of cardiac events in patients with a high number of Micronutrient deficiencies than in those with a low number of Micronutrient deficiencies. Patients with a PHQ-9 score ≥10 and number of Micronutrient deficiencies >5 had 2.4 times higher risk for cardiac events compared with patients with a PHQ-9 score P = .005). Conclusions There was a synergistic effect on the association of depressive symptoms with cardiac event–free survival in HF patients that differed by Micronutrient Deficiency.
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Association of Depressive Symptoms and Micronutrient Deficiency With Cardiac Event–Free Survival in Patients With Heart Failure
Journal of Cardiac Failure, 2015Co-Authors: Eun Kyeung Song, Seokmin Kang, Debra K. Moser, Terry A. LennieAbstract:Abstract Background Depressive symptoms and malnutrition independently predict cardiac events in heart failure (HF) patients. However, the relationships among depressive symptoms, nutritional intake, and cardiac event–free survival have not been examined. Methods and Results A total of 232 patients with HF completed the Patient Health Questionnaire 9 (PHQ-9) to measure depressive symptoms and a 3-day food diary to determine the number of Micronutrient deficiencies. Patients were followed for 2 years to collect data on cardiac event–free survival. Patients were divided into 4 groups by a PHQ-9 score of 10 and the median value of Micronutrient deficiencies. Cox regressions were used to determine the relationships among depressive symptoms, Micronutrient Deficiency, and cardiac event–free survival. Depressive symptoms conferred greater risk of cardiac events in patients with a high number of Micronutrient deficiencies than in those with a low number of Micronutrient deficiencies. Patients with a PHQ-9 score ≥10 and number of Micronutrient deficiencies >5 had 2.4 times higher risk for cardiac events compared with patients with a PHQ-9 score P = .005). Conclusions There was a synergistic effect on the association of depressive symptoms with cardiac event–free survival in HF patients that differed by Micronutrient Deficiency.
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Less Than 2g of Daily Sodium Intake Independently Predict Higher Micronutrient Deficiency in Patients with Heart Failure
Journal of Cardiac Failure, 2013Co-Authors: Eun Kyeung Song, Debra K. Moser, Terry A. LennieAbstract:Background: Micronutrient Deficiency is an important factor to determine quality of patients’ diets. Micronutrient Deficiency is known to be associated with adverse health outcome in patients with heart failure (HF). A strict low sodium diet is assumed to be related to inadequate food intake, resulting in poor nutritional status. However, there is limited research about the link of a strict low sodium diet to Micronutrient Deficiency. The purpose of this study was to determine whether a strict low sodium diet affects Micronutrient Deficiency. We hypothesized that less than 2g of daily sodium intake independently predict higher Micronutrient Deficiency. Methods: A total of 100 outpatients with HF (age 61612 years, 27% female, 50% New York Heart Association [NYHA] class III/IV) completed a 3-day food diary to estimate the total number of Micronutrient deficiencies (range 0 to 15) and daily sodium intake. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary Micronutrient deficiencies including phosphate, calcium, magnesium, niacin, zinc, folate, selenium, vitamin B1, B2, B6, B12, C, D, E and K. Patients were divided into 2 groups by the median split as 5 of a total number of Micronutrient deficiencies; higher vs. lower Micronutrient Deficiency. Patients were divided into 4 groups by the level of daily sodium intake; ! 2g, 2 to 3g, 3 to 4g, and O 4g. Hierarchical logistic regression was used to determine the association of less than 2g of daily sodium intake with Micronutrient Deficiency. Results: The average sodium intake was 3.2 6 1.4 g/day. Fourteen patients had less than 2g of daily sodium intake. A half of patients had at least 5 Micronutrient deficiencies (range 0-15). The most common Micronutrient deficiencies were calcium, magnesium, and vitamin D. In univariate logistic regression, less than 2g of daily sodium intake independently predicted higher Micronutrient Deficiency (OR5 4.67, 95% CI5 1.04 20.94, p5 0.044). In hierarchical multivariate logistic regression, less than 2g of daily sodium intake was independently associated with an almost 9 times greater risk for higher Micronutrient Deficiency after controlling for age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, and use of diuretics (OR 5 9.08, 95% CI 5 1.06 20.5, p 5 0.027). Conclusion: This finding shows that patients with HF had poor nutritional intake if daily sodium intake was restricted to less than 2g. This result suggests clinically relevant evidence for raising concerns about a strict low sodium diet in patients with HF.
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abstract 1549 Micronutrient Deficiency independently predicts event free survival in patients with heart failure
Circulation, 2009Co-Authors: Terry A. Lennie, Eun Kyeung Song, Seongkum Heo, Misook L Chung, Sandra B Dunbar, Susan J Pressler, Debra K. MoserAbstract:Background. Nutrition is believed to be important in heart failure (HF) management. However, except for sodium, there is little evidence that nutritional intake affects HF outcomes. Purpose. To determine whether number of dietary Micronutrient deficiencies predicted event-free survival after controlling for age, gender, body mass index, dietary sodium, HF etiology, NYHA class, co-morbidities, and ejection fraction. Methods. A total of 228 patients with HF (age 61±12 years, 66% male, 53% NYHA class III/IIV, EF 34±14%) completed a 4-day food diary to measure intake of sodium and 15 Micronutrients. Nutrition Data System software was used to determine intake of sodium, phosphate, calcium, magnesium, niacin, zinc, folate, thiamin, riboflavin, selenium, and vitamins B 6 , B 12 , C, D, E and K. Micronutrient deficiencies were defined using formulas from the Institute of Medicine. Patients were followed for 1year to determine time to all cause-hospitalization or death. Hierarchical Cox regression hazard methods were used to determine if number of Micronutrient deficiencies predicted event-free survival. Results. Sixty-seven patients (29%) were hospitalized or died during follow-up. Number of Micronutrient deficiencies independently predicted event-free survival (hazard ratio=1.10, 95% CI=1.01–1.19). The risk of an event increased by 10% for each additional Micronutrient Deficiency. Fig 1 shows event-rates by quartiles of nutrient deficiencies. Conclusion. Quality of patients’ diet was an independent predictor of event-free survival. These are among the first data to show nutritional intake beyond sodium affects outcomes. This research has received full or partial funding support from the American Heart Association, Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
Agozie C Ubesie - One of the best experts on this subject based on the ideXlab platform.
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multiple Micronutrient deficiencies among patients with intestinal failure during and after transition to enteral nutrition
The Journal of Pediatrics, 2013Co-Authors: Agozie C Ubesie, Adam Mezoff, Carol J. Henderson, Samuel A. Kocoshis, Michael A Helmrath, Conrad R. ColeAbstract:Objectives To determine the prevalence of deficiencies of specific Micronutrients (iron, zinc, magnesium, phosphorus, selenium, copper, folate, and vitamins A, D, E, and B12) in children with intestinal failure (IF), and to identify risk factors associated with developing these deficiencies. Study design This study was a retrospective review of prospectively collected data from 178 children with IF managed by the Intestinal Care Center of Cincinnati Children's Hospital Medical Center between August 1, 2007, and July 31, 2012. Transition to full enteral nutrition (FEN) was defined as the period during which the patient received between 20% and 100% of estimated required nutrition enterally. FEN was defined as the patient's ability to tolerate 100% estimated required nutrition enterally for >2 weeks. Results Necrotizing enterocolitis was the most common cause of IF (27.5%). Iron was the most common Micronutrient Deficiency identified both during (83.9%) and after (61%) successful transition to FEN, with a significant reduction in the percentage of patients with iron Deficiency between these 2 periods ( P = .003). Predictors of Micronutrient Deficiency after successful transition to FEN included birth weight ( P = .03), weight percentile ( P = .02), height percentile ( P = .04), and duration of parenteral nutrition (PN) ( P = .013). After multivariate adjustments, only duration of PN remained statistically significant ( P = .03). Conclusion Micronutrient deficiencies persist in patients with IF during and after transition to FEN. These data support the need for routine monitoring and supplementation of these patients, especially those on prolonged PN.
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Micronutrient deficiencies in pediatric and young adult intestinal transplant patients
Pediatric Transplantation, 2013Co-Authors: Agozie C Ubesie, Conrad R. Cole, Jaimie D. Nathan, Greg Tiao, Maria H. Alonso, Adam Mezoff, Carol J. Henderson, Samuel A. KocoshisAbstract:Intestinal transplant recipients are at risk of Micronutrient Deficiency due to the slow process of post-transplant adaptation. Another contributing factor is calcineurin inhibitor–induced renal tubular dysfunction. Patients are typically supplemented with Micronutrients during PN; however, the risk of Deficiency may persist even after a successful transition to FEN. The goal was to determine the prevalence of, and associated risk factors for, iron, zinc, magnesium, phosphorus, selenium, copper, folate, and vitamins A, D, E, and B12 Deficiency in pediatric intestinal transplant recipients after successful transition to FEN. A retrospective review of prospectively collected data from children who underwent intestinal transplantation at Cincinnati Children's Hospital Medical Center was done. Deficiencies of various Micronutrients were defined using the hospital reference values. Twenty-one intestinal transplant recipients, aged one to 23 yr, who were successfully transitioned to FEN were included in the study. The prevalence of Micronutrient Deficiency was 95.2%. The common deficient Micronutrients were iron (94.7%) and magnesium (90.5%). Age ≤ 10 yr (p = 0.002) and tube feeding (p = 0.02) were significant risk factors for Micronutrient deficiencies. Pediatric intestinal transplant recipients have a high risk of Micronutrient and mineral deficiencies. These deficiencies were more common among younger patients and those who received jejunal feeding.
Debra K. Moser - One of the best experts on this subject based on the ideXlab platform.
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association of depressive symptoms and Micronutrient Deficiency with cardiac event free survival in patients with heart failure
Journal of Cardiac Failure, 2015Co-Authors: Eun Kyeung Song, Seokmin Kang, Debra K. Moser, Terry A. LennieAbstract:Abstract Background Depressive symptoms and malnutrition independently predict cardiac events in heart failure (HF) patients. However, the relationships among depressive symptoms, nutritional intake, and cardiac event–free survival have not been examined. Methods and Results A total of 232 patients with HF completed the Patient Health Questionnaire 9 (PHQ-9) to measure depressive symptoms and a 3-day food diary to determine the number of Micronutrient deficiencies. Patients were followed for 2 years to collect data on cardiac event–free survival. Patients were divided into 4 groups by a PHQ-9 score of 10 and the median value of Micronutrient deficiencies. Cox regressions were used to determine the relationships among depressive symptoms, Micronutrient Deficiency, and cardiac event–free survival. Depressive symptoms conferred greater risk of cardiac events in patients with a high number of Micronutrient deficiencies than in those with a low number of Micronutrient deficiencies. Patients with a PHQ-9 score ≥10 and number of Micronutrient deficiencies >5 had 2.4 times higher risk for cardiac events compared with patients with a PHQ-9 score P = .005). Conclusions There was a synergistic effect on the association of depressive symptoms with cardiac event–free survival in HF patients that differed by Micronutrient Deficiency.
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Association of Depressive Symptoms and Micronutrient Deficiency With Cardiac Event–Free Survival in Patients With Heart Failure
Journal of Cardiac Failure, 2015Co-Authors: Eun Kyeung Song, Seokmin Kang, Debra K. Moser, Terry A. LennieAbstract:Abstract Background Depressive symptoms and malnutrition independently predict cardiac events in heart failure (HF) patients. However, the relationships among depressive symptoms, nutritional intake, and cardiac event–free survival have not been examined. Methods and Results A total of 232 patients with HF completed the Patient Health Questionnaire 9 (PHQ-9) to measure depressive symptoms and a 3-day food diary to determine the number of Micronutrient deficiencies. Patients were followed for 2 years to collect data on cardiac event–free survival. Patients were divided into 4 groups by a PHQ-9 score of 10 and the median value of Micronutrient deficiencies. Cox regressions were used to determine the relationships among depressive symptoms, Micronutrient Deficiency, and cardiac event–free survival. Depressive symptoms conferred greater risk of cardiac events in patients with a high number of Micronutrient deficiencies than in those with a low number of Micronutrient deficiencies. Patients with a PHQ-9 score ≥10 and number of Micronutrient deficiencies >5 had 2.4 times higher risk for cardiac events compared with patients with a PHQ-9 score P = .005). Conclusions There was a synergistic effect on the association of depressive symptoms with cardiac event–free survival in HF patients that differed by Micronutrient Deficiency.
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Less Than 2g of Daily Sodium Intake Independently Predict Higher Micronutrient Deficiency in Patients with Heart Failure
Journal of Cardiac Failure, 2013Co-Authors: Eun Kyeung Song, Debra K. Moser, Terry A. LennieAbstract:Background: Micronutrient Deficiency is an important factor to determine quality of patients’ diets. Micronutrient Deficiency is known to be associated with adverse health outcome in patients with heart failure (HF). A strict low sodium diet is assumed to be related to inadequate food intake, resulting in poor nutritional status. However, there is limited research about the link of a strict low sodium diet to Micronutrient Deficiency. The purpose of this study was to determine whether a strict low sodium diet affects Micronutrient Deficiency. We hypothesized that less than 2g of daily sodium intake independently predict higher Micronutrient Deficiency. Methods: A total of 100 outpatients with HF (age 61612 years, 27% female, 50% New York Heart Association [NYHA] class III/IV) completed a 3-day food diary to estimate the total number of Micronutrient deficiencies (range 0 to 15) and daily sodium intake. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary Micronutrient deficiencies including phosphate, calcium, magnesium, niacin, zinc, folate, selenium, vitamin B1, B2, B6, B12, C, D, E and K. Patients were divided into 2 groups by the median split as 5 of a total number of Micronutrient deficiencies; higher vs. lower Micronutrient Deficiency. Patients were divided into 4 groups by the level of daily sodium intake; ! 2g, 2 to 3g, 3 to 4g, and O 4g. Hierarchical logistic regression was used to determine the association of less than 2g of daily sodium intake with Micronutrient Deficiency. Results: The average sodium intake was 3.2 6 1.4 g/day. Fourteen patients had less than 2g of daily sodium intake. A half of patients had at least 5 Micronutrient deficiencies (range 0-15). The most common Micronutrient deficiencies were calcium, magnesium, and vitamin D. In univariate logistic regression, less than 2g of daily sodium intake independently predicted higher Micronutrient Deficiency (OR5 4.67, 95% CI5 1.04 20.94, p5 0.044). In hierarchical multivariate logistic regression, less than 2g of daily sodium intake was independently associated with an almost 9 times greater risk for higher Micronutrient Deficiency after controlling for age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, and use of diuretics (OR 5 9.08, 95% CI 5 1.06 20.5, p 5 0.027). Conclusion: This finding shows that patients with HF had poor nutritional intake if daily sodium intake was restricted to less than 2g. This result suggests clinically relevant evidence for raising concerns about a strict low sodium diet in patients with HF.
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abstract 1549 Micronutrient Deficiency independently predicts event free survival in patients with heart failure
Circulation, 2009Co-Authors: Terry A. Lennie, Eun Kyeung Song, Seongkum Heo, Misook L Chung, Sandra B Dunbar, Susan J Pressler, Debra K. MoserAbstract:Background. Nutrition is believed to be important in heart failure (HF) management. However, except for sodium, there is little evidence that nutritional intake affects HF outcomes. Purpose. To determine whether number of dietary Micronutrient deficiencies predicted event-free survival after controlling for age, gender, body mass index, dietary sodium, HF etiology, NYHA class, co-morbidities, and ejection fraction. Methods. A total of 228 patients with HF (age 61±12 years, 66% male, 53% NYHA class III/IIV, EF 34±14%) completed a 4-day food diary to measure intake of sodium and 15 Micronutrients. Nutrition Data System software was used to determine intake of sodium, phosphate, calcium, magnesium, niacin, zinc, folate, thiamin, riboflavin, selenium, and vitamins B 6 , B 12 , C, D, E and K. Micronutrient deficiencies were defined using formulas from the Institute of Medicine. Patients were followed for 1year to determine time to all cause-hospitalization or death. Hierarchical Cox regression hazard methods were used to determine if number of Micronutrient deficiencies predicted event-free survival. Results. Sixty-seven patients (29%) were hospitalized or died during follow-up. Number of Micronutrient deficiencies independently predicted event-free survival (hazard ratio=1.10, 95% CI=1.01–1.19). The risk of an event increased by 10% for each additional Micronutrient Deficiency. Fig 1 shows event-rates by quartiles of nutrient deficiencies. Conclusion. Quality of patients’ diet was an independent predictor of event-free survival. These are among the first data to show nutritional intake beyond sodium affects outcomes. This research has received full or partial funding support from the American Heart Association, Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
C. M. Doak - One of the best experts on this subject based on the ideXlab platform.
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What Approaches are Most Effective at Addressing Micronutrient Deficiency in Children 0–5 Years? A Review of Systematic Reviews
Maternal and Child Health Journal, 2019Co-Authors: M. Campos Ponce, K. Polman, N. Roos, F. T. Wieringa, J. Berger, C. M. DoakAbstract:Introduction Even though Micronutrient Deficiency is still a major public health problem, it is still unclear which interventions are most effective in improving Micronutrient status. This review therefore aims to summarize the evidence published in systematic reviews on intervention strategies that aim at improving Micronutrient status in children under the age of five. Methods We searched the literature and included systematic reviews that reported on Micronutrient status as a primary outcome for children of 0–5 years old, had a focus on low or middle income countries. Subsequently, papers were reviewed and selected by two authors. Results We included 4235 reviews in this systematic review. We found that (single or multiple) Micronutrient deficiencies in pre-school children improved after providing (single or multiple) Micronutrients. However home fortification did not always lead to significant increase in serum vitamin A, serum ferritin, hemoglobin or zinc. Commercial fortification did improve iron status. Cord clamping reduced the risk of anemia in infants up to 6 months and, in helminth endemic areas, anthelminthic treatment increased serum ferritin levels, hemoglobin and improved height for age z-scores. Anti-malaria treatment improved ferritin levels. Discussion Based on our results the clearest recommendations are: delayed cord clamping is an effective intervention for reducing anemia in early life. In helminth endemic areas iron status can be improved by anthelminthic treatment. Anti-malaria treatment can improve ferritin. In deficient populations, single iron, vitamin A and multiMicronutrient supplementation can improve iron, vitamin A and multiMicronutrient status respectively. While the impact of home-fortification on multiMicronutrient status remains questionable, commercial iron fortification may improve iron status.
Eun Kyeung Song - One of the best experts on this subject based on the ideXlab platform.
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Micronutrient Deficiency Independently Predicts Adverse Health Outcomes in Patients With Heart Failure.
The Journal of cardiovascular nursing, 2017Co-Authors: Eun Kyeung Song, Seokmin KangAbstract: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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association of depressive symptoms and Micronutrient Deficiency with cardiac event free survival in patients with heart failure
Journal of Cardiac Failure, 2015Co-Authors: Eun Kyeung Song, Seokmin Kang, Debra K. Moser, Terry A. LennieAbstract:Abstract Background Depressive symptoms and malnutrition independently predict cardiac events in heart failure (HF) patients. However, the relationships among depressive symptoms, nutritional intake, and cardiac event–free survival have not been examined. Methods and Results A total of 232 patients with HF completed the Patient Health Questionnaire 9 (PHQ-9) to measure depressive symptoms and a 3-day food diary to determine the number of Micronutrient deficiencies. Patients were followed for 2 years to collect data on cardiac event–free survival. Patients were divided into 4 groups by a PHQ-9 score of 10 and the median value of Micronutrient deficiencies. Cox regressions were used to determine the relationships among depressive symptoms, Micronutrient Deficiency, and cardiac event–free survival. Depressive symptoms conferred greater risk of cardiac events in patients with a high number of Micronutrient deficiencies than in those with a low number of Micronutrient deficiencies. Patients with a PHQ-9 score ≥10 and number of Micronutrient deficiencies >5 had 2.4 times higher risk for cardiac events compared with patients with a PHQ-9 score P = .005). Conclusions There was a synergistic effect on the association of depressive symptoms with cardiac event–free survival in HF patients that differed by Micronutrient Deficiency.
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Association of Depressive Symptoms and Micronutrient Deficiency With Cardiac Event–Free Survival in Patients With Heart Failure
Journal of Cardiac Failure, 2015Co-Authors: Eun Kyeung Song, Seokmin Kang, Debra K. Moser, Terry A. LennieAbstract:Abstract Background Depressive symptoms and malnutrition independently predict cardiac events in heart failure (HF) patients. However, the relationships among depressive symptoms, nutritional intake, and cardiac event–free survival have not been examined. Methods and Results A total of 232 patients with HF completed the Patient Health Questionnaire 9 (PHQ-9) to measure depressive symptoms and a 3-day food diary to determine the number of Micronutrient deficiencies. Patients were followed for 2 years to collect data on cardiac event–free survival. Patients were divided into 4 groups by a PHQ-9 score of 10 and the median value of Micronutrient deficiencies. Cox regressions were used to determine the relationships among depressive symptoms, Micronutrient Deficiency, and cardiac event–free survival. Depressive symptoms conferred greater risk of cardiac events in patients with a high number of Micronutrient deficiencies than in those with a low number of Micronutrient deficiencies. Patients with a PHQ-9 score ≥10 and number of Micronutrient deficiencies >5 had 2.4 times higher risk for cardiac events compared with patients with a PHQ-9 score P = .005). Conclusions There was a synergistic effect on the association of depressive symptoms with cardiac event–free survival in HF patients that differed by Micronutrient Deficiency.
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Less Than 2g of Daily Sodium Intake Independently Predict Higher Micronutrient Deficiency in Patients with Heart Failure
Journal of Cardiac Failure, 2013Co-Authors: Eun Kyeung Song, Debra K. Moser, Terry A. LennieAbstract:Background: Micronutrient Deficiency is an important factor to determine quality of patients’ diets. Micronutrient Deficiency is known to be associated with adverse health outcome in patients with heart failure (HF). A strict low sodium diet is assumed to be related to inadequate food intake, resulting in poor nutritional status. However, there is limited research about the link of a strict low sodium diet to Micronutrient Deficiency. The purpose of this study was to determine whether a strict low sodium diet affects Micronutrient Deficiency. We hypothesized that less than 2g of daily sodium intake independently predict higher Micronutrient Deficiency. Methods: A total of 100 outpatients with HF (age 61612 years, 27% female, 50% New York Heart Association [NYHA] class III/IV) completed a 3-day food diary to estimate the total number of Micronutrient deficiencies (range 0 to 15) and daily sodium intake. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary Micronutrient deficiencies including phosphate, calcium, magnesium, niacin, zinc, folate, selenium, vitamin B1, B2, B6, B12, C, D, E and K. Patients were divided into 2 groups by the median split as 5 of a total number of Micronutrient deficiencies; higher vs. lower Micronutrient Deficiency. Patients were divided into 4 groups by the level of daily sodium intake; ! 2g, 2 to 3g, 3 to 4g, and O 4g. Hierarchical logistic regression was used to determine the association of less than 2g of daily sodium intake with Micronutrient Deficiency. Results: The average sodium intake was 3.2 6 1.4 g/day. Fourteen patients had less than 2g of daily sodium intake. A half of patients had at least 5 Micronutrient deficiencies (range 0-15). The most common Micronutrient deficiencies were calcium, magnesium, and vitamin D. In univariate logistic regression, less than 2g of daily sodium intake independently predicted higher Micronutrient Deficiency (OR5 4.67, 95% CI5 1.04 20.94, p5 0.044). In hierarchical multivariate logistic regression, less than 2g of daily sodium intake was independently associated with an almost 9 times greater risk for higher Micronutrient Deficiency after controlling for age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, and use of diuretics (OR 5 9.08, 95% CI 5 1.06 20.5, p 5 0.027). Conclusion: This finding shows that patients with HF had poor nutritional intake if daily sodium intake was restricted to less than 2g. This result suggests clinically relevant evidence for raising concerns about a strict low sodium diet in patients with HF.
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abstract 1549 Micronutrient Deficiency independently predicts event free survival in patients with heart failure
Circulation, 2009Co-Authors: Terry A. Lennie, Eun Kyeung Song, Seongkum Heo, Misook L Chung, Sandra B Dunbar, Susan J Pressler, Debra K. MoserAbstract:Background. Nutrition is believed to be important in heart failure (HF) management. However, except for sodium, there is little evidence that nutritional intake affects HF outcomes. Purpose. To determine whether number of dietary Micronutrient deficiencies predicted event-free survival after controlling for age, gender, body mass index, dietary sodium, HF etiology, NYHA class, co-morbidities, and ejection fraction. Methods. A total of 228 patients with HF (age 61±12 years, 66% male, 53% NYHA class III/IIV, EF 34±14%) completed a 4-day food diary to measure intake of sodium and 15 Micronutrients. Nutrition Data System software was used to determine intake of sodium, phosphate, calcium, magnesium, niacin, zinc, folate, thiamin, riboflavin, selenium, and vitamins B 6 , B 12 , C, D, E and K. Micronutrient deficiencies were defined using formulas from the Institute of Medicine. Patients were followed for 1year to determine time to all cause-hospitalization or death. Hierarchical Cox regression hazard methods were used to determine if number of Micronutrient deficiencies predicted event-free survival. Results. Sixty-seven patients (29%) were hospitalized or died during follow-up. Number of Micronutrient deficiencies independently predicted event-free survival (hazard ratio=1.10, 95% CI=1.01–1.19). The risk of an event increased by 10% for each additional Micronutrient Deficiency. Fig 1 shows event-rates by quartiles of nutrient deficiencies. Conclusion. Quality of patients’ diet was an independent predictor of event-free survival. These are among the first data to show nutritional intake beyond sodium affects outcomes. This research has received full or partial funding support from the American Heart Association, Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).