Caloric deficiencies increase readmission risk in HF
Patients with HF who had insufficient calorie intake had increased burden of readmission and a poor quality of life after discharge, according to findings from the GOURMET-HF trial.
“The main message of this paper is that patients who are eating low-sodium diets may also have deficiencies in other important dietary components like micronutrients that help with mitochondrial function and protein for building muscle,” Scott L. Hummel, MD, MS, associate professor at the University of Michigan in Ann Arbor and section chief of cardiology at VA Ann Arbor, told Healio. “We show the potential consequences of dietary deficiencies in patients hospitalized with heart failure. We should be thinking about these issues when we advise a low-sodium diet, how do people do that while maintaining their nutrition?”
In this study published in JACC: Heart Failure, Feriha Bilgen, MPH, RD, dietetic intern at the University of Michigan in Ann Arbor, and colleagues analyzed data from 57 patients (mean age, 70 years; 31% women, mean BMI, 32 kg/m2) who were hospitalized for decompensated HF. All patients completed the Block Food Frequency Questionnaire at baseline to assess nutritional intake. Serum albumin and body weight were used to calculate the Nutritional Risk Index.
Insufficient calorie intake was defined as meeting less than 90% of estimated metabolic needs. Researchers also developed a 15-point deficiency score that took into consideration intake of certain micronutrients including folate, magnesium, iron and calcium.
Outcomes of interest included all-cause hospital readmission and change in the Kansas City Cardiomyopathy Questionnaire clinical summary score, both of which were assessed at 12 weeks after discharge.
Patients included in this trial had a median sodium intake of 2,987 mg per day and a median calorie intake of 1,602 kcal per day. Based on the Nutritional Risk Index equation, only 11% were considered malnourished.
Patients who consumed less than 2,000 mg of sodium per day, a typical recommendation in HF, often had insufficient calorie intake, in addition to deficiencies in protein and micronutrient intake.
At 12 weeks, patients who had insufficient calorie intake were more likely to be readmitted to the hospital (OR = 14.5; 95% CI, 2.2-94.4) and had less improvement in their Kansas City Cardiomyopathy Questionnaire clinical summary score (beta, 14.6; 95% CI, 27.3 to 1.9; P = .03). In addition, these patients were readmitted to the hospital for more days compared with those who had sufficient calorie intake (incident rate ratio, 31.3; 95% CI, 4.3-229.3; P = .001).
“Mainly, I hope … clinicians recognize that telling a patient to eat less sodium may not be enough,” Hummel said during an interview. “You need to make sure that they can maintain their overall nutrition while they do that. This means taking time to understand their home environment, usual dietary patterns, knowledge base about nutrition, if they know how to read labels, etc. The best way to do this might be to refer more of our patients to dietitians.”
Potential benefits of certain diets
In a related editorial, Kathleen E. Allen, MS, RD, of Dartmouth College Geisel School of Medicine, and colleagues wrote: “In chronic stable HF, dietary interventions aimed at increasing unsaturated fatty acids consumption or improving adherence to the DASH (Dietary Approaches to Stop Hypertension) diet, among others, have proven to be feasible and associated with favorable changes in exercise and functional capacity. Of note, both the Mediterranean diet and DASH diet are primarily composed of plant-based foods, suggesting that a prudent plant-based dietary pattern might be beneficial in HF.”
For more information:
Scott L. Hummel, MD, MS, can be reached at firstname.lastname@example.org; Twitter: @shummelmd.