Author + information
- Received January 13, 2020
- Revision received March 31, 2020
- Accepted April 1, 2020
- Published online August 31, 2020.
- Feriha Bilgen, MPH, RDa,
- Peiyu Chen, MS, RDa,
- Armella Poggi, BSa,
- Joanna Wells, BSa,
- Erika Trumble, MPHb,
- Stephen Helmke, MPHc,
- Sergio Teruya, MDc,
- Tonimarie Catalana,
- Hannah R. Rosenblum, MDc,
- Maria L. Cornellier, RDa,
- Wahida Karmally, DrPH, RDc,
- Mathew S. Maurer, MDc and
- Scott L. Hummel, MD, MSa,b,∗ ()
- aUniversity of Michigan, Ann Arbor, Michigan
- bColumbia University, New York, New York
- cAnn Arbor Veterans Affairs Health System, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Scott L. Hummel, University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, Michigan 48109-5853.
Objectives The purpose of this study was to evaluate the relationship between calorie intake and post-discharge outcomes in hospitalized patients with heart failure (HF).
Background Malnutrition increases adverse outcomes in HF, and dietary sodium restriction may inadvertently worsen nutritional intake.
Methods In a dietary intervention trial, baseline nutritional intake in HF inpatients was estimated using the Block Food Frequency Questionnaire (FFQ), and the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs, and a 15-point micronutrient deficiency score was created. Adjusted linear, logistic, and negative binomial regression were used to evaluate associations between insufficient calorie intake and quality of life (using the Kansas City Cardiomyopathy Questionnaire Clinical Summary [KCCQ-CS]), readmission risk, and days rehospitalized over 12 weeks.
Results Among 57 participants (70 ± 8 years of age; 31% female; mean body mass index 32 ± 8 kg/m2); median sodium and calorie intake amounts were 2,987 mg/day (interquartile range [IQR]: 2,160 to 3,540 mg/day) and 1,602 kcal/day (IQR: 1,201 to 2,142 kcal/day), respectively; 11% of these patients were screened as malnourished by the NRI. All patients consuming <2,000 mg/day sodium had insufficient calorie intake; this group also more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient calorie intake had less improvement in the KCCQ-CS score (β = −14.6; 95% confidence interval [CI]: −27.3 to −1.9), higher odds of readmission (odds ratio: 14.5; 95% CI: 2.2 to 94.4), and more days rehospitalized (incident rate ratio: 31.3; 95% CI: 4.3 to 229.3).
Conclusions Despite a high prevalence for obesity and rare overt malnutrition, insufficient calorie intake was associated with poorer post-discharge quality of life and increased burden of readmission in patients with HF. Inpatient dietary assessment could improve readmission risk stratification and identify patients for nutritional intervention. (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure [GOURMET-HF] NCT02148679)
The GOURMET-HF trial was jointly funded by U.S. National Institutes of Health/National Institute on Aging grant R21-AG047939 and PurFoods. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received January 13, 2020.
- Revision received March 31, 2020.
- Accepted April 1, 2020.
- 2020 American College of Cardiology Foundation
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