Department of Nursing, College of Medicine, Soonchunhyang University, Cheonan, South Korea.
Eur J Cardiovasc Nurs. 2013 Apr;12(2):184-92. doi: 10.1177/1474515112443439. Epub 2012 May 30.
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.
We aimed to determine whether nutritional risk is associated with worse HRQoL after controlling for daily sodium intake.
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.
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.
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.
心力衰竭（HF）管理的最理想结果是以患者为中心的健康结果来改善健康相关生活质量（HRQoL）。人们认为营养在 HF 管理中很重要，尽管有证据表明营养风险会影响 HRQoL，但除了钠以外，几乎没有证据表明营养风险会影响 HRQoL。
我们旨在确定在控制每日钠摄入量后，营养风险是否与 HRQoL 更差相关。
共有 134 例连续 HF 患者[年龄 63±11 岁，女性 35%，纽约心脏协会（NYHA）分级 III/IV 级 45%，射血分数（EF）33±13%]完成了营养筛查倡议（NSI）以评估营养风险，并进行 24 小时尿液钠排泄评估以估计基线时的每日钠摄入量。使用明尼苏达州心力衰竭生活质量问卷评估基线和 6 个月后的 HRQoL。使用分层线性回归来确定营养风险是否预测基线和 6 个月后的 HRQoL。
78 例（58.2%）患者的总 NSI 评分≥6，表明存在高营养风险。在控制年龄、性别、病因、体重指数、NYHA 分级、EF、总合并症评分、处方药物和每日钠摄入量后，营养风险增加与基线和 6 个月后 HRQoL 更差独立相关（β=0.33，p<0.001；β=0.35，p<0.001）。
这些发现表明，HF 患者中，除钠摄入外，更高的营养风险会导致更差的 HRQoL。需要进一步研究提供具体的饮食指南，以改善 HF 患者的健康结果。
