Colin-Ramirez Eloisa, Castillo-Martinez Lilia, Orea-Tejeda Arturo, Zheng Yinggan, Westerhout Cynthia M, Ezekowitz Justin A
University of Alberta, Edmonton, Canada.
Instituto Nacional de Ciencias Medicas y Nutricion "SZ" Mexico City, Mexico.
Nutrition. 2014 Nov-Dec;30(11-12):1366-71. doi: 10.1016/j.nut.2014.04.006. Epub 2014 Apr 19.
Dietary strategies in heart failure (HF) are focused on sodium and fluid restriction to minimize the risk for acute volume overload episodes. However, the importance of dietary factors beyond sodium intake in the prognosis of the disease is uncertain. The purpose of this study was to evaluate the association of macro- and micronutrients intake on 1-y mortality in patients with HF.
A secondary analysis of 203 patients with chronic HF enrolled in a randomized trial of sodium reduction was completed. Patients with a complete 3-d food record at baseline were included in this analysis (N = 118); both control and intervention arms were combined. Three-d mean dietary intake was estimated. Cox multivariable regression analysis was used to evaluate the association between dietary factors and 1-y mortality.
Among the 118 included patients, 54% were men, median (25th-75th percentiles) age 66 y (52-75 y), median ejection fraction 45% (30%-60%), and ischemic etiology present in 49% of patients. The association with 1-y mortality was significant for both polyunsaturated fatty acids (PUFA; adjusted hazard ratio [HR], 0.67; 95% confidence interval [CI]. 0.51-0.86 for intake as percentage of daily energy) and saturated fatty acids (SFA; adjusted HR, 1.15; 95% CI, 1.03-1.30 for intake as percentage of daily energy). Median of intake as percentage of daily energy was 5.3% for PUFAs and 8.2% for SFAs.
Intake of PUFAs and SFAs was independently associated with 1-y all-cause mortality in patients with chronic HF. Limiting dietary SFA and increasing PUFA intake may be advisable in this population.
心力衰竭（HF）的饮食策略主要集中在限制钠和液体摄入，以尽量降低急性容量超负荷发作的风险。然而，饮食因素中除钠摄入外的其他因素对该疾病预后的重要性尚不确定。本研究的目的是评估宏量营养素和微量营养素摄入与HF患者1年死亡率之间 的关联。
对纳入一项钠减少随机试验的203例慢性HF患者进行了二次分析。本分析纳入了在基线时有完整3天饮食记录的患者（N = 118）；将对照组和干预组合并。估计了3天的平均饮食摄入量。采用Cox多变量回归分析来评估饮食因素与1年死亡率之间的关联。
在纳入的118例患者中，54%为男性，年龄中位数（第25-75百分位数）为66岁（52-75岁），射血分数中位数为45%（30%-60%），49%的患者有缺血性病因。多不饱和脂肪酸（PUFA；调整后风险比[HR]，0.67；95%置信区间[CI]，每日能量摄入量百分比为0.51-0.86）和饱和脂肪酸（SFA；调整后HR，1.15；95%CI，每日能量摄入量百分比为1.03-1.30）与1年死亡率均显著相关。PUFA的每日能量摄入量百分比中位数为5.3%，SFA为8.2%。
PUFA和SFA的摄入与慢性HF患者的1年全因死亡率独立相关。对于该人群，限制饮食中的SFA并增加PUFA摄入可能是可取的。
