Song Eun Kyeung, Kang Seok-Min
Eun Kyeung Song, PhD, RN Associate Professor, Department of Nursing, College of Medicine, University of Ulsan, South Korea. Seok-Min Kang, MD, PhD Professor, Cardiology Division, Severance Hospital, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Seoul, South Korea.
J Cardiovasc Nurs. 2017 Jan/Feb;32(1):47-53. doi: 10.1097/JCN.0000000000000304.
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.
The aim of this study was to determine whether micronutrient deficiency independently predicts adverse health outcomes.
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.
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).
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.
尽管越来越多的证据表明微量营养素在心力衰竭（HF）预后中起着重要作用，但关于微量营养素缺乏能否预测HF患者健康结局的研究仍然有限。
本研究旨在确定微量营养素缺乏是否能独立预测不良健康结局。
共有113例连续性HF门诊患者完成了一份为期3天的食物日记，以测量15种微量营养素的摄入量。使用专业人员计算机辅助营养分析程序分析食物日记，并确定膳食微量营养素缺乏情况。患者完成明尼苏达心力衰竭生活问卷以评估健康相关生活质量（HRQoL），并随访1年以确定心脏相关住院或心脏死亡情况。采用分层多元线性回归和Cox比例风险回归来确定微量营养素缺乏是否能预测健康结局。
58例患者（51%）至少存在3种微量营养素缺乏（范围为0 - 14种）。钙、镁和维生素D是最常见的微量营养素缺乏种类。在分层多元线性回归中，微量营养素缺乏与较差的HRQoL独立相关（β = 0.187，P = 0.025）。39例患者在1年随访期间因心脏问题住院或死亡。微量营养素缺乏的数量独立预测了无心脏事件生存期（风险比，1.14；95%置信区间，1.02 - 1.28）。
这些发现表明，微量营养素缺乏可独立预测HF患者HRQoL较差和较早出现无心脏事件生存期。需要进一步研究以提供针对HF患者更好健康结局的具体饮食指南。
