Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): National Institutes of Health R01 NR 009280 & P20 NR 010679
Background
Poor appetite is commonly reported in patients with heart failure, which may lead to a diet with limited food variety. Limited food variety, in turn, can result in dietary nutritional insufficiencies.
Purpose
The purpose of the study was to determine whether the relationship between appetite and dietary nutritional insufficiencies was mediated through diet variety.
Methods
In this secondary analysis, patients with heart failure rated appetite on a 10-point visual analog scale from 1 to 10. Nutritional insufficiency and diet variety were assessed by a four-day food diary analyzed by Nutrition Data Systems. Nutrition insufficiency was defined as the total number of 18 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. A mediation analysis was conducted controlling for age, gender, New York Heart Association (NYHA), and body mass index using the PROCESS v3.5 macro program with 5,000 bootstrap samples in SPSS.
Results
A total of 238 patients (mean age 61, SD = 12; male n = 164, 69%; NYHA III/IV, n = 107, 45%) were included. The mean body mass index was 30 kg/m2 (SD = 7). The mean appetite score was 7.5 (SD = 2.3). The mean number of micronutrient insufficiencies was 4.7 (SD = 3.5), and the mean diet variety score was 12.4 (SD = 2.6). Appetite was not directly associated with nutrition insufficiency (effect = -.1802; 95% CI = -.3715, .0111) controlling co-variates. However, there was a significant indirect effect of appetite on nutrition insufficiency through diet variety controlling for covariates (effect = -.0828: 95% CI = -.1585, -.0150).
Conclusions
Diet variety mediated the association between appetite and dietary micronutrient insufficiency in patients with heart failure. The findings suggest that dietary intervention aimed at increasing patients’ appetite may increase diet variety and enhance the nutritional quality of diets of patients with heart failure.