Appetite is an important factor for dietary intake in patients with heart failure - a comparison study

Abstract

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden, the Swedish Heart and Lung Foundation. Background Loss of appetite and suboptimal dietary intake is common in heart failure, which can result in malnutrition. Malnutrition is associated with poor prognosis and needs to be identified and treated. Despite this, few studies have investigated whether appetite and dietary intake may be intertwined. Purpose To compare dietary intake between heart failure patents with poor and good appetite. Methods A cross-sectional observational study design was used, and patients were recruited from three outpatient heart failure clinics in Sweden. The sample included 186 patients with confirmed heart failure with NYHA class II-IV (Mdn = NYHA class II). The mean age was 70 (SD = 11) years and 119 were male 69%. Dietary intake was assessed by a 3-day self-recorded food diary, including two weekdays and one week-end-day. Components including energy intake, macronutrients, fiber, minerals, vitamins, and water were collected, entered, and calculated by a dietician using the software Dietist XP. Appetite was self-reported using the Council on Nutritional Appetite Questionnaire (CNAQ). The total score ranges between 8-40, low scores indicate poor appetite. Mann-Whitney U test was used to investigate differences in dietary intake between patients with poor appetite (CNAQ ≤ 28) and good appetite (CNAQ > 28). The eta2 (Z2/N-1) was used to estimate the effect size. Results Patients with poor appetite (n = 71, 38%) reported significantly lower intake (p < 0.05) of calories, protein, fat, fiber, vitamin B6 and B12, thiamin, riboflavin, niacin, folate, phosphor, potassium, sodium, magnesium, iron, zinc, selenium and water compared to those with good appetite (n = 115, 62%). The effect size was small (eta2 = 0.02-0.09). Conclusions This study shows that poor appetite contributes to a significant lower intake of essential nutrients compared to patients with good appetite. Health care professionals should assess appetite routinely during heart failure follow-up since poor appetite may contribute to inadequate dietary intake with risk for malnutrition. Future longitudinal studies are required to increase the knowledge whether assessment of appetite can be used to determine malnutrition in heart failure.