Extended Non-Fasting Period And Delayed Last Meal Are Associated With Peak Oxygen Consumption In Heart Failure With Preserved Ejection Fraction

Abstract

<h3>Introduction</h3> Delayed time of eating last meal has been recently associated with favorable cardiorespiratory fitness (CRF) in patients with Heart Failure with preserved ejection fraction (HFpEF). However, whether the overall 24-hour non-fasting period is associated with CRF in these patients is unknown. The aim of this analysis was to examine associations between non-fasting period and CRF in HFpEF, and we hypothesized that a greater non-fasting period was associated with improved CRF, independent of daily caloric intake. <h3>Methods</h3> Twenty-one consecutive patients with HFpEF (left ventricular ejection fraction >50%) underwent maximal cardiopulmonary exercise testing to measure CRF, defined as peak oxygen consumption (VO₂) (ml•kg⁻¹•min⁻¹) and exercise time. A 5-pass, 24-hour dietary recall was administered to collect all timing of caloric intake. Daily non-fasting time was considered as the duration between the first and last meals. Dietary recall was analyzed with Nutrition Data Systems for Research Software to obtain total calories. The International Physical Activity Questionnaire was administered to collect self-reported physical activity. Spearman rank correlation and multiple linear regression was utilized to examine associations. Results are displayed as median (interquartile range; IQR). <h3>Results</h3> Patient characteristics are displayed in <b>Table 1</b>. On univariate analysis, daily non-fasting time was associated with peak VO₂ and exercise time (<b>Figure 1</b>). Time of last meal was also associated with peak VO₂ (r=0.571, <i>P</i>=0.007) and exercise time (r=0.528, <i>P</i>=0.014), however, time of first meal was not associated with peak VO₂ or exercise time (both <i>P</i>>0.6). On multivariate analysis, peak VO₂ remained associated with daily non-fasting time (<i>P</i>=0.041) and last meal time (<i>P</i>=0.022) when adjusted for total calories, physical activity, and age. <h3>Conclusion</h3> Extended daily non-fasting time and delayed last meal time are independently associated with more favorable CRF in patients with HFpEF. Prospective clinical trials to extend daily non-fasting window by delaying the final evening meal are warranted.