Time of Eating and Cardiorespiratory Fitness in Patients with Heart Failure With Preserved Ejection Fraction and Obesity

Abstract

Abstract Objectives To examine the impact of eating prior to or after the mean time of evening meal on cardiorespiratory fitness (CRF) in patients with heart failure with preserved ejection fraction (HFpEF) and concomitant obesity. Methods Twelve patients with HFpEF (left ventricular ejection fraction ≥50%) and obesity (body mass index (BMI) ≥30 kg/m2 or fat mass % (FM%) ≥25% men or ≥35% women) underwent a maximal cardiopulmonary exercise test to obtain peak oxygen consumption (VO2) relative to body weight (ml•kg−1•min−1) and exercise time. Bioelectrical impedance analysis was used to measure FM%. Mean evening meal time was established as 7:25 (SD = 2.1 hours) post meridiem (PM) by averaging three consecutive five-pass 24-hour dietary recalls. Participants were classified by having intake prior to (Group I) or after (Group II) 7:25 PM. Total caloric intake and physical activity were obtained at baseline. Differences between groups were assessed with Mann-Whitney U and Spearman's rank correlation was used to examine associations. Results Participants were 64 (52–65) years of age, 75% female, 58% black, and had a BMI of 36.6 (34.2–41.6) kg/m2 with a FM of 42.5 (36.1–45.5)%. Median peak VO2 was 14.6 (11–19.6) ml•kg−1•min−1 and exercise time was 566 (453–786) seconds. Group II had a significantly greater peak VO2 (Group 1: 10.4 (9.5–15.2) ml•kg−1•min−1; Group II: 14.8 (14.4–23.4) ml•kg−1•min−1, P = 0.028) and exercise time (Group 1: 452 (360–505) seconds; Group II: 662 (578–846) seconds, P = 0.007). Physical activity, body composition, age and total daily calories did not differ between groups (all P > 0.1). On univariate analysis, both peak VO2 (r = 0.736, P = 0.006) and exercise time (r = 0.767, P = 0.004) demonstrated a favorable association with time of eating. Conclusions Caloric intake after the mean time of evening meal was associated with better CRF in patients with HFpEF and obesity. Providing nutrients later may help avoid fasting-related stress associated with cardiac metabolic abnormalities found in HF. Prospective randomized controlled trials examining the effects of later evening meal time in patients with HFpEF and obesity are warranted. Funding Sources Study funding was obtained through the American Heart Association, National Institutes of Health and Virginia Commonwealth University Health System.