Vasodilator Response in Exercise Induced Pulmonary Hypertension

Abstract

Background: Micronutrient deficiency is an important factor to determine quality of patients’ diets. Micronutrient deficiency is known to be associated with adverse health outcome in patients with heart failure (HF). A strict low sodium diet is assumed to be related to inadequate food intake, resulting in poor nutritional status. However, there is limited research about the link of a strict low sodium diet to micronutrient deficiency. The purpose of this study was to determine whether a strict low sodium diet affects micronutrient deficiency. We hypothesized that less than 2g of daily sodium intake independently predict higher micronutrient deficiency. Methods: A total of 100 outpatients with HF (age 61612 years, 27% female, 50% New York Heart Association [NYHA] class III/IV) completed a 3-day food diary to estimate the total number of micronutrient deficiencies (range 0 to 15) and daily sodium intake. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary micronutrient deficiencies including phosphate, calcium, magnesium, niacin, zinc, folate, selenium, vitamin B1, B2, B6, B12, C, D, E and K. Patients were divided into 2 groups by the median split as 5 of a total number of micronutrient deficiencies; higher vs. lower micronutrient deficiency. Patients were divided into 4 groups by the level of daily sodium intake; ! 2g, 2 to 3g, 3 to 4g, and O 4g. Hierarchical logistic regression was used to determine the association of less than 2g of daily sodium intake with micronutrient deficiency. Results: The average sodium intake was 3.2 6 1.4 g/day. Fourteen patients had less than 2g of daily sodium intake. A half of patients had at least 5 micronutrient deficiencies (range 0-15). The most common micronutrient deficiencies were calcium, magnesium, and vitamin D. In univariate logistic regression, less than 2g of daily sodium intake independently predicted higher micronutrient deficiency (OR5 4.67, 95% CI5 1.04 20.94, p5 0.044). In hierarchical multivariate logistic regression, less than 2g of daily sodium intake was independently associated with an almost 9 times greater risk for higher micronutrient deficiency after controlling for age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, and use of diuretics (OR 5 9.08, 95% CI 5 1.06 20.5, p 5 0.027). Conclusion: This finding shows that patients with HF had poor nutritional intake if daily sodium intake was restricted to less than 2g. This result suggests clinically relevant evidence for raising concerns about a strict low sodium diet in patients with HF.