Low-Sodium Diet In Patients Research Articles

Examining the Individual Response to a Low-Sodium Diet in Patients with Hypertension: Protocol for a Pilot Randomized Controlled Trial.

Excessive dietary sodium intake is an independent risk factor for hypertension and cardiovascular disease (CVD). Despite the large body of evidence concerning the effects of dietary interventions on blood pressure (BP) and CVD outcomes, trials have often reported low adherence to decreased sodium intake, likely due in part to heterogeneous BP responses. To address the challenges, recent clinical findings suggested a precise and personalized dietary approach that seeks to deliver more preventive and practical dietary advice than the "one-size-fits-all" guidelines and weighs the personal risk of developing specific diseases. The purpose of this pilot randomized controlled trial was to test the feasibility and preliminary efficacy of integrating the use of mobile technology and metabolomics with a low-sodium diet intervention in patients with hypertension to develop personalized low-sodium diet programs. Additionally, the study will examine the associations of urine metabolites with urinary sodium levels and BP control based on the hypothesis that targeted urine metabolites. In this report, we describe the design and protocol of the pilot trial. A total of 40 patients with hypertension will be randomly assigned to either a 8-week low-sodium diet group (n=20) or a standard care group (n=20). Each week, intervention participants went through individual sessions with an interventionist via videoconferencing to discuss low-sodium diet regimens, patients' food choices, and BP tracks on mobile apps. The control group followed their usual care for hypertension management. All participants in both groups monitored diet and BP using mobile apps for 8 weeks. A 24-hour urinary sodium excretion for the estimation of dietary sodium intake, systolic, and diastolic BPs were measured at the baseline and at 8 weeks. The primary outcomes of this study include the feasibility of conducting a randomized controlled trial (RCT) by reporting recruitment, retention, and completion statistics. The preliminary effects of intervention will be tested by a generalized estimating equation model. This pilot RCT study was approved by the institutional review board at the University of Texas Health San Antonio in January 2021. The first participant was enrolled in April 2021, and currently, 26 participants were enrolled. All data collection is expected to conclude by March 2023, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. The findings of this proposed study will establish a comprehensive knowledge base for future research and development of personalized dietary interventions to promote adherence to dietary strategies and self-management of chronic disease using the Precision Health approach for millions of Americans who are struggling with uncontrolled hypertension. ClinicalTrials.gov NCT04764253; https://clinicaltrials.gov/ct2/show/NCT04764253. DERR1-10.2196/39058.

Linking salt preference to enjoyment of low sodium diet in patients with heart failure

Abstract Background Preference for salty foods is linked to dietary sodium intake. Increased salt preference is a barrier to low sodium diet (LSD) adherence due to perceived poor taste. Although patients with heart failure (HF) are advised to follow a LSD, the adherence remains poor. Understanding the relationship among attitudes, subjective norms (individuals' beliefs about how much they follow the advice of respected others), and perceived control for following a LSD, salt preference, and LSD enjoyment will help in designing interventions to increase adherence in patients with HF. Purpose The purpose of this study was to examine whether attitudes toward following a LSD, subjective norms about LSD, and perceived behavioral control for following a LSD mediated the association between salt preference and enjoyment of a LSD in patients with HF. Methods In this cross-sectional study, outpatients with HF completed the Dietary Sodium Restriction Questionnaire (DSRQ) based on the Theory of Planned Behavior, and rated salt preference and enjoyment of a LSD on a scale from 0 to 10 with 10 indicating the highest salt preference and enjoyment of LSD. Parallel mediation analyses were conducted using the PROCESS macro program in SPSS with 5,000 bootstrap samples controlling for age and gender. Three subscales of the DSRQ (i.e., attitude, subjective norms, and perceived behavioral control) were used as mediators. Results A sample of 117 patients with HF (65% male, mean age = 61.2±14.3, range 27 to 94, 82% white) completed the study. The mean salt preference rating was 5.26 (SD=2.7), and the LSD enjoyment rating was 4.56 (SD=2.5). Salt preference was not directly associated with LSD enjoyment (direct effect = −0.0506, 95% CI: [−0.2394, 0.1381]). There was a significant indirect effect of salt preference on the enjoyment of LSD through perceived behavioral control (indirect effect = −0.1178, 95% CI: [−0.0321, 0.0446]) (Figure 1). Patients with a high salt preference were more likely to have low levels of LSD enjoyment through the mediator of having low levels of perceived behavioral control over following a LSD. Subjective norms and attitudes toward LSD were not significant mediators of the association between salt preference and LSD enjoyment. Conclusion High preference for salty food decreased perceived behavioral control of LSD, which reduced enjoyment of LSD in patients with HF. Salt preference and perceived behavioral control in LSD are behavioral barriers in hedonic shift in LSD enjoyment. The findings suggest that intervention to promote LSD adherence should include strategies to increase perceived behavioral control in eating LSD and decreasing salt preference. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health in the USA

TAS2R38 Haplotype Predicts 24-Hour Urinary Sodium Excretion in Patients With Heart Failure and Their Family Caregivers.

Adherence to a low-sodium diet is essential to self-care of heart failure (HF). Genetic determinants of preference for high-sodium foods may impede adherence but have not been well-studied. Our purpose was to examine if TAS2R38 haplotype predicted salt taste sensitivity and dietary sodium intake among patients with HF. This pilot study used baseline data from a large interventional randomized control trial to support adherence to a low-sodium diet in patients with HF and their family caregivers. Participants were tested for salt taste sensitivity and provided a 24-hour urinary sodium sample and a blood sample for DNA analysis at baseline. Fungiform papillae were counted. χ2 Test and 1-way analysis of variance were used to compare haplotype groups. Linear regression was performed to examine predictors of salt taste sensitivity and 24-hour urinary sodium excretion, controlling for age, gender, ethnicity, smoking status, and fungiform papillae density. There were 42 patients with HF and their family caregivers (age, 64.6 ± 13.4 years, 46.5% male, 97.7% white, and 90.7% nonsmoker). Pronine-alanine-valine homozygous haplotype predicted lower urinary sodium excretion (b = -1780.59, t41 = -2.18, P = .036), but genotype was not a significant predictor of salt taste sensitivity. The results of our study partially supported our hypothesis that PAV homozygous haplotype predicts 24-hour urinary sodium excretion. With our small sample size, more research is needed. Understanding genetic influences on taste can lead to development of educational interventions tailored to patients with HF and their family caregivers to better support dietary adherence.

Change in Knowledge of and Adherence to the Low-Sodium Diet in Patients with Heart Failure after Nutrition Education by a Registered Dietitian Nutritionist

Nutrition intervention by a registered dietitian nutritionist (RDN) is effective in improving patients’ knowledge or adherence to low-sodium diet (LSD, <2,000 mg/d); however, changes in knowledge and adherence in heart failure (HF) patients.  have not been simultaneously assessed in the same study Therefore, the objective of the present study was to identify both HF patient sodium knowledge and adherence to the LSD before and after an education session with an RDN. A quasi-experimental study with a one-group, pre-test post-test design was conducted. An RDN conducted a 15-minute individualized nutrition education regarding the LSD at the initial visit. Sodium knowledge was measured by the Parkland Sodium Knowledge Test, and sodium intake was measured by a 29-item sodium-specific food frequency questionnaire created by NutritionQuest© at both the initial and follow-up visits. A total of 71 patients were educated on the LSD and assessed for changes in sodium knowledge and intake at their next visit. Most patients were middle aged, obese, male, and non-Hispanic Black with an education level of greater than 12 years. At the initial visit, the majority of patients were considered knowledgeable but not accordant to the LSD. Following RDN education, sodium knowledge significantly improved and sodium intake significantly decreased. RDNs should be included as members of the HF multidisciplinary team to increase sodium knowledge and reduce sodium intake through individualized nutrition education.

Long-Term Adherence to Low-Sodium Diet in Patients With Heart Failure.

Although following a low-sodium diet (LSD) for heart failure (HF) has been recommended for decades, little is known about factors related to long-term patient adherence. The purposes of this study were to (a) compare sodium intake and factors affecting adherence in a long-term adherent group and in a non-adherent group and (b) examine predictors of membership in the long-term adherent group. Patients with HF ( N = 74) collected 24-hr urine samples and completed the Dietary Sodium Restriction Questionnaire and the Patient Health Questionnaire-9. Long-term adherence was determined using the Stage of Dietary Behavior Change Scale. The long-term adherent group had lower sodium intake (3,086 mg vs. 4,135 mg, p = .01) and perceived more benefits from LSD than the non-adherent group. Only positive attitudes toward LSD predicted membership in the long-term adherence group (odds ratio [OR] = 1.18, p = .005). Interventions focused on enhancing positive perceptions of the benefits of an LSD may improve long-term dietary adherence in patients with HF.

Evaluation of Psychometric Properties in the Argentine-Adapted Dietary Sodium Restriction Questionnaire in Heart Failure Patients

Background: The Dietary Sodium Restriction Questionnaire (DSRQ) is based on the theory of planned behavior. Originallydeveloped in English, this instrument, consisting of three subscales (divided in 16 items evaluating the parameters associatedwith attitude relative to behavior, the subjective norm and the perceived behavioral control), identifies the factors affectingadherence to low-sodium diet in patients with congestive heart failure (CHF).Objectives: The purpose of this study was to perform the DSRQ transcultural adaptation into Spanish to be used in Argentinaand assess its psychometric properties (validity and reliability).Methods: The transcultural adaptation was done with the recommended methodology (translation, synthesis, revision and backtranslation). Its validity was explored by principal component structure and factor analysis with factor extraction and Varimaxrotation. Reliability was analyzed by internal consistency calculation (Cronbach’s alpha) and the item-total scale correlation.Results: Headlines were adjusted and one question only had relevant semantic changes in the transcultural adaptation. Atotal of 230 CHF patients were included for the psychometric analysis. The proportion of missing data was very low (0.20%).Three factors were extracted from the main component analysis. After Varimax rotation, the items were grouped with theselected factors, matching the three original subscales. In the item-total analysis, no correlation showed a value < 0.30. GlobalCronbach’s alpha was 0.86 (0.89, 0.71 and 0.89 for the three subscales, of attitude relative to behavior, subjective norm andperceived behavioral control, respectively).Conclusions: We performed for the first time the DSRQ transcultural adaptation into Spanish for its use in Argentina. Thisversion of the instrument showed adequate validity and reliability.

Adherence to a Low-Sodium Diet in Patients With Heart Failure Is Best When Family Members Also Follow the Diet

Adherence to a low-sodium diet (LSD) is difficult without continuous support from spouses or family members. Whether having a family member follow an LSD improves patient adherence has not been tested objectively. The aim of this study was to examine the effect of family adherence to an LSD on patient adherence to an LSD and to examine whether this effect differed by relationship status and living arrangement. In this secondary data analysis, we analyzed data from 379 outpatients with heart failure who had objective evidence of adherence to an LSD (ie, a 24-hour urinary sodium excretion). The t test, analysis of variance, and logistic regressions were used to compare levels of adherence among groups that were categorized by family adherence to an LSD, relationship status, and living arrangement with family member and to predict the likelihood of being adherent to an LSD (24-hour urinary sodium excretion <3000 mg) by the groups. Compared with patients whose family did not follow an LSD, patients whose family member followed an LSD had lower average urinary sodium excretion (3651 vs 4280 mg; P = .003) and were 1.6 times more likely to be adherent to an LSD (95% confidence interval, 1.03-2.4; P = .035). Patients whose spouses followed the LSD had lower sodium excretion than did patients whose spouses did not follow the LSD (3730 vs 4534 mg; P = .012). Patients whose nonspousal family member followed an LSD were 4 times more likely to be adherent than were patients whose spousal member did not follow an LSD (odds ratio, 3.94; 95% confidence interval, 1.81-8.58; P = .001). Living with a spouse or other family member improved patient adherence to LSD only when the spouse or family member also followed the LSD. These results suggest that interventions aimed at improving LSD adherence should target patient and family member dyads to encourage family members to follow the LSD with patients.

Association Between Self-reported Adherence to a Low-Sodium Diet and Dietary Habits Related to Sodium Intake in Heart Failure Patients

Sodium restriction is the primary dietary therapy in heart failure (HF); however, assessing sodium intake is challenging to clinicians, who commonly rely on patients' self-report of following a low-sodium diet to determine adherence. It is important to further explore the utility of self-reported adherence to a low-sodium diet in patients with HF. The objective of this study was to evaluate the association between patients' self-reported adherence to a low-sodium diet and dietary habits related to sodium intake in patients with chronic HF. Patients with HF seen in a tertiary care Heart Function Clinic and who have been taught on a low-sodium diet with a target of less than 2300 mg/d were included. Self-perception of compliance and dietary habits related to sodium intake was evaluated by using a dietary questionnaire. Patients were divided into 3 groups according to self-reported adherence to a low-sodium diet: never, sometimes, and always. Overall, 237 patients (median age, 66 years, 72.6% men) were included. Compared with the other 2 groups, patients who stated always following a low-sodium diet were less likely to use salt in cooking or at the table. However, 4.2% of the patients in the always group reported eating canned or package soups every day. Moreover, the highest proportion of patients eating fast foods 1 to 3 times a week was found among those in the sometimes group (22.9%) compared with the never (9.1%) and always (6.7%) groups (P = .002). Importantly, the rest of the food items did not show any significant differences between self-reported adherence groups. Self-report of adherence to a low-sodium diet is not reliable among patients with HF, who associate the idea of following a low-sodium diet mainly with not using salt for cooking or at the table but not with reducing frequency of intake of high-sodium processed foods.

Abstract 16922: Feasibility of Family Sodium Watcher Program to Improve Adherence to Low Sodium Diet in Patients with Heart Failure and Caregivers

Introduction: Poor adherence to the low sodium diet (LSD), common in patients with heart failure (HF), is a major predictor of hospitalization for exacerbation of HF. When family member’s consume the same LSD recommended for patients, patient adherence is increased. The Sodium Watcher Program (SWAP) was developed to improve adherence to LSD using a gradual adaptation strategy and an electronic salt monitoring device that allows detection of sodium content in food. The purpose of this study was to examine whether the SWAP was feasible and if it resulted in reduction in sodium intake for patients with HF and their caregivers. Method: In this 2-group randomized controlled trial, 15 patient-caregiver dyads completed 24-hour urine collection for sodium excretion level (24h UNa) at baseline and 3 months follow up. Dyads in the SWAP intervention (n=8) received 12 weeks of self-care education for HF and LSD with gradual adaptation strategies in salt intake via 2 home visits and 4 calls. Paired t-test was used to compare adherence to LSD at two data collection times. Only intervention group evaluated use of the electronic salt monitoring devices and the intervention program at 3 months. Results: The intervention group had a significant reduction in 24h UNa (Patients 3894mg vs. 3604mg, p=.02; caregivers 4123mg vs. 3380mg, p&lt;.05). They also reported significant increased level of enjoying eating LSD (M =5.4 on 10-point rating scale vs. M=7.9 p &lt;.01) and 90% noticed a change in their ability to taste salt in their food at the 3-month follow up. They reported that use of the electronic monitoring devices was easy (M=8.3 on 10-point rating scale) and helpful in supporting LSD adherence (M=8.8 on 10-point rating scale). Caregivers in the intervention reported no significant changes in burden levels. The usual care control group had no change in 24h UNa (patients 4369 mg vs. 4434 mg; caregivers 3301 mg vs. 4826mg). Conclusion: The findings demonstrated that the SWaP is feasible and efficacious for following LSD by dyads. The intervention was feasible for caregivers and did not increase caregiver burden. This family intervention may have potential for promoting long-term adherence and needs to be tested in a larger clinical trial.

Vasodilator Response in Exercise Induced Pulmonary Hypertension

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.

A dieta com baixo teor de sódio é de fato indicada para todos os pacientes com insuficiência cardíaca estável?

Although a low-sodium diet is indicated for heart failure HF, there is no evidence this dietary restriction is beneficial to all patients.To prospectively study the acute effectsof a low-sodium diet in patients (pts) with heart failure (HF).Fifty stable outpatients with mild to moderate HF who reported previously consuming 6.6 g table salt/day were studied. In Phase 1, all pts were submitted to a diet with 2 g of salt during 7 days, followed by randomization in 2 subgroups (Phase 2): one to receive 6 g of salt (subgroup 1) and the other, 2 g of salt/day for 7 days (subgroup II).Phase 1: the diet with 2 g of salt reduced the BMI, plasma and urinary sodium, protein consumption, iron, zinc, selenium and vitamin B12; it increased plasma levels of norepinephrine, nitrate, serum aldosterone and improved quality of life. Phase 2: for pts with low BMI, the use of 6 g salt/day acutely decreased the levels of norepinephrine, albumin and cholesterol in plasma. No difference was observed in pts with higher BMI.The diet with 2 g salt/day for pts with HF increased the neurohormonal activation associated to HF progression. The BMI can influence the response to the neurohormonal activation in a low-sodium diet in pts with HF. Further studies to test salt restriction for longer periods are recommended.

Adherence to the Low Sodium Diet in Patients with Heart Failure Is Best When Family Members Also Follow the Diet

Background: Adherence to the low sodium diet (LSD) is difficult without continuous support from spouses or family members. Patients have reported that family members not following the LSD is a major barrier to adherence. Whether having a family member follow a LSD diet improves patient adherence has not been tested objectively. The purposes of this study were to examine the effect of family participation in the LSD on adherence and to examine whether this effect differed if the family member was a spouse.

Section 8: Disease Management in Heart Failure

Section 8: Disease Management in Heart Failure