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Dietary Antioxidants, Inflammatory Markers, and QOL in Heart Failure
Quick Takes
- Patients with HF are more likely to have dietary antioxidant insufficiency than healthy adults.
- Antioxidant insufficiency can increase inflammatory activity and the risk for myocardial infarction and HF due to increased oxidative stress and myocardial workload.
- Dietary antioxidant insufficiency among patients with chronic HF is associated with increased inflammatory markers (higher CRP, lower IL-10) and poorer health-related quality of life.
Study Questions:
What are the associations among dietary antioxidant intake, inflammatory markers, and health-related quality of life (HRQOL) in patients with heart failure (HF)?
Methods:
This prospective cohort study of HF patients analyzed secondary data from a 4-day food diary to collect dietary intake of antioxidants. Nurses educated patients about how to measure dietary intake at home using a digital scale. Antioxidant insufficiency was defined as a level below the estimate average requirement (EAR) or lower than median for antioxidants without an EAR. The inflammatory markers chosen to reflect oxidative stress triggers were serum C-reactive protein (CRP), interleukin (IL)-6 and IL-10, tumor necrosis factor-alpha, and soluble receptors (sTNFR1 and sTNFR2); and were assessed using enzyme immunoassay. HRQOL was measured at 12 months using the Minnesota Living With Heart Failure questionnaire.
Results:
This study enrolled 265 patients with HF: overall left ventricular ejection fraction (LVEF) was 33.5% ± 13.2; 31% in New York Heart Association (NYHA) class III, 13% in NYHA class IV, 67% were male, 26% were African American. Patients on guideline-directed medical treatment for HF received angiotensin-converting enzyme inhibitors (70%, n = 179) and beta-blockers (89%).
Dietary levels not meeting EAR were vitamin C (41%), vitamin E (60%), and zinc (46%). Alpha carotene, beta carotene, beta cryptoxanthin, lutein, zeaxanthin, and lycopene were 50% below the median. Only 8% had no dietary antioxidant insufficiencies. Dietary antioxidant insufficiency predicted CRP (β = 0.135, p = .032) and IL-10 (β = −.155, p = .027). Patients with higher antioxidant insufficiency had higher CRP and lower IL-10. The mean score for the Minnesota Living With Heart Failure questionnaire was 42.1 (± 25.5). Both antioxidant insufficiency (β = 0.13, p = .049) and higher CRP (β = 0.16, p = .019) were independently associated with poorer HRQOL while adjusting for covariates.
Conclusions:
Dietary antioxidant insufficiency in patients with chronic HF was associated with increased inflammatory markers and poorer HRQOL. Improvement of diet quality among patients with HF may enhance HRQOL.
Perspective:
This study found that dietary antioxidant insufficiency in patients with HF was associated with poorer QOL. While this study noted limitations due to data (4-day diary, inflammatory markers, HRQOL) being collected at one time point, it also did not include patients with preserved LVEF (EF >50%)—which comprise 50% of the HF population—to determine if LVEF % was associated with worse outcomes. In addition to salt and fluid restrictions, patients with HF often have comorbidities such as diabetes, renal failure, and autoimmune diseases that further restrict their dietary choices. Therefore, providers can counsel patients regarding quality antioxidant dietary choices such as those containing fruits, vegetables, legumes, and whole grains, or the potential use of antioxidant supplementation.
Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Stress
Keywords: Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Antioxidants, Ascorbic Acid, beta Carotene, C-Reactive Protein, Diet Records, Heart Failure, Immunoenzyme Techniques, Inflammation, Interleukins, Lycopene, Myocardial Infarction, Oxidative Stress, Patient Care Team, Primary Prevention, Quality of Life, Stroke Volume, Tumor Necrosis Factor-alpha, Ventricular Function, Left, Vitamin E, Zinc
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