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J Am Heart Assoc. 2018 Sep 4;7(17):e007251. doi: 10.1161/JAHA.117.007251.

Micronutrient Deficiency Independently Predicts Time to Event in Patients With Heart Failure.

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1 College of Nursing University of Kentucky Lexington KY.
2 Division of Nursing Science Department of Medical and Health Sciences Linköping University Linköping Sweden.
3 Department of Nursing College of Medicine University of Ulsan Korea.
4 Emory University Atlanta GA.
5 Indiana University Indianapolis IN.
6 College of Nursing University of Arkansas for Medical Sciences Little Rock AR.
7 Gachon University College of Nursing Incheon Korea.


Background Dietary micronutrient deficiencies have been shown to predict event-free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event-free survival, defined as a combined end point of all-cause hospitalization and death. Methods and Results Four-day food diaries were collected from 246 patients with heart failure (age: 61.5±12 years; 67% male; 73% white; 45% New York Heart Association [NYHA] class III / IV ) and analyzed using Nutrition Data Systems for Research. Micronutrient deficiencies were determined according to methods recommended by the Institute of Medicine. Patients were followed for 1 year to collect data on all-cause hospitalization or death. Patients were divided according to number of dietary micronutrient deficiencies at a cut point of ≥7 for the high deficiency category versus <7 for the no to moderate deficiency category. In the full sample, 29.8% of patients experienced hospitalization or death during the year, including 44.3% in the high-deficiency group and 25.1% in the no/moderate group. The difference in survival distribution was significant (log rank, P=0.0065). In a Cox regression, micronutrient deficiency category predicted time to event with depression, NYHA classification, comorbidity burden, body mass index, calorie and sodium intake, and prescribed angiotensin-converting enzyme inhibitors, diuretics, or β-blockers included as covariates. Conclusions This study provides additional convincing evidence that diet quality of patients with heart failure plays an important role in heart failure outcomes.


diet; heart failure; nutrition; risk factor; survival analysis

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