Macro- and Micronutrient Dietary Quality in Patients with Advanced Systolic Heart Failure Receiving Left Ventricular Assist Devices

Introduction Macro- and micronutrient insufficiencies are common in patients with ambulatory systolic heart failure (HF) and are associated with adverse clinical outcomes. Less is known about dietary quality in advanced systolic HF, particularly the adequacy of protein intake. It is also unknown if dietary quality improves during mechanical support and so we sought to determine nutrient intake changes early after left ventricular assist device (LVAD) implantation. Methods We recruited adults with advanced systolic HF ±21 days from LVAD implantation. Weight and appendicular lean mass (ALM) were assessed by whole-body dual X-ray absorptiometry (DXA). Food intake was assessed with 3-day facilitated food records and entered into the Food Processor Nutrition Analysis Software. Study procedures were repeated after 3 months ±14 days of LVAD support. The Institute of Medicine's Estimated Average Requirement values (EARs, age and sex-specific ranges) were tabulated beside the median (quartile 1-3) results from the baseline and 3-month food records.Comparisons were made between baseline and 3-month intakes using Wilcoxon matched-pairs signed rank tests. Results The cohort (n=18) was 78% male, with median age 60 years, weight 77.5 kg, BMI 25.2 kg/m2 and serum albumin 3.4 g/dL. Baseline dietary quality was poor as compared to general population EARs (Table 1), with a high prevalence of vitamin A, B1, B6, D, E, folate, calcium, magnesium, zinc and selenium insufficiencies. Protein supplementation products were used by 78% at baseline and 39% at 3 months. Despite no changes in average daily calorie or carbohydrate intake from baseline to 3 months, and only a non-significant upward trend in protein and fat intake, there was an increase in total body weight and appendicular lean mass (Table). Micronutrient intakes did not significantly improve at 3 months, and intake of calcium and vitamin D decreased. Conclusions Baseline micronutrient dietary quality was poor amongst patients with systolic HF undergoing LVAD implantation. Micronutrient changes at 3 months were variable, with some intakes including calcium and vitamin D decreasing, possibly secondary to reduced use of supplementation products after the LVAD implantation hospitalization. Protein intake was sufficient per estimated average requirements and non-significantly trended upwards during the first 3 months of LVAD support.