Nutrition Intervention to Decrease Symptoms in Patients With Heart Failure (NIHFT)

March 15, 2017 updated by: Terry Lennie

Nutrition Intervention to Reduce Symptoms in Patients With Advanced Heart Failure

The purpose of is to test the effects of a 6-month nutrition intervention of dietary sodium reduction combined with supplementation of lycopene and omega-3 fatty acids on heart failure symptoms, health-related quality of life, and time to heart failure rehospitalization or all-cause death.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

For a majority of patients with advanced heart failure, medical treatment is only partially effective in relieving heart failure symptoms. Therefore, it is recommended that palliative care be initiated soon after diagnosis. There is a need for complementary, nonpharmacologic interventions that could be easily implemented by health care providers to provide palliative care. Three major pathologic pathways underlying heart failure symptoms have been identified: fluid overload, inflammation, and oxidative stress. Prior research has demonstrated that three nutrients-sodium, omega-3 fatty acids, and lycopene-can alter these pathologic pathways. Clinical trials to date have only tested each nutrient individually. There is strong theoretical rationale that a combined intervention targeting all three nutrients would have substantial benefit in relieving symptoms in advanced heart failure. Therefore, the purposes of this study are to test the effects of a 6-month nutrition intervention of dietary sodium reduction combined with supplementation of lycopene and omega-3 fatty acids on heart failure symptoms, health-related quality of life, and time to heart failure rehospitalization or all-cause death. The aims of this placebo controlled study are 1) to determine the effects of a 6-month nutrition intervention on symptom burden (edema, shortness of air, and fatigue) and health related quality of life at 3 and 6 months, and time to heart failure rehospitalization or all-cause death over 12 months from baseline; 2) compare dietary sodium intake, inflammation, and markers of oxidative stress between the nutrition intervention group and a placebo group at 3 and 6 months; and 3) compare body weight, serum lycopene, and erythrocyte omega-3 index between the nutrition intervention group and a placebo group at 3 and 6 months. A total of 150 patients with advanced heart failure will be randomized to either the nutrition intervention or placebo group (75 per group). The nutrition intervention group will receive a theory based education and skill building intervention designed to decrease dietary sodium intake to ~2 g per day. A research nurse will make 4 home visits and one follow-up telephone call over 6 months to provide the education-skill building intervention. The intervention group will take 3 omega-3 fatty acid capsules (350 mg eicosapentaenoic acid and 50 mg docosahexaenoic acid) and consume tomato juice or other tomato-based products containing 20-25 mg of lycopene daily for six months. The placebo group will receive the same number of visits and phone calls but only general nutrition information will be provided. They will take 3 placebo capsules containing rice oil (500 mg/capsule) and consume their choice of fruit juices that do not contain lycopene daily for six months. Data will be collected in person at baseline, 3 months, and 6 months by a research assistant blinded to the group assignment. Patients will be followed for an additional 6 months by telephone to collect longer term data on symptom burden and quality of life as well as heart failure hospitalization and all-cause mortality at 9 and 12 months.

Study Type

Interventional

Enrollment (Anticipated)

150

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Kentucky
      • Lexington, Kentucky, United States, 40536-0232
        • University of Kentucky, College of Nursing
      • Louisville, Kentucky, United States, 40217
        • Norton Health Care

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • chronic heart failure with either preserved or non-preserved ejection fraction
  • for chronic heart failure, have undergone evaluation of heart failure and optimization of medical therapy, for patients discharged from hospital for acute/newly diagnosed heart failure, have undergone evaluation of heart failure and optimization of medical therapy for at least 1 month post discharge
  • New York Heart Association functional classification of II, III or IV
  • have not been referred for heart transplantation
  • able to read and speak English
  • no cognitive impairment that precludes giving informed consent or ability to follow protocol instruction.

Exclusion Criteria:

  • BMI < 17 kg/m2 or > 46 kg/m2
  • co-existing illness documented in the medical record known to be associated with systemic inflammation decreased appetite or absorption, fatigue, edema, or weight loss
  • currently taking dietary supplements that contain lycopene or omega-3 fatty acids
  • allergy to rice bran oil

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: sodium reduction, omega-3, lycopene
combination of dietary sodium restriction with supplementation of omega-3 capsules and lycopene containing juices or foods
Behavioral: Sodium reduction
Teaching and skill building to reduce dietary sodium
Dietary supplement: omega 3 and lycopene supplements
omega-3 fatty acid supplements and juices containing lycopene
Placebo Comparator: Control
Limited nutritional counseling, juice without lycopene, rice oil capsules
Dietary supplement: rice bran oil capsules
placebo capsules
Other Names:
  • placebo
Behavioral: Generic dietary feedback from
Provided a summary of the 3 day dietary recalls at baseline, 3 months, and 6 months
Other Names:
  • attention control

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Event-Free Survival
Time Frame: 12 months
Combined endpoint of cardiac-related hospitalization and all cause mortality
12 months
Symptom burden
Time Frame: baseline, 3, 6, 9, and 12 months
combined score of symptom severity, frequency, and distress for common symptoms of heart failure
baseline, 3, 6, 9, and 12 months
Quality of life
Time Frame: baseline, 3, 6, 9, 12 months
heart failure related quality of life
baseline, 3, 6, 9, 12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
omega-3 index
Time Frame: baseline, 3, 6, 9, 12 months
the ratio of EPA plus DHA as a percentage of total fatty acids in the cell membrane of erythrocytes
baseline, 3, 6, 9, 12 months
oxidative stress
Time Frame: baseline, 3, 6, 9, 12 months
serum levels of malondialdehyde and 8-iso-PGF2a isoprostane will serve as markers of increased lipid peroxidation due to oxygen free radical production exceeding antioxidant capacity
baseline, 3, 6, 9, 12 months
Inflammation
Time Frame: baseline, 3, 6, 9, 12 months
Serum levels of tumor necrosis factor-alpha (TNFα), soluble TNF receptors: sTNFR1 and sTNFR2 will be measured as markers of proinflammatory cytokine activity; interleukin-10 (IL-10) will be measured as a marker of anti-inflammatory cytokine activity
baseline, 3, 6, 9, 12 months
Lycopene
Time Frame: baseline, 3, 6, 9, 12 months
Plasma lycopene will be measured as a marker intervention effectiveness
baseline, 3, 6, 9, 12 months
Sodium intake
Time Frame: baseline, 3, 6, 9, 12 months
Three 24-hour diet recall interviews at each timepoint will be used estimate sodium intake and to identify high sodium foods and eating patterns for the sodium reduction component of the intervention.
baseline, 3, 6, 9, 12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Terry Lennie

Collaborators

Ohio State University

Investigators

  • Principal Investigator: Terry A Lennie, PhD, University of Kentucky College of Nursing

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2011

Primary Completion (Actual)

January 1, 2017

Study Completion (Actual)

January 1, 2017

Study Registration Dates

First Submitted

November 15, 2012

First Submitted That Met QC Criteria

November 19, 2012

First Posted (Estimate)

November 26, 2012

Study Record Updates

Last Update Posted (Actual)

March 17, 2017

Last Update Submitted That Met QC Criteria

March 15, 2017

Last Verified

March 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • R01NR013430 (U.S. NIH Grant/Contract)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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