Nutritional Interventions in Chronic Heart Failure
The Effect of Using Nutrition Education as an Intervention Measure on Elevating the Nutritional Status, Quality of Life, and Self-Care Behavior of Patients With Chronic Heart Failure
This study recruited patients diagnosed with heart failure by cardiologists and cardiac outpatients whose cardiac functions were graded from 1 to 4 according to the New York Heart Association as the study participants. The participants were provided active nutrition intervention including diet optimization,specific recommendations and nutritional supplement prescriptions in cases in which nutritional goals were not reached.In addition, this study offered advice by referencing lifestyle change advice provided by the American Heart Association for patients with heart failure.
The Mini Nutritional Assessment Short-Form was used to assess malnutrition indicator values. The participant water, nutrient (i.e., carbohydrates, protein, and fat), and calorie intake data were collected using their recollection of their dietary intake and food intake frequency over a 24-hour dietary recall. The amount of fluid and sodium administered was provided according to the cardiac function grades indicated by the New York Heart Association.In addition, dietary assessments and nutritional advice were offered on the basis of the patients' conditions (i.e., age, activity, and comorbidity).
Finally, instrumental activities of daily living, EQ-5D (an instrument for measuring quality of life), grip performance, and 6-minute walk test data were utilized to analyze the changes in the participants before and after intervention, identifying the correlation between using nutrition education as an intervention measure and improvement in the participants' nutritional status, quality of life, and self-care behavior.
研究概览
详细说明
Malnutrition may be caused by decreased nutrient intake or absorption, inflammation, or other disease-related mechanisms. Malnutrition resulting from disease or injury may be caused by decreased food intake or varying degrees of acute or chronic inflammation, which alters body composit ion and prompts a decline in biological functions. The effects of decreased food intake induced by an inflammatory reaction are related to the malnourishment resulted from anorexia, changes in metabolism, increased resting energy expenditure, and increased muscle catabolism. Changes in body composition are characterized by a decrease in any muscle mass marker (excluding fat mass, muscle mass index, or body cell mass). Therefore, malnutrition is associated with clinical results of clinical malfunction.
The primary objectives of heart failure treatment include preventing the need for hospitalization, increasing the survival rate, and improving health status. Patient symptoms, bodily functions, and health status are also referred to as health-related quality of life (HRQoL). The EuroQol-5D (EQ-5D) is used to assess the quality of life of patients undergoing cardiac rehabilitation. This assessment uses 5 aspects, namely mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, to assess patient health status.
Cardiopulmonary exercise testing (CPET) is the gold standard method for evaluating the motor ability of patients with chronic heart failure (CHF), yet is not extensively used. A more commonly used and simpler method is the 6-minute walk test, which measures the distance traveled by walking for 6 minutes. Changes in this value correlate to quality of life. This test is used to investigate the ability to perform daily activities and intensity of exercise in patients with mild to moderate CHF.
Muscle strength is a key indicator for assessing patients with sarcopenia because decreased muscle strength is considered a crucial element in diagnosing muscle reduction. For circumstances in which muscle mass is difficult to assess, muscle strength, such as handgrip strength, can serve as a standard assessment of muscle functions.
Exercise training is considered a valid method for stabilizing patients with heart failure. One study reported that the self-management intervention of a patient with heart failure notably decreased the occurrence of hospitalization and hospital readmission related to heart failure as well as all-cause mortality.
The present study determines the effectiveness of nutrition intervention in routine medical treatment for improving the nutrition and quality of care among patients with heart failure.
This study does not involve drugs, medical technology, or medical equipment.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Yunlin County
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Douliu、Yunlin County、台湾、640
- Department of Internal Medicine, National Taiwan Univeristy Hospital Yun-Lin branch
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Patients diagnosed with CHF by a cardiologist. Clinical patients with the functional classification of NYHA FcI-NYHA FcⅣ according to the New York Heart Association (NYHA).
- Adults aged 20 years or older who are conscious, have normal cognitive function, can walk without assistance, and do not require breathing aids. Additionally, participants must be able to answer questionnaires in Mandarin Chinese or Taiwanese, either orally or in writing.
- Patients who have agreed to participate in the study by completing a consent form.
Exclusion Criteria:
- Patients with an expected survival period of less than 6 months because of a disease not related to CHF
- Long-term bed-bound patients
- Patients with no potential for rehabilitation because of decline in functions of neural or musculoskeletal systems
- Patients with severe disorders of consciousness or cognitive disorders or those with mental illness
- Patients who require breathing aids for an extended period of time
- Patients with end-stage severe CHF who have been diagnosed by doctors as unable to recover within a short period
- Patients who are scheduled to undergo coronary artery bypass surgery or a heart valve surgery within 1 month
- Patients who are on hemodialysis or are awaiting a kidney transplant
- Patients with severe pulmonary diseases who require long-term home oxygen therapy
- Patients who themselves decline to participate or who have a family member who objects to their participation.
学习计划
研究是如何设计的?
设计细节
- 主要用途:支持治疗
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:Nutritional intervention for CHF
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Limitations on liquid and sodium intake will be established in accordance with the NYHA functional classification, and patients will be provided with dietary assessments and nutrition advice according to personal characteristics such as age, physical activity level, and comorbidities.
Additionally, suggestions on lifestyle changes were provided by referring to the advice for patients with heart failure from the American Heart Association.
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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Mini Nutritional Assessment Short-Form
大体时间:Change from Baseline Mini Nutritional Assessment Short-Form on months 0, 3 at 6 months(Do higher values represent a better outcome).
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Assess malnutrition indicator values. Nutrition status evaluated by the MNA correlates with energy and nutrient intakes as well as anthropometrics, hematologic, and biological nutrition parameters. MNA has 4 sections: anthropometrics (BMI, weight loss, arm and calf circumference), general assessment (lifestyle, medication, mobility, presence of depression or dementia), dietary assessment (number of meals, food and fluid intake, autonomy of feeding), and subjective assessment (self-perception of health and nutrition). The maximum score for the MNA-SF is 14, with scores ≥12 indicating satisfactory nutrition status and ≤11 indicating a risk of malnutrition. |
Change from Baseline Mini Nutritional Assessment Short-Form on months 0, 3 at 6 months(Do higher values represent a better outcome).
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Instrumental Activities of Daily Living
大体时间:Change from Baseline Instrumental Activities of Daily Living on months 0, 3 at 6 months.
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Instrumental Activities of Daily Living Heath-related quality of life. IADL Scale was developed to assess more complex activities (termed "instrumental activities of daily living") necessary for functioning in community settings (e.g., shopping, cooking, managing finances). The capacity to handle these complex functions normally is lost before basic "activities of daily living" (e.g., eating, bathing, toileting) which are measured by ADL scales. Therefore, assessing IADLS may identify incipient decline in older adults or other individuals who are otherwise capable and healthy. It contains 8 items that are rated with a summary score from 0 (low functioning) to 8 (high functioning). This scale can be administered through an interview or by a written questionnaire. |
Change from Baseline Instrumental Activities of Daily Living on months 0, 3 at 6 months.
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EuroQol-5D
大体时间:Change from Baseline EuroQol-5D on months 0, 3 at 6 months(Do higher values represent a better outcome).
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Assess the quality of life of patients undergoing cardiac rehabilitation. the generic EuroQol fivedimensional questionnaire (EQ-5D) instrument are commonly referred to as value sets; an important distinction lies in whether the valuations are elicited from individuals with experience of the health state (experience-based values) or from individuals from the general population to whom the health states are described (hypothetical values).
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Change from Baseline EuroQol-5D on months 0, 3 at 6 months(Do higher values represent a better outcome).
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Handgrip strength
大体时间:Change from Baseline Handgrip strength on months 0, 3 at 6 months.
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Assessment of muscle functions.
Measured by dynamometer, before and after intervention.
We will compare the statistical properties of between baseline and after 0, 3 at 6 months intervention.
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Change from Baseline Handgrip strength on months 0, 3 at 6 months.
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6-Minute walk test
大体时间:Change from Baseline 6-Minute walk test on months 0, 3 at 6 months(Do higher values represent a better outcome).
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Changes in this value correlate to quality of life
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Change from Baseline 6-Minute walk test on months 0, 3 at 6 months(Do higher values represent a better outcome).
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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Energy intake
大体时间:Change from Baseline Energy intake on months 0, 3 at 6 months.
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Energy intake (Kcal/day)will be assessed by dietary survey on 24-hour recall.
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Change from Baseline Energy intake on months 0, 3 at 6 months.
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Carbohydrate intake
大体时间:Change from Baseline Carbohydrate intake on months 0, 3 at 6 months.
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Carbohydrate intake (g / day) will be assessed by dietary survey on 24-hour recall.
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Change from Baseline Carbohydrate intake on months 0, 3 at 6 months.
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Protein intake
大体时间:Change from Baseline Protein intake on months 0, 3 at 6 months.
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Protein intake (g / day) will be assessed by dietary survey on 24-hour recall.
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Change from Baseline Protein intake on months 0, 3 at 6 months.
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Fat intake
大体时间:Change from Baseline Fat intake on months 0, 3 at 6 months.
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Fat intake (g / day) will be assessed by dietary survey on 24-hour recall.
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Change from Baseline Fat intake on months 0, 3 at 6 months.
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Sodium intake
大体时间:Change from Baseline Sodium intake on months 0, 3 at 6 months.
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Sodium intake (gm / day) will be evaluated by dietary survey on 24-hour recall.
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Change from Baseline Sodium intake on months 0, 3 at 6 months.
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Water intake
大体时间:Change from Baseline Water intake on months 0, 3 at 6 months.
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Water intake (ml / day) will be evaluated by dietary survey on 24-hour recall.
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Change from Baseline Water intake on months 0, 3 at 6 months.
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合作者和调查者
调查人员
- 首席研究员:Jien-Jiun Chen, MD、National Taiwan University Hospital Yunlin Branch
- 首席研究员:Feng-Ching Liao, BS、National Taiwan University Hospital Yunlin Branch
- 首席研究员:Sheng Nan Chang, PhD、National Taiwan University Hospital Yunlin Branch
- 首席研究员:Shao-Chi Yang, MD、National Taiwan University Hospital Yunlin Branch
- 首席研究员:Chih-Neng Hsu, MD、National Taiwan University Hospital Yunlin Branch
出版物和有用的链接
一般刊物
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研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)?
IPD 计划说明
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Self-Care Behavior的临床试验
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University of North Carolina, Chapel HillEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); National... 和其他合作者完全的