Relationships among Dietary Patterns, Metabolites, and Symptoms in Persons with Heart Failure Public
Davis, Erica (Summer 2022)
Published
Abstract
Black Americans have a disproportionate rate of onset with heart failure (HF) at an earlier age and a 30-44% higher 5-year mortality rate compared to other racial and ethnic groups. Symptom burden is a significant health concern among Black populations with HF and may be addressed by examining the relationships between diet and inflammatory processes to identify symptom triggers and subsequently guide intervention by diet modification. The dietary gut derived metabolite trimethylamine-N-oxide (TMAO) has been noted as a key contributor to HF severity and has interconnections with inflammatory processes in the heart and blood vessels as well as dietary links. The purpose of this study was to examine associations of an inflammatory diet, the specific gut derived metabolite (TMAO), an inflammatory biomarker tumor necrosis factor-alpha (TNF-α), and symptoms in the Black HF population.
For this cross-sectional study, 30 Black men and women with HF, who were between the ages of 30-80 years, were enrolled from the Emory outpatient cardiology clinics. Measures included sociodemographic and clinical data, questionnaires (heart failure symptom survey, multidimensional social support, and the Center for Epidemiology Studies scale for depressive symptoms), a food frequency questionnaire with a calculated dietary inflammatory index score (DII), and biomarkers of TMAO and TNF-α. Analysis included correlations and linear regression. Covariates included age, sex, left ventricular ejection fraction, social support, comorbidities (Charlson comorbidity index) and lifestyle factors of smoking, alcohol intake, body mass index (BMI), and physical activity.
Findings from this study included a moderate correlation between TNF-α and TMAO (r=.28, p=.138). No significant relationships with DII and TMAO nor DII and TNF-α were detected. Although models with TNF-α and TMAO accounted for 37%-45.9% of variance in physical HF symptoms, only the covariates were significant predictors.
These data suggest that, in addition to managing physical inflammatory influences on HF symptoms, other factors to consider include a person’s age, metabolite levels, comorbidities, lifestyle, ejection fraction and needs related to life quality. This information may help clinicians as it can assist with understanding the individual and subjective nature of HF physical and psychological symptoms along with the influencing factors of the person experiencing them.
Table of Contents
Table of Contents
Chapter 1: Introduction……………………………………………………………………………….................….1
Figure 1.1 Theoretical Framework……………………………………………………………..................7
Table 1.1 Table of Variables and Measures………………………………………………….................13
Chapter 2: Heart Failure Symptom Burden, Dietary Intake, and Inflammation……………………….....21
Figure 2.1 Integrative Literature Review Methodology……………………………………….....................44
Figure 2.2 Theory Based Conceptual Model………………………………………………….........................45
Table 2.1 Description of the Studies…………………………………………………………..........................46
Chapter 3: Relationships between The Western Diet and Inflammatory Mechanisms………………....63
Figure 3.1 Relationship among the Western Diet, TMAO, and Inflammatory Process………...80
Figure 3.2 Positive Correlation between TMAO and TNF-α…………………………………...........81
Figure 3.3 TMAO Levels by Pork Consumption……………………………………………….............82
Figure 3.4 TNF-α and BMI Differences………………………………………………………...............83
Table 3.1 Baseline Characteristics of the Participant Cohort…………………………………........84
Table 3.2 Means and Standard Deviations of Key Study Variables…………………………..........85
Table 3.3 Clinical Characteristics and Key Study Variables by Sex…………………………..........85
Table 3.4 Dietary Patterns for Men and Women………………………………………………...........86
Chapter 4: The Influence of the Western Diet, Trimethylamine N-Oxide, and Inflammation………..88
Table 4.1. Sociodemographic and Clinical Variables…………………………………………..........105
Table 4.2 Study Variables……………………………………………………………………..................106
Table 4.3 TNF-α and Heart Failure Symptoms-Interference with Enjoyment of Life…………106
Table 4.4 Regression Analysis for Total Physical Heart Failure Symptoms and TMAO……....107
Table 4.5 The Influence of TNF-α and Related Covariates on HF Symptom Frequency………107
Table 4.6 The Influence of TNF-α and Related Covariates on the Total HF Symptoms……….108
Table 4.7 The Influence of TMAO on HF Symptoms Frequency………………………………......108
Table 4.8 TMAO, Covariates, and HF Symptoms that Interfere with Enjoyment of Life…......109
Table 4.9 Differences Between Men and Women with Symptom Scores………………………...110
Table 4.10 Top Symptoms for HF and Depressive Symptoms…………………………………......110
Chapter 5: Discussion and Synthesis…………………………………………………………………...........111
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