Abstract 15807: Adverse Nutritional Consequences of Dietary Sodium Reduction in Patients With Heart Failure
Background: Sodium restriction is the primary dietary therapy for heart failure (HF) patients. Whether unintended nutritional consequences occur with changes to sodium intake is unknown, and is plausible with excessive levels of sodium in the food supply. Such changes would be concerning since HF patients are at risk of nutritional abnormalities as a result of loop diuretic use and altered food intake.
Objective: To evaluate nutritional and physiologic changes resulting from dietary sodium restriction in stable ambulatory HF patients.
Methods: Eighteen systolic HF patients (60±11 years, 78% male) followed a sodium-restricted diet for one week. Neurohumoral and hemodynamic indices were measured at baseline and end of study. Patients were counselled to change food intake patterns to permit a lowering of sodium intake. Nutrient intake was measured by food records and 24-hour urine collections for 3 days prior to baseline and each day during the study.
Results: Following a 49% reduction in dietary sodium (3.6±0.2 to 1.8±0.2 g/d), we observed a significant reduction in caloric (2467±187 to 1931±97 kcal/d, p<0.01), carbohydrate (293±27 to 232±14 g/d, p=0.01), calcium (995±124 to 609±52 mg/d, p<0.01), thiamin (2.0±0.2 to 1.5±0.2 mg/d, p=0.02), and folate (413±48 to 331±43 mcg/d, p=0.02) intakes. There was also a decrease in saturated fat (32±5 to 21±2 g/d, p=0.03), and a trend to lower total fat (89±8 to 68±5 g/d, p=0.07) and higher potassium (1262±82 to 1405±67 mg/1000kcal, p=0.06) intakes. There were decreases in body weight (93±7 to 91±7 kg, p<0.01) and systolic blood pressure (122±5 to 115±4 mmHg, p<0.01). We also identified anticipated neurohumoral changes including a significant reduction in brain natriuretic peptide and increases in plasma norepinephrine, aldosterone and renin.
Conclusion: We found multiple unintentional nutritional consequences with dietary sodium restriction in HF patients, including significant reductions in caloric intake, calcium, thiamin and folate intake. However, total fat, saturated fat and potassium intakes improved with sodium reduction. In the current food environment that is excessive in sodium, these findings highlight the need to consider the whole diet when counselling HF patients to lower sodium intake.
- © 2011 by American Heart Association, Inc.