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High nutritional risk is associated with worse health-related quality of life in patients with heart failure beyond sodium intake

Background: The most desirable outcome in heart failure (HF) management is to improve health-related quality of life (HRQoL) as a patient-centred health outcome. Nutrition is assumed to be important in HF management, whereas there is little evidence that nutritional risk affects HRQoL, except for sodium. Purpose: We aimed to determine whether nutritional risk is associated with worse HRQoL after controlling for daily sodium intake. Methods: A total of 134 consecutive patients with HF [age 63±11 years, 35% female, 45% New York Heart Association (NYHA) class III/IV, ejection fraction (EF) 33±13%] completed the Nutrition Screening Initiative (NSI) to assess nutritional risk and a 24-h urine sodium excretion assessment to estimate daily sodium intake at baseline. The Minnesota Living with HF Questionnaire was used to evaluate HRQoL at baseline and 6 months later. Hierarchical linear regressions were used to determine whether nutritional risk predicted HRQoL at baseline and 6 months later. Results: Seventy-eight (58.2%) patients had high nutritional risk as indicated by a total NSI score ≥6. Increased nutritional risk was independently associated with worse HRQoL at baseline and 6 months later (β=0.33, p<0.001; β=0.35, p<0.001, respectively), after controlling for age, gender, aetiology, body mass index, NYHA class, EF, total comorbidity score, prescribed medications, and daily sodium intake. Conclusion: These findings show that higher nutritional risk beyond sodium intake affects worse HRQoL in patients with HF. Further work is required to provide specific dietary guidelines to improve health outcomes for patients with HF.