Low-sodium diet self-management intervention in heart failure: Pilot study results

University of Kentucky, Lexington, Kentucky, USA.
European Journal of Cardiovascular Nursing (Impact Factor: 1.88). 04/2012; 12(1). DOI: 10.1177/1474515111435604
Source: PubMed


BACKGROUND: Self-care management of a low-sodium diet is a critical component of comprehensive heart failure (HF) treatment. AIMS: The primary purpose of this study was to examine the effectiveness of an educational intervention on reducing the dietary sodium intake of patients with HF. Secondary purposes were to examine the effects of the intervention on attitudes, subjective norm, and perceived behavioural control towards following a low-sodium diet. METHODS: This was a randomized clinical trial of an educational intervention based on The Theory of Planned Behavior. Patients were randomized to either a usual care (n=25) or intervention group (n=27) with data collection at baseline, 6 weeks, and 6 months. The intervention group received low-sodium diet instructions and the usual care group received no dietary instructions. Nutrition Data Systems-Research software was used to identify the sodium content of foods on food diaries. Attitudes, subjective norm, and perceived behavioural control were measured using the Dietary Sodium Restriction Questionnaire. RESULTS: Analysis of covariance (between-subjects effects) revealed that dietary sodium intake did not differ between usual care and intervention groups at 6 weeks; however, dietary sodium intake was lower in the intervention group (F=7.3, df=1,29, p=0.01) at 6 months. Attitudes subscale scores were higher in the intervention group at 6 weeks (F=7.6, df=1, 38, p<0.01). CONCLUSION: Carefully designed educational programmes have the potential to produce desired patient outcomes such as low-sodium diet adherence in patients with heart failure.

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    ABSTRACT: For a majority of patients with advanced heart failure, there is a need for complementary, non-pharmacologic 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. 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 double blind-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 175 patients with advanced heart failure will be randomized to either the nutrition intervention or placebo group. © 2013 Wiley Periodicals, Inc. Res Nurs Health.
    Full-text · Article · Apr 2013 · Research in Nursing & Health
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    ABSTRACT: This article is a review of current evidence regarding the recommended level of dietary sodium, involvement of family members in adoption of a low sodium diet, and evidence-based strategies to increase patient and family member willingness and ability to a follow a low sodium diet. The available evidence suggests that recommending a 2.5 to 3 g sodium diet will meet nutritional needs and decrease risk of hospitalizations. The best strategy identified for patient success is to fully involve both patients and family members in jointly reducing sodium intake. Motivational interviewing techniques should be used before counseling begins to guide patients and family members toward realization of the need to follow a low sodium diet. Successful counseling starts with determining perceptions, barriers, and individual characteristics that impede adherence. This information is incorporated into theory-based teaching strategies to promote behavior change and successful adoption of a low sodium diet.
    Full-text · Article · Jul 2013 · Current Heart Failure Reports
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    ABSTRACT: Background Dietary strategies in heart failure (HF) are focused on sodium and fluid restriction in order to minimize the risk of acute volume overload episodes. However, the importance of dietary factors beyond sodium intake in the prognosis of the disease is uncertain. The purpose of this study was to evaluate the association of macro and micronutrients intake on 1-year mortality in patients with HF. Research Methods & Procedures A secondary analysis of 203 patients with chronic HF enrolled in a randomized trial of sodium reduction. Patients with a complete 3-day food record at baseline were included in this analysis (n=118); both control and intervention arms were combined. Three-day mean dietary intake was estimated. Cox multivariable regression analysis was used to evaluate the association between dietary factors and 1-year mortality. Results Among the 118 included patients, 54% were male, median (25th – 75th percentiles) age 66 years (52-75), median ejection fraction 45% (30-60) and ischemic etiology present in 49% of patients. The association with 1-year mortality was significant for both polyunsaturated fatty acids (PUFA) [adjusted hazard ratio (HR) 0.67 (95% confidence interval (CI) 0.51-0.86) for intake as percentage of daily energy] and saturated fatty acids (SFA) [adjusted HR 1.15 (95%CI 1.03-1.30) for intake as percentage of daily energy]. Median of intake as percentage of daily energy was 5.3% for PUFAs and 8.2% for SFAs. Conclusions PUFAs and SFAs intake were independently associated with 1-year all-cause mortality in patients with chronic HF. Limiting dietary SFA and increasing PUFA intake may be advisable in this population.
    Full-text · Article · Nov 2014 · Nutrition
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