Micronutrient deficiency independently predicts time to event in patients with heart failure

Terry A. Lennie, Christina Andreae, Mary Kay Rayens, Eun Kyeung Song, Sandra B. Dunbar, Susan J. Pressler, Seongkum Heo, Jin Shil Kim, Debra K. Moser

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Background—Dietary micronutrient deficiencies have been shown to predict event-free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event-free survival, defined as a combined end point of all-cause hospitalization and death. Methods and Results—Four-day food diaries were collected from 246 patients with heart failure (age: 61.5_12 years; 67% male; 73% white; 45% New York Heart Association [NYHA] class III/IV) and analyzed using Nutrition Data Systems for Research. Micronutrient deficiencies were determined according to methods recommended by the Institute of Medicine. Patients were followed for 1 year to collect data on all-cause hospitalization or death. Patients were divided according to number of dietary micronutrient deficiencies at a cut point of ≥7 for the high deficiency category versus <7 for the no tomoderate deficiency category. In the full sample, 29.8% of patients experienced hospitalization or death during the year, including 44.3% in the high-deficiency group and 25.1% in the no/moderate group. The difference in survival distribution was significant (log rank, P=0.0065). In a Cox regression, micronutrient deficiency category predicted time to event with depression, NYHA classification, comorbidity burden, body mass index, calorie and sodium intake, and prescribed angiotensin-converting enzyme inhibitors, diuretics, or b-blockers included as covariates. Conclusions—This study provides additional convincing evidence that diet quality of patients with heart failure plays an important role in heart failure outcomes.

Original languageEnglish
Article numbere007251
JournalJournal of the American Heart Association
Issue number17
StatePublished - Sep 1 2018

Bibliographical note

Publisher Copyright:
© 2018 The Authors.


  • Diet
  • Heart failure
  • Nutrition
  • Risk factor
  • Survival analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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