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Micronutrient Deficiency Independently Predicts Adverse Health Outcomes in Patients With Heart Failure

Song, Eun Kyeung PhD, RN; Kang, Seok-Min MD, PhD

doi: 10.1097/JCN.0000000000000304
ARTICLES: Heart Failure

Background: Despite growing evidence on the important role of micronutrients in prognosis of heart failure (HF), there has been limited research that micronutrient deficiency predicts health outcomes in patients with HF.

Purpose: The aim of this study was to determine whether micronutrient deficiency independently predicts adverse health outcomes.

Methods: A total of 113 consecutive outpatients with HF completed a 3-day food diary to measure intake of 15 micronutrients. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary micronutrient deficiencies. Patients completed the Minnesota Living With HF Questionnaire to assess health-related quality of life (HRQoL) and were followed up for 1 year to determine cardiac-related hospitalization or cardiac death. Hierarchical multiple linear regressions and Cox proportional hazard regressions were used to determine whether micronutrient deficiencies predicted health outcomes.

Results: Fifty-eight patients (51%) had at least 3 micronutrient deficiencies (range, 0–14). Calcium, magnesium, and vitamin D were the most common micronutrient deficiencies. Micronutrient deficiency was independently associated with worse HRQoL (β = .187, P = .025) in hierarchical multiple linear regression. Thirty-nine patients were hospitalized or died during 1-year follow-up because of cardiac problems. The number of micronutrient deficiencies independently predicted cardiac event–free survival (hazard ratio, 1.14; 95% confidence interval, 1.02–1.28).

Conclusions: These findings show that micronutrient deficiency independently predicted poor HRQoL and earlier cardiac event–free survival in patients with HF. Further research is needed to provide for specific dietary guidelines for better health outcomes in HF patients.

Eun Kyeung Song, PhD, RN Associate Professor, Department of Nursing, College of Medicine, University of Ulsan, South Korea.

Seok-Min Kang, MD, PhD Professor, Cardiology Division, Severance Hospital, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Seoul, South Korea.

This work was supported by the Research Fund of University of Ulsan (no. 2014-0042).

The authors have no conflicts of interest to disclose.

Correspondence Eun Kyeung Song, PhD, RN, Department of Nursing, College of Medicine, University of Ulsan, Daehak-ro 93, Nam-gu, Ulsan, South Korea 680-749 (

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