An exploratory study of before hospitalization nutrients associated with N-terminal pro b-type natriuretic peptide during the exacerbation of chronic heart failure.

BACKGROUND & AIMS: In patients with chronic heart failure (CHF), insufficient salt/fluid restriction is the most frequent problem necessitating re-hospitalization, and its prevention represents a challenge in nutrition management. However, the quantities involved have yet to be established, and in particular, the relationship between the detailed dietary status before and after hospitalization has not been characterized. In this study, we aimed to assess the dietary habits of patients before hospitalization and exploration analysis to identify the nutrients associated with N-terminal pro b-type natriuretic peptide (NT-proBNP) during the exacerbation of CHF. METHODS: We performed a cross-sectional study of elderly patients allocated to two groups according to their NT-proBNP concentration at the time of hospitalization, using a cut-off value of 2,000 pg/mL. Categorical datasets were compared using the χ2 test or Fisher's exact test, and continuous datasets were compared using the Wilcoxon rank-sum test. Furthermore, multivariate logistic regression analysis was performed using an NT-proBNP concentration >2,000 pg/mL as the dependent variable and the n-3 polyunsaturated fatty acids, alpha-tocopherol, vitamin B1, vitamin D, zinc, iron, potassium, magnesium, salt equivalent, and fluid status, and the propensity score (PS), estimated glomerular filtration rate (eGFR) and HFpEF as explanatory variables. RESULTS: Data for 63 patients were analyzed. Their overall median age was 82 years, and 26 were female (41%). Of the coronary risk factors assessed, hypertension was present in 42 of the patients (67%). In addition, the albumin concentration, left ventricular ejection fraction, and eGFR of the high NT-proBNP group were lower than those of the low NT-proBNP group (p=0.013, p=0.002, and p=0.047, respectively). In the primary analysis, multivariate logistic regression showed that n-3 polyunsaturated fatty acids [Model1: odds ratio(OR):0.29, 95% confidence interval (CI): 0.09-0.95, p=0.041, Model2: OR:0.18, 95%CI: 0.05-0.68, p=0.012, Model3: OR:0.19, 95%CI: 0.05-0.69, p=0.012, Model4: OR:0.19, 95%CI: 0.05-0.75, p=0.018] and vitamin D [Model1: OR:0.89, 95%CI: 0.79-0.99, p=0.035, Model2: OR:0.84, 95%CI: 0.74-0.95, p=0.007, Model3: OR:0.85, 95%CI: 0.75-0.97, p=0.012, Model4: OR:0.84, 95%CI: 0.74-0.96, p=0.011] were independently and significantly associated with NT-proBNP concentrations >2,000 pg/mL. Additionally, in the secondary analysis, multivariate logistic regression showed that high intakes of alpha-tocopherol [Model3: OR:0.21, 95%CI: 0.05-0.92, p=0.039] were independently and significantly associated with NT-proBNP concentrations >2,000 pg/mL, but vitamin B1, zinc, iron, potassium, magnesium, salt equivalent, and fluid status were not. CONCLUSION: In this exploratory study, a high dietary intake of n-3 polyunsaturated fatty acids, vitaminD and alpha-tocopherol may be associated with lower NT-proBNP circulating concentrations during the exacerbation of CHF.