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Andreae, C. (2018). Appetite in patients with heart failure: Assessment, prevalence and related factors. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Appetite in patients with heart failure: Assessment, prevalence and related factors
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Appetite is an important component in nutrition for maintaining the food intake needed by the body. Decreased appetite is a common clinical problem in patients with heart failure. It has a negative impact on food intake and possibly on malnutrition and health outcomes. There is a lack of evidence on how to assess appetite in heart failure. Furthermore, there are knowledge gaps about factors associated with appetite and which role appetite plays for health status in heart failure.  

Aim: The overall aim of the thesis was to investigate appetite in patients with heart failure. Four studies were conducted with the goal to evaluate the psychometric properties of the Council on Nutrition Appetite Questionnaire (CNAQ) (I) and to explore the prevalence of decreased appetite and related factors associated with appetite in patients with heart failure (II-IV).  

Methods: A multicenter study was conducted in three outpatient heart failure clinics in the center of Sweden during 2009-2012. Data were collected through a baseline measurement (I-IV) and an 18-month follow-up (IV). The first study was a psychometric evaluation study (I), while the other studies had an observational cross-sectional design (II-III) and an observational prospective design (IV). One hundred and eighty-six patients diagnosed with heart failure and experiencing heart failure symptoms participated at baseline. At the 18-month follow-up study (IV), one hundred and sixteen participants from the baseline participated. Data were collected from medical records (pharmacological treatment, comorbidity, left ventricle ejection fraction, time of diagnosis), self-reported questionnaires (demographic background data, appetite, symptoms of depression, health status, sleep, self-reported physical activity), objective measurements (anthropometric assessment of body size, blood samples, six minutes’ walk test, and physical activity measured with an actigraph) and clinical assessment (New York Heart Association (NYHA) functional classification, and cognitive assessment). The main outcome variables included appetite (I, II and IV) and health status (III). Descriptive and inferential statistics were used in the studies (I-IV).  

Results: The majority of the participants had moderate heart failure symptoms, i.e., NYHA class II (n=114, 61%). Most of the participants were men (n=130, 70%). Mean age was 70,7 years, (SD=11,0), and mean BMI was 28.7 (SD=5.3). The CNAQ showed acceptable psychometric properties for assessing appetite in patients with heart failure (I). This thesis shows that 38% of the participants experienced an appetite level that put them at risk of weight loss (I). It was shown that factors such as biological, medical, psychological (II) and physical activity/exercise capacity (IV) are associated with appetite. Also, appetite was associated with impaired health status. However, this association was found to be moderated by symptoms of depression (III). Neither appetite nor physical activity changed during the 18-month follow-up (IV).  

Conclusion: Decreased appetite is a serious phenomenon that needs attention in the care of patients with heart failure. Health care professionals can now use a validated and simple appetite instrument to assess appetite in heart failure. In addition, attention should be paid to elderly patients and those who have symptoms of depression, sleep problems, impaired cognitive function and impaired physical activity, as well as to patients on suboptimal medical treatment. Higher appetite was shown to contribute to a better health status, but this was only evident in patients without symptoms of depression. Therefore, special attention should be paid to symptoms of depression, as this risk factor affected the association between appetite and health status. This thesis enhances the understanding of the magnitude of the problem with decreased appetite in heart failure both in numbers and factors. New priorities in nutrition care and new ideas can be established, both in practice and in research, in order to improve a nutrition care that is vital for patients with heart failure.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 87
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1606
Keywords
Appetite, Age, Cognitive function, Depression, Health status, Heart failure, Malnutrition, Physical activity, Psychometrics, Pharmacotherapy, Sleep
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-145533 (URN)10.3384/diss.diva-145533 (DOI)9789176853733 (ISBN)
Public defence
2018-04-20, Berzeliussalen, Ingång 65, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2018-03-14 Created: 2018-03-05 Last updated: 2018-04-26Bibliographically approved
Andreae, C., Strömberg, A., Chung, M. L., Hjelm, C. & Årestedt, K. (2018). Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure. Journal of Cardiovascular Nursing, 33(2), E15-E20
Open this publication in new window or tab >>Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 2, p. E15-E20Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status.

OBJECTIVE: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association.

METHODS: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status.

RESULTS: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001).

CONCLUSIONS: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
Keywords
appetite, association, depression, health status, heart failure, nutritional status
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-139105 (URN)10.1097/JCN.0000000000000428 (DOI)000440241700003 ()28574973 (PubMedID)2-s2.0-85020167287 (Scopus ID)
Available from: 2017-07-01 Created: 2017-07-01 Last updated: 2018-09-27Bibliographically approved
Lennie, T. A., Andreae, C., Rayens, M. K., Song, E. K., Dunbar, S. B., Pressler, S. J., . . . Moser, D. K. (2018). Micronutrient Deficiency Independently Predicts Time to Event in Patients with Heart Failure. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(17), 1-10, Article ID e007251.
Open this publication in new window or tab >>Micronutrient Deficiency Independently Predicts Time to Event in Patients with Heart Failure
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 17, p. 1-10, article id e007251Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151417 (URN)10.1161/JAHA.117.007251 (DOI)000452804600001 ()
Note

Funding agencies: National Institute of Nursing Research [NIH P20NR0106791, NIH RO1NR009280]; American Heart Association; Great Rivers Affiliate Postdoctoral Fellowship; National Center for Research Resources; National Center for Advancing Translational Sciences; General C

Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2019-01-07Bibliographically approved
Andreae, C., Franzén Årestedt, K., Evangelista, L. & Strömberg, A. (2018). The associations between physical activity and appetite in patients with heart failure – a prospective observational study. In: : . Paper presented at American Heart Association. 10-12 November. Chicago, Illinois.. American Heart Association, Inc., 138, Article ID A14932.
Open this publication in new window or tab >>The associations between physical activity and appetite in patients with heart failure – a prospective observational study
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction: Physical activity and appetite both play a crucial role for health outcomes and quality of life in patients with heart failure. Nevertheless, both of these key functions are frequently decreased in patients with heart failure. Whilst most attention focuses independently on the physical activity levels, the associations with appetite has been insufficiently investigated. The aim was therefore to explore the associations between physical activity and appetite in community dwelling heart failure patients.

Methods: This prospective observational study consisted of 186 patients with symptomatic heart failure of whom 56 (30%) were women and 130 (70%) were men. Mean age was 70.7 (SD=11 years), the majority had NYHA-class II, 114 (63%). Objective and subjective methods were used to measure physical activity include a wearable actigraph (SenceWear) for 4 days and six minutes’ walk test. The actigraph calculate total energy expenditure, active energy expenditure, number of steps and METs daily average index. Patients also stated their physical activity level on a numeric rating scale. A self-reported questionnaire, the Council on Nutrition Appetite Questionnaire was used to assess appetite. Simple linear regression was conducted to explore the associations between physical activity and appetite at baseline and at 18-month follow-up.

Results: In general, the levels of physical activity in this sample was low and appetite was poor. There was a significant association between objective physical activity measures and appetite at baseline ranging between (p=<0.001-0.041). The number of steps and walking distance had the strongest association, each explaining 6% and 7% of the total variance in appetite. At the 18-month follow-up, all objective and subjective physical activity measures were associated with appetite (p=0.001-0.035) with the number of steps being most strongly associated (p=<0.001) explaining 14% of the total variation in appetite.

Conclusions: Patients with heart failure who are more physically active experiences better appetite. These findings underscore the importance of placing greater attention on both physical activity and appetite in clinical practice as these factors has implications for patient’s health outcomes. Further longitudinally oriented studies are needed to determine whether there is a causal relationship between physical activity and appetite in heart failure populations.

Keywords: Appetite, Heart Failure, Physical activity

Place, publisher, year, edition, pages
American Heart Association, Inc., 2018
Series
Circulation, ISSN 0569-6704 ; 138
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-153900 (URN)
Conference
American Heart Association. 10-12 November. Chicago, Illinois.
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-01-22Bibliographically approved
Andreae, C., Årestedt, K., Evangelista, L. L. & Strömberg, A. (2017). Physical activity and appetite in patients with stable heart failure – A cross sectional study. In: : . Paper presented at American Heart Association, Anaheim CA 11-15 November.
Open this publication in new window or tab >>Physical activity and appetite in patients with stable heart failure – A cross sectional study
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151418 (URN)
Conference
American Heart Association, Anaheim CA 11-15 November
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-09-19
Andreae, C., Årestedt, K., Evangelista, L. & Strömberg, A. (2017). Sedentary lifestyle is associated with poor appetite in patients with heart failure.. In: : . Paper presented at EuroHeartCare Jönköping Sweden 18-20 May.
Open this publication in new window or tab >>Sedentary lifestyle is associated with poor appetite in patients with heart failure.
2017 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151410 (URN)
Conference
EuroHeartCare Jönköping Sweden 18-20 May
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-09-19
Wleklik, M., Uchmanowicz, I., Jankovska-Polanska, B. & Andreae, C. (2017). The role of nutritional status in elderly patients with heart failure. The Journal of Nutrition, Health & Aging, 22(5), 581-588
Open this publication in new window or tab >>The role of nutritional status in elderly patients with heart failure
2017 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 22, no 5, p. 581-588Article in journal (Refereed) Published
Abstract [en]

Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.

Place, publisher, year, edition, pages
Springer, 2017
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-151414 (URN)10.1007/s12603-017-0985-1 (DOI)000432630800005 ()
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-09-28Bibliographically approved
Andreae, C., Strömberg, A., Sawatzky, R. & Årestedt, K. (2016). Correction: Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure (vol 21, pg 954, 2015). Journal of Cardiac Failure, 22(3), 245-245
Open this publication in new window or tab >>Correction: Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure (vol 21, pg 954, 2015)
2016 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, no 3, p. 245-245Article in journal (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127054 (URN)10.1016/j.cardfail.2015.11.011 (DOI)000372211300015 ()
Available from: 2016-04-19 Created: 2016-04-13 Last updated: 2017-05-05
Andreae, C., Strömberg, A. & Årestedt, K. (2016). Prevalence and associated factors for decreased appetite among patients with stable heart failure. Journal of Clinical Nursing, 25(11-12), 1703-1712
Open this publication in new window or tab >>Prevalence and associated factors for decreased appetite among patients with stable heart failure
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 11-12, p. 1703-1712Article in journal (Refereed) Published
Abstract [en]

Aims and objectivesTo explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure. BackgroundDecreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group. DesignObservational, cross-sectional study. MethodsA total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite. ResultsSeventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance. ConclusionIn this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Relevance to clinical practiceLoss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
age; appetite; cognitive function; depression; heart failure; insomnia; outpatient; pharmacological treatment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-128929 (URN)10.1111/jocn.13220 (DOI)000375866200022 ()26879764 (PubMedID)
Note

Funding Agencies|Centre for Clinical Research Sormland, Uppsala University, Eskilstuna, Sweden; Swedish Heart and Lung Foundation; King Gustaf V and Queen Victorias Freemason Foundation; Medical Research Council of Southeast Sweden

Available from: 2016-06-09 Created: 2016-06-07 Last updated: 2018-03-14
Andreae, C., Strömberg, A., Chung, M., Lennie, T. & Årestedt, K. (2015). Depressive symptoms as a moderator and mediator of the relationship between physical activity, appetite and perceived health among patients with heart failure. In: : . Paper presented at EuroHeartCare, Dubrovnic, Croatia, 14 - 15 June 2015 (pp. Abstract nr. 61). European Society of Cardiology
Open this publication in new window or tab >>Depressive symptoms as a moderator and mediator of the relationship between physical activity, appetite and perceived health among patients with heart failure
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2015 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Purpose: Depressive symptoms have been shown to directly influence perceived health among persons with heart failure (HF). Decreased physical activity and appetite may also be predictive of poor perceived health.The purposes of this study were to determine whether appetite and physical activity predicted perceived health, and to determine whether depressive symptoms mediated or moderated their relationship with perceived health.

Methods: A total of 184 patients with mild to severe HF were included. Appetite, depressive symptoms and perceived health were measured by self-report questionnaires (Council on Nutrition Appetite Questionnaire, Patient Health Questionnaire and EuroQol 5D index). Physical activity was measured by SenceWearTM for 6 days. A separate series of multiple linear regression analyses were run to determine whether depressive symptoms mediated or moderated the relationship between physical activity and perceived health, and between appetite and perceived health.

Results: Higher physical activity predicted better perceived health (ß=0.202, p=.006) but the strength of the association decreased (ß=0.13, p=.048) when depressive symptoms were included in the model. There was a significant mediation effect for depressive symptoms on perceived health (sobel=2.03, p=.041) (Fig 1). Appetite was a significant predictor of perceived health. Examination of this association among those with and without depressive symptoms, however showed positive association between appetite and perceived health remained only for patients without depressive symptoms demonstrating a moderating effect (p<.001) (Fig 2).

Conclusion: Identifying and treating depression simultaneously while addressing appetite and physical activity may be key to improving perceived health among persons with HF.

Place, publisher, year, edition, pages
European Society of Cardiology, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-121553 (URN)
Conference
EuroHeartCare, Dubrovnic, Croatia, 14 - 15 June 2015
Available from: 2015-09-24 Created: 2015-09-24 Last updated: 2015-10-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1482-767X

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