Low sodium diet: nutritional adequacy and factors limiting adherence

Background: Existing data suggest that nonadherence to low-sodium diet (LSD) is the most common cause of rehospitalization among heart failure (HF) patients. Yet, little is known about specific factors that affect patients’ ability to follow this commonlyprescribed measure. Further, many have expressed concern that patients who follow a LSD may suffer nutritional deficits that could counterbalance any positive effects of the LSD. Method and Results: The specific aims of this prospective, comparative study were to: a) describe factors that influence the ability of participants to follow a LSD, b) determine the relationship between self-reported adherence to prescribed LSD and actual sodium intake, and c) determine the nutritional adequacy of a LSD. Patients recruited from two Midwestern HF clinics filled out a questionnaire that measured perceptions about ability to follow a LSD and identified factors that limit ability to follow the diet. Thirty days later, they filled out a 4-day food diary and completed a 24-hour urine collection to measure urine sodium. Twelve males and 11 females with a mean age of 65 yrs and NYHA functional class II or III participated in the study. Sodium intake was 3.2 g for those who reported always following a LSD, 2.6 g for those who followed it most of the time, and 4.1 g. for those who never followed it. Thirty-three percent said it was difficult to follow the LSD, while 66% reported it was easy. Sodium intake on 4-day food diary and 24-hour urine sodium were strongly correlated (r 0.55, p 0.05). The factors reported most to hinder ability to follow the LSD were: friends/relatives don’t serve low sodium foods; difficult to find appetizing low sodium food, to keep track of total daily sodium intake, and to identify low sodium foods in restaurants. No relationship between perceived difficulty following the LSD and actual sodium intake was found. Individual daily caloric intake ranged from a low of 318 kcal to a high of 3,373 kcal, with a four-day group average intake of 1,548 ( 361) kcal. The percent of calories from fat ranged from 21 percent to 50 percent, with a mean of 34 ( 7) percent. The percent of calories derived from carbohydrate sources ranged from 23 percent to 61 percent, with a mean of 50 ( 10) percent. The percent of calories from protein sources ranged from 9 to 27 percent with a mean of 17 ( 4) percent. The only macronutrient related to sodium intake was protein (r 0.58, p 0.05). Protein intake of patients with high sodium intake ( 3g) was significantly greater than those with low sodium intake. All diets were deficient in at least one nutrient, regardless of sodium intake. Themost common nutrient deficiency was magnesium (76%), followed by vitamin A (74%), calcium (71%), and vitamin D (65%). Conclusions: Some patients were able to limit sodium intake, however actual sodium intake was not related to perceived ability to follow a LSD nor selfreported adherence. Further, many individuals with HF may have multiple nutritional inadequacies regardless of their level of sodium intake, although protein deficiencies are prominent in those most closely following a LSD. Modulating the Cost of Prolonged Survival in Heart Failure: Long-Term Benefits of a Nurse-Led, Multidisciplinary, Home-Based Intervention Simon Stewart1—School of Nursing & Midwfery, University of South Australia, Adelaide, South Austrlia, Australia