Heart Failure Patients May Have Trouble Following Low-Sodium Diets

Only one-third of heart failure patients comply with recommended daily sodium intake. Researchers fault eating higher calories; frequent intake of foods with hidden salt such as fast food, lunch meat, bread and pizza; and lower economic status.

29/04/09 Even when they attempt to reduce their sodium intake, only one-third of heart failure patients in a small study were able to adhere to a recommended low-sodium diet, researchers reported at the American Heart Association’s 10th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

The recommended daily intake of sodium for heart failure patients is 2,000 milligrams (mg). However, the 116 heart failure patients in the study consumed an average 2,671 mg per day with a range of 522 to 9251 mg per day.

The American Heart Association recommends healthy people aim to eat less than 2,300 mg of salt per day. Some people — African Americans, middle-aged and older adults and people with high blood pressure — should aim for less than 1,500 mg per day.

“The patients themselves were shocked to find out they were eating more than 2000 mg of sodium a day,” said Carolyn M. Reilly, R.N., Ph.D., abstract co-author and postdoctoral fellow at Emory University in Atlanta.

Most of the patients thought they were taking steps to reduce their sodium, but focused on the wrong target, Reilly said.

“There is so much salt hidden in foods that patients aren’t aware of. While they may have thrown away their salt shakers, they didn’t know that 70 percent of the sodium in the American diet is in the food, not the shaker,” she said. “Everything processed has sodium in it to give it a longer shelf life. In addition to safety, sodium is also added to foods to enhance texture and mask bitterness. Some of the big culprits we have identified in this population are cured meats such as hot dogs and bacon, and other processed foods like canned soups, salad dressings and condiments.”

The analysis of the ENSPIRE (Education and Supportive Partners Improving Self Care) study included 116 patients (28 to 78 years old, 64 percent male and 58 percent black) with mild and moderate heart failure on standard therapy. Baseline analyses showed that higher sodium intake was associated with higher caloric intake, male gender, eating fast food and lower economic status.

For the study, patients wrote down everything they ate for three days, then received personalized instructions on how they could further reduce the sodium in their diets with examples from the food diary.

Caloric intake ranged from 688 to 4,207 calories per day, with an average of 1,674 calories. Participants ate 110 percent of the recommended amounts of protein, 63 percent of recommended carbohydrates and 89 percent of recommended total fat. “Most of the patients in the study ate meat and other protein, but didn’t eat enough carbohydrates such as greens, fruits, vegetables and whole grains, nor enough low-fat (1 percent) or fat-free dairy,” Reilly said.

Frequent high-sodium food selections included fast-food burgers and chicken sandwiches, lunch meat, salad dressing, processed entrees, corn products such as prepared grits and cornbread, pork sausage, bread and pizza. More than 40 percent of patients ate at least one fast-food sandwich with 1,115 mg of sodium during the three-day period and one in seven had pizza with 1,461 mg of sodium.

Participants who were able to adhere to the recommended sodium levels tended to eat fewer calories, less carbohydrates and less fat, but not less protein. Women and those making $35,000 or more a year were more likely to adhere to the low-sodium diet.

The recommendations need to be individualized for the heart failure patient, keeping overall quality of the diet in mind, Reilly said. “The food diary shows what they actually ate. The dietary education needs to be tailored to the patient and individual needs.”

“It’s not good enough just to give patients a list of foods to eat and tell them to read food labels,” she said. “The diary helps open their eyes to what they are eating. A nurse or dietitian then can show them better choices that they could make.”

Patients need to keep the sodium to 2,000 milligrams a day or less, Reilly said. “That’s 500 mg a meal and two snacks with 250 mg each. Another rule of thumb is to limit eating anything that has more than 100 mg of sodium per serving.”

These findings are from a larger study in which patients and families are provided education on how to read food labels and strategize on how to make healthier food and beverage choices when eating out, shopping or attending social functions, she said. “Our goal is to help heart failure patients make better choices.”

The study was funded by The National Institutes of Health/National Institute of Nursing Research and the Emory General Clinical Research Center/National Institutes of Health grants.