DIETARY INFLAMMATORY INDEX AND ASSOCIATED FACTORS IN INDIVIDUALS WITH HEART FAILURE
Heart Failure; Diet; Inflammation; Food intake; Mortality
The Dietary Inflammatory Index (DII) has been widely studied regarding its associations with cardiovascular diseases (CVD). However, there are still gaps in the literature concerning factors associated with DII in individuals with heart failure (HF), particularly the impact of DII on mortality and hospitalization outcomes. This study aimed to identify DII and associated factors in outpatients with HF. A total of 124 adults and elderly individuals of both sexes diagnosed with HF were studied at the Interprofessional Heart Failure Outpatient Clinic of Onofre Lopes University Hospital. Sociodemographic, anthropometric, clinical, and biochemical parameters, as well as clinical outcomes (hospitalization and mortality) occurring over a period of up to 36 months, were evaluated. Dietary intake was assessed using a 24-hour Dietary Recall (R24h), with an average of 3 recalls per individual, identifying dietary parameters for DII calculation. Variables were analyzed according to DII tertiles (T1: -3.427 to - 1.1866; T2: -1.1865 to -0.15643; T3: -0.15642 to 2.872). Kruskal-Wallis test was used for group comparisons, followed by Dunn's post-test. Qualitative variables were compared using the Chi-square (χ2) or Fisher's Exact test. Binomial Logistic Regression Models were used to analyze associations between DII tertiles and biochemical variables: hemoglobin, hematocrit, non-HDL cholesterol, and ultrasensitive C-reactive protein (us-CRP). Associations between DII and clinical outcomes (hospitalization and mortality) were observed through Cox Regression. HF individuals were predominantly male (66.1%), overweight (60.0%) and HF with Reduced Ejection Fraction (HFrEF) and Mid-range (HFmrEF) (79.8%). It was observed that 13.7% of the studied population had mortality as an outcome, and 32.3% had hospitalization. It was found that 74.2% of individuals with HF had an anti-inflammatory dietary classification. In DII T3, lower concentrations of hemoglobin and us-CRP were observed compared to T1 (p=0.020 and p=0.008), and higher nonHDL cholesterol values (p=0.049). Total fiber intake, beta-carotene, vitamin A, vitamin B6, vitamin C, magnesium, potassium, garlic, and onion were lower in T3 compared to T1 and T2 (all p<0.05), whereas protein intake, vitamin B3, and phosphorus intake were higher in T3 compared to T2 (all p<0.05), and saturated fat intake was higher in T3 compared to T1 (p=0.012). Differences were identified in hemoglobin, hematocrit, non-HDL cholesterol, and us-CRP values among DII tertiles (all p<0.05). Regression models indicated only a significant association between DII and hematocrit (p=0.036). No associations were observed between DII categorized in tertiles and mortality or hospitalization outcomes (all p>0.05). In conclusion, a higher consumption of potentially anti-inflammatory diet was evidenced, along with a high frequency of hospitalization and mortality, without associations with DII.