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Aims Eating a varied diet promotes adequate micronutrient intake. Poor appetite could decrease the desire to eat a varied diet leading to dietary micronutrient insufficiencies. The interrelationships among appetite, diet variety, and dietary micronutrient intake have not been investigated in patients with heart failure (HF). The purpose of the study was to determine whether the relationship between appetite and micronutrient insufficiency was mediated through diet variety. Methods and results A total of 238 patients with HF, mean age 61 +/- 12.1; 68% male, and 45% NYHA class III/IV were included in this secondary analysis. Data collection consisted of a 4-day food diary and self-reported appetite on a 10-point visual analogue scale. Micronutrient insufficiency was defined as the total number of 17 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. Mediation analysis, controlling for covariates age, gender, NYHA class, and body mass index showed that diet variety mediated the relationship between appetite and micronutrient insufficiencies [indirect effect = -0.0828, 95% confidence interval (CI): -0.1585 to -0.0150]. There was no direct effect of appetite on micronutrient insufficiency (c = -0.1802; 95% CI = -0.3715 to.0111). Conclusions Diet variety played a previously unrecognized role in the relationship between appetite and dietary micronutrient intake in patients with HF. More research is needed to validate these associations in patients with HF., Funding Agencies|NIH [R01 NR 009280, P20 NR 010679, UL1 RR025008, UL1TR000117, MO1 RR000750]; Clarion Health Partners (Indiana); Atlanta Veterans Administration Medical Center

Aims Patients with heart failure (HF) and their family caregivers commonly experience depressive symptoms associated with low quality of life (QOL) at the individual level. However, there is a lack of knowledge about how QOL and family function are associated with depressive symptoms at the dyad level. The aim of this article is to compare QOL and family function among dyads stratified by depressive symptoms. Methods and results Outpatients with HF and their primary caregivers completed the Beck Depression Inventory-II for depressive symptoms, the Short Form 36 for physical and mental QOL, and the McMaster Family Assessment Device for a family function. Analysis of variance was used to compare QOL and family function among the four dyad groups. A total of 91 dyads were categorized into four groups: neither member having depressive symptoms (43.9%), only the caregiver having depressive symptoms (13.2%), only the patient having depressive symptoms (23.1%), and both members having depressive symptoms (20.9%). Dyads without depressive symptoms had the highest levels of physical and mental QOL among the groups. The dyads with both members having depressive symptoms had the lowest levels of physical and mental QOL (P < 0.001) and the lowest levels of general family functioning, problem-solving ability, and communication ability (P < 0.001). Intermediate levels of QOL were seen in dyads with only one member having depressive symptoms, and a similar pattern of intermediate scores was found in all three subscales of family function. Conclusion Dyads with both members having depressive symptoms may be at greatest risk of having poor QOL and low family functioning., Funding Agencies|National Institutes of Nursing ResearchUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Nursing Research (NINR) [K23NR010011]

AIMS: Eating a varied diet promotes adequate micronutrient intake. Poor appetite could decrease desire to eat a varied diet leading to dietary micronutrient insufficiencies. The interrelationships among appetite, diet variety, and dietary micronutrient intake has not been investigated in patients with heart failure. The purpose with the study was to determine whether the relationship between appetite and micronutrient insufficiency was mediated through diet variety. METHODS AND RESULTS: A total of 238 patients with heart failure, mean age 61 ± 12.1; 68% male and 45% NYHA class III/IV were included in this secondary analysis. Data collection consisted of a four-day food diary and self-reported appetite on a 10-point visual analog scale. Micronutrient insufficiency was defined as the total number of 17 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. Mediation analysis, controlling for co-variates age, gender, NYHA-class and body mass index showed that diet variety mediated the relationship between appetite and micronutrient insufficiencies (indirect effect = -.0828, 95% CI: -.1585 to -.0150). There was no direct effect of appetite on micronutrient insufficiency (c´ = -.1802; 95% CI = -.3715 to.0111). CONCLUSIONS: Diet variety played a previously unrecognized role in the relationship between appetite and dietary micronutrient intake in patients with heart failure. More research is needed to validate these associations in patients with heart failure.