Year of Publication

2010

Degree Name

Doctor of Philosophy (PhD)

Document Type

Dissertation

College

Medicine

Department

Nutritional Sciences

First Advisor

Dr. Terry A. Lennie

Abstract

Overweight and obesity are paradoxically associated with better survival in patients with heart failure (HF). This association is poorly understood, in part because the impact of diabetes (DM) on survival of overweight and obese HF patients has not been considered. Inflammation may contribute to worse survival in overweight and obese HF patients with DM, and levels of inflammation may be associated with fruit and vegetable consumption. However, neither of these relationships has been investigated in patients with HF.

The purposes of this dissertation were to a) examine the effect of DM on survival of overweight and obese patients with HF, b) explore potential inflammatory-related factors that underlie differences in survival of overweight and obese HF patients with and without DM and c) examine the association between nutrition and inflammation in patients with HF. To address these purposes three investigations were conducted: 1) comparison of event-survival (the combined endpoint of all cause hospitalization and death) of normal weight HF patients without DM to overweight and obese HF patients with and without DM 2) comparison of levels of inflammatory markers in overweight and obese patients with DM to normal weight, overweight and obese patients without DM 3) determination of the association of fruit and vegetable consumption with levels of inflammatory markers in patients with HF.

In the presence of DM, patients who were overweight and obese had increased risk of all cause hospitalization and death. Obese patients without DM had similar risk as normal weight patients without DM. Overweight and obese patients with DM had higher levels of some, but not all, inflammatory markers compared with normal weight, overweight and obese patients without DM. Higher vegetable, but not fruit consumption was associated with lower levels of some inflammatory markers.

This dissertation has addressed an important gap in the current evidence by demonstrating the contribution of DM to all cause hospitalization and death in overweight and obese patients with HF. This investigation has also demonstrated that higher levels of inflammation may contribute to differences in survival between these groups. Increasing vegetable consumption may be one avenue to lowering inflammation in patients with HF.

Included in

Nutrition Commons

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