Dietary Diversity and Food Security Status in Heart Failure Patients in Northern Iran | BMC Nutrition


Adequate nutrition for people with heart failure is of great importance due to the imbalance of electrolytes and vitamins and the lack of micronutrients due to the use of diuretics [10, 11]. According to dietary guidelines, dietary diversity is one of the components of a healthy diet. A varied diet offers the best protection against chronic diseases [35, 36]. There is very little information on the nutritional status of heart patients in northern Iran [37]. To our knowledge, this study is one of the first studies to assess DDS and food safety in patients with HF.

This study in patients with HF showed a high prevalence of low dietary diversity in subjects (mean DDS = 2.10 ± 0.92). Regarding the assessment of DDS in relation to CVD risk factors, the mean dietary diversity score (mean DSD = 4.71) obtained in Farhangi et al. study was higher than this study [4]. In the study by Dere KAL et al. who studied DDS in diabetic and hypertensive patients, the mean of the individual DDS was reported to be low, although the mean of DDS obtained in the two groups of patients was higher than the present study. [5]. In addition, the average DDS in Azadbakht et al. research evaluating the association of risk factors for DDS and CVD was found to be higher than this study [3]. Iran is a multi-ethnic country with a rapid nutritional and health transition resulting in significant changes in the nutritional status of the population [38, 39]; Therefore, food insufficiency and deficiencies of specific nutrients characterize the diet of the population, and overeating and obesity are evident in more than a third of the population. [40, 41].

In the present study, the most consumed food groups were fruits and grains, however, Azadbakht et al. study which investigated the association of DDS with metabolic syndrome in Tehranian adults reported that dairy products, vegetables and fruits, were used the most by study subjects, respectively [6]. In Dere K et al. research the most consumed food groups were vegetables (onion, tomato and peppers), grains, fish, oils and fats in the diabetic and hypertensive groups while fruits, other vegetables, nuts and seeds were consumed the least [5]. The differences between the studies can be seen as the result of differences in the characteristics of the study population, the sample size and the different use of the questionnaire. In addition, geographic and cultural aspects can strongly affect eating and nutritional habits which should not be ignored.

The current survey reported a significant relationship between duration of heart failure, hypertension, smoking, and dietary diversity. The subjects with hypertension, suffering from HF for a longer time and the patients who took no supplements had a less varied diet while those who quit smoking (former smokers) had a greater dietary diversity compared to those who did not. -smokers. Additionally, our results showed that people with high cholesterol and low ejection fraction were more likely to experience low diversity in their diet.

Based on Azadbakht et al. In a study, performed on Tehranian adults, dietary diversity was inversely associated with metabolic syndrome, high blood pressure, high triglyceride levels, and abnormal glucose levels. In their study, participants with greater DDS reported consuming healthier food groups. Therefore, they concluded that greater dietary diversity could be associated with a lower possibility of having metabolic disorders. [6]. Another research in Iran showed that people with a higher dietary diversity score had a lower risk of hypertension [3]. In addition, Farhangi et al. found that patients with lower DDS had significantly higher serum triglycerides and systolic blood pressure [4]. This can possibly be attributed to a healthier lifestyle linked to higher DDS, such as using more fiber, fruits, vegetables, and lower consumption of meat and cholesterol. [3].

All these results demonstrate that dietary diversity may be associated with certain risks of cardiovascular disease. Greater dietary diversity can have a significant correlation with lower cardiovascular disease risks and better health. It may also show that DDS can be useful in studying the correlations between diet quality and certain chronic diseases, including cardiovascular risks. [3, 4, 6].

There are several definitions of food security. All say that food security has two main parts; physical access (availability of food) and economic access [22, 23]. Regarding the results obtained on the state of food security in IC patients, in current research, more than half of patients (57%) experienced degrees of food insecurity. The prevalence of food insecurity in this study is consistent with previous studies conducted in this region. A systematic review of 31 studies in 2016 indicated that the prevalence of food insecurity among Iranian households was around 49% [42]. In addition, an estimated 294.7 million people in South Asia have experienced food insecurity to some extent. [43]. Bashir et al. also reported that 23% of households in Pakistan were food insecure [44]. The situation is worsening in developing countries due to high product prices and economic crises.

Food insecurity being associated with several cardio-metabolic problems, including diabetes and obesity [24, 25], interventions aimed at reducing the prevalence of food insecurity can be effective in improving the nutritional status of patients with chronic diseases.

Based on the results of this study, subjects with lower education and a higher waist circumference were more likely to be food insecure. In addition, food insecurity was independently associated with gender and household economic status. Patients with low economic status were more likely to be food insecure. The prevalence of food insecurity based on household income / expenditure surveys was 10% according to a meta-analysis based on experience / perception in Iran, this systematic review and meta-analysis reported rates light, moderate and severe food insecurity of 9.3, 5.6 and 3.7%, respectively in 2004 [41]. In the present study, we found that women tended to be more food secure and slightly insecure than men; during this time, men were more likely to be severely food insecure than women. This result may be due to the likelihood that men, as heads of household in this region, pay more attention to the nutrition of other family members than to theirs, especially in low-income families. income struggling with difficult financial access to food.

Chronic disease is related to nutrition and establishing therapy to prevent and manage chronic disease is a modification [45,46,47]. Seligman et al. in their study found a relationship between food insecurity and clinical evidence for hypertension and diabetes [46]. In the study by Vaccaro et al. adults with chronic diseases were more food insecure and men were more food secure [48], but in the present study, no significant correlation was found between chronic disease and food insecurity, which may be due to the possibility that, in our study, the overall level of severe food insecurity was low.

Although the mean of dietary diversity at different food security levels was higher in patients with complete food security and mild insecurity than in patients with moderate to severe insecurity, the difference was not statistically significant. This could be because the food security questionnaire focuses primarily on economic access and availability of safe and nutritious food rather than on dietary diversity.

There are some limitations in this study, such as the cross-sectional study design which limits the causal relationship between dietary diversity, food security and related factors. Furthermore, although the sample size calculated on the basis of the previous study has a power of 80 and a 95% confidence interval, it seems that the design of larger prospective cohort studies could be useful. to better study the determining factors of dietary diversity and food security.

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