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Nutrition intervention by a registered dietitian nutritionist (RDN) is effective in improving patients’ knowledge or adherence to low-sodium diet (LSD, <2,000 mg/d); however, changes in knowledge and adherence in heart failure (HF) patients have not been simultaneously assessed in the same study period Therefore, the objective of the present study was to identify both HF patient sodium knowledge and adherence to the LSD before and after an education session with an RDN. A quasi-experimental study with a one-group, pre-test post-test design was conducted. An RDN conducted a 15-minute individualized nutrition education regarding the LSD at the initial visit. Sodium knowledge was measured by the Parkland Sodium Knowledge Test, and sodium intake was measured by a 29-item sodium-specific food frequency questionnaire created by NutritionQuest© at both the initial and follow-up visits. A total of 71 patients were educated on the LSD and assessed for changes in sodium knowledge and intake at their next visit. Most patients were middle aged, obese, male, and non-Hispanic Black with an education level of greater than 12 years. At the initial visit, the majority of patients were considered knowledgeable but not accordant to the LSD. Following RDN education, sodium knowledge significantly improved and sodium intake significantly decreased. RDNs should be included as members of the HF multidisciplinary team to increase sodium knowledge and reduce sodium intake through individualized nutrition education. Heart failure (HF) prevalence is increasing, with an estimated 6.2 million Americans ≥20 years of age with HF between 2013-2016, up from 5.7 million from 2009-2012.1 Among the risk factors for HF; hypertension, obesity, cardiovascular disease, and diabetes are all modifiable through diet.2-6 Additionally, in an effort to improve HF-associated symptoms and quality of life, a low-sodium diet (LSD) is recommended.. The Heart Failure Society of America recommends a daily sodium restriction of 2,000-3,000 mg for symptomatic HF patients, and less than 2,000 mg/day for those with moderate to severe HF.7 The American College of Cardiology Foundation/American Heart Association recommends no more than 1,500 mg of sodium a day for stage A and B and less than 3,000 mg/day for stage C and D for symptom improvement.8 While specific recommendations differ between associations, sodium restriction remains a key therapeutic recommendation for this condition. While the LSD is a component of non-pharmacological regimens for HF, lack of patient knowledge related to a LSD and low adherence to a sodium restriction is common.9-11 Sodium knowledge, such as correct use of a nutrition facts label, may be important to improve adherence to the LSD. However, few studies have specifically tested HF patients’ sodium knowledge. The Parkland sodium knowledge test has been used as an indicator of sodium knowledge through container sorting, label reading, and knowledge of the sodium recommendation.12,13 Using these constructs, the majority of HF patients had low sodium knowledge defined as scores less than 3 (range of 0-10). However, individual patient sodium knowledge was not simultaneously compared to sodium intake in these studies. Adherence to the LSD may be assessed through 24-hr urine collection, but patient burden prohibits this as routine in clinical practice. Sodium adherence has also been assessed by 3-day food records;14 however, practical limitations exist regarding patient completion of food records in a clinic setting. Evidence for adherence has largely been assessed through one-question responses asking whether patients follow a LSD or not;10,15,16 HF patient perception of their diet accordance 1Department of Clinical Nutrition, Rush University Medical Center, 1700 W Van Buren St Ste 425, Chicago, IL, USA 60612 2Department of Clinical Nutrition, Rush University Medical Center, 1700 W Van Buren St Ste 425, Chicago, IL, USA 60612 3Department of Clinical Nutrition, Rush University Medical Center, 1700 W Van Buren St Ste 425, Chicago, IL, USA 60612 4Department of Clinical Nutrition, Rush University Medical Center, 1700 W Van Buren St Ste 425, Chicago, IL, USA 60612 5Department of Clinical Nutrition, Rush University Medical Center, 1700 W Van Buren St Ste 425, Chicago, IL, USA 60612 6Department of Clinical Nutrition, Rush University Medical Center, 1700 W Van Buren St Ste 425, Chicago, IL, USA 60612 *Correspondence to: Heather E. Rasmussen, Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 1700 N 35th St, Lincoln, NE, USA 68583, Heather.Rasmussen@unl.edu Cite This Article: Tan, C.A., Holland, S.J., Mozer, M.E., Sarcinella, K.E., Tangney, C.C., Rasmussen, H.E. 2019. Change in Knowledge of and Adherence to the Low-Sodium Diet in Patients with Heart Failure after Nutrition Education by a Registered Dietitian Nutritionist. Diabesity 5(1): 23-30. DOI: 10.15562/ diabesity. 2019.62 Volume No.: 5

diabesity

Change in Knowledge of and Adherence to the Low-Sodium Diet in Patients with Heart Failure after Nutrition Education by a Registered Dietitian Nutritionist