The Relationships Between Dietary Patterns,Obesity Subtypes And Cognitive Impairment In Patients With Chronic Heart Failure

Objectives:To acknowledge the prevalence of the global cognitive,short-term memory,global memory,attention and executive impairment in patients with chronic heart failure(CHF);and to explore dietary patterns in patients with CHF;and to identify obesity subtypes in CHF patients;and to examine relationships between dietary patterns,obesity subtypes and the global cognitive,short-term memory,global memory,attention and executive impairment in patients with CHF.Methods:This study adopted a cross-sectional study design and a convenience sampling method.From November 2019 to December 2020,291 patients with CHF were recruited from cardiology units of two tertiary hospitals in Shandong Province.Patients weight,waist circumference,hip circumference and abdominal skinfold thickness were measured.Questionnaires included sociodemographic and clinical characteristics questionnaire,the Montreal Cognitive Assessment,the Auditory Verbal Memory Test,the Shape Trail Test and the Food Frequency Questionnaire 25 were used to assess global cognitive function,short-term memory,global memory,attention function,executive function and dietary patterns.IBM SPSS 24.0 and Mplus 7.0 software packages were employed to analyse the data,including a cluster analysis,a latent profile analysis and hierarchical linear regression analyses.Results:1.The status quo of cognitive impairment in patients with CHF.Among 291 CHF patients,the mean score of global cognitive function was(22.42±4.14),of which 195 patients(67.0%)with global cognitive impairment.The mean scores of short-term memory,global memory and attention function were(15.10±5.07),(23.98±9.82)and(85.89±48.42),respectively.Regarding the executive function test,the mean time consumed for the Shape Trail Test Part B was(182.43±56.20)seconds,and the mean numbers that patients connected in the Shpae Trail Test Part B within the first 1 minute were(8.74±3.56).2.The relationships between sociodemographic and clinical characteristics and cognitive impairment in patients with CHF.(1)CHF patients with poorer global cognitive function were female,lived in rural areas,were educated less than 12 years,were unemployed or retired,were single,lived with children,had family’s per capita monthly income lower than 3,000 yuan,had new rural cooperative medical care insurance,never smoking or drinking,and were with New York Heart Association Functional Class(NYHA class)Ⅳ.(2)Sociodemographic and clinical characterstics in CHF patients with poorer short-term memory were as follows:living in rural areas,years of education less than 12 years,family per capita monthly income less than 3,000 yuan,and having new rural cooperative medical care insurance.(3)CHF patients with poorer global memory lived in rural areas,were educated less than 12 years,did the physical job,had family’s per capita monthly income less than 3,000 yuan,and had new rural cooperative medical care insurance.(4)CHF patients with poorer attention function were female,lived in rural areas,had years of education less than 12 years,were currently unemployed or retired,were single,had family per capita monthly income lower than 3,000 yuan,had new rural cooperative medical care insurance,never smoking or drinking,were with a disease duration longer than 6 months,were with NYHA class Ⅲ,and had hypertension.(5)Sociodemographic and clinical characteristics in CHF patients with poorer executive function were as follows:female,living in rural areas,having years of education less than 12 years,unemployed or retired,single,family per capita monthly income less than 3,000 yuan,no drinking habits,disease duration longer than 6 months,and NYHA class III.3.The relationships between dietary patterns and cognitive impairment in patients with CHF.The dietary patterns of CHF patients were nut-fruit diet(42.6%),processed food-livestock-poultry diet(38.1%),and traditionl diet(19.2%).The dietary pattern of CHF patients with poorer global cognitive function,short-term memory,global memory,attention and executive function was the traditonal diet4.The relationships between obesity subtypes and cognitive impairment in CHF patients.This study identified obesity subtypes of CHF patients using a latent profile analysis and basd on height,abdominal skinfold thickness(ASK),Chinese visceral adiposity index(CVAI),waist-to-height ratio(WHtR)and body adiposity index(BAI)in CHF patients.The results showed that CHF patients’ obesity subtypes were high-normal type(23.4%),medium-overweight type(56.0%)and short-obesity type(20.6%).The height(168.34±6.88)cm of patients with high-normal type was the highest among 3 obesity subtypes,while ASK(18.51±6.77)mm,CVAI(93.57±26.30),WHtR(0.50±0.03)and BAI(23.57±2.19)were the lowest among 3 obesity subtypes.Regarding the medium-overweight type,CHF patients’ height,ASK,CVAI,WHtR and BAI were(166.23±7.80)cm,(29.42±6.15)mm,(141.82±29.93),(0.57±0.03)and(27.39±2.60),respectively.CHF patients with short-obesity type had the shortest height(158.53±6.16)cm among 3 obesity subtypes,while ASK(33.34±7.02)mm,CVAI(169.31±29.93),WHtR(0.66±0.03)and BAI(34.56±2.84)were the highest among 3 obesity subtypes.The obesity subtype of CHF patients with poorer global cognitive function,short-term memory,global memory,attention and executive function was the short-obesity type.5.Hierarchical linear regression analyses of cognitive function in CHF patients.(1)Hierarchical linear regression analyses of global cognitive functionDietary patterns(nut-fruit diet VS traditional diet:β=0.252,P<0.001;processed food-livestock-poultry diet VS traditional diet:β=0.222,P=0.002),obesity subtypes(high-normal type VS short-obesity type:β=0.233,P=0.001;medium-overweight type VS short-obesity type:β=0.193,P=0.004)were significantly associated with global cognitive function in CHF patients.Dietary patterns,obesity subtypes,age,residence,years of education,marital status,medical insurance and NYHA class explained 40.8%of the variance in global cognitive function.(2)Hierarchical linear regression analyses of short-term memoryDietary patterns(nut-fruit diet VS traditional diet:β=0.314,P<0.001;processed food-livestock-poultry diet VS traditional diet:β=0.181,P=0.015)and obesity subtypes(high-normal type VS short-obesity type:β=0.162,P=0.024)of CHF patients were significantly associated with short-term memory.Dietary patterns,obesity subtypes,age and years of education explained 20.1%of the variance in short-term memory.(3)Hierarchical linear regression analyses of global memoryDietary patterns(nut-fruit diet VS traditional diet:β=0.319,P<0.001;processed food-livestock-poultry diet VS traditional diet:β=0.218,P=0.004)and obesity subtypes(high-normal type VS short-obesity type:β=0.169,P=0.020;medium-overweight type VS short-obesity type:β=0.142,P=0.043)of CHF patients were significantly associated with global memory.Dietary patterns,obesity subtypes,age and years of education explained 20.7%of the variance in global memory.(4)Hierarchical linear regression analyses of attention functionDietary patterns(nut-fruit diet VS traditional diet:β=-0.170,P=0.019;processed food-livestock-poultry diet VS traditional diet:β=-0.215,P=0.005)and obesity subtypes(medium-overweight type VS short-obesity type:β=-0.160,P=0.023)were associated with attention function in CHF patients.Dietary patterns,obesity subtypes,age,medical insurance and NYHA class explained 34.9%of the variance in attention function.(5)Hierarchical linear regression analyses of executive functionDietary patterns(nut-fruit diet VS traditional diet:β=0.146,P=0.041)were associated with executive function in CHF patients,while obesity subtypes were not associated with executive function.Dietary patterns,age,years of education,medical insurance,and NYHA class explained 39.2%of the variance in executive function.Conclusions:1.The global cognitive function,short-term memory,global memory and executive function were at lower-middle levels,while attention function was at a higher-middle level.About two thirds of CHF patients had global cognitive impairment.2.The dietary patterns were nut-fruit diet,processed food-livestock-poultry diet and traditonal diet in CHF patients.In comparison with CHF patients with traditional diet,those with nut-fruit diet and processed food-livestock-poultry diet had better global cognitive function,short-term memory,global memory,attention and executive function.3.The obesity subtypes were high-normal type,medium-overweight type and short-obesity type in CHF patients.In comparison with CHF patients with short-obesity type,CHF patients with high-normal type and medium-overweight type had better global cognitive function,short-term memory,global memory and attention function.4.Clinicians need to explore dietary patterns and to identify obesity subtypes in CHF patients with cognitive impairment.And clinicians should develop interventions targeted dietary patterns and obesity subtypes to improve cognitive function in CHF patients,and subsequently to improve clinical outcomes of CHF patients.