B-Vitamin Deficiency in Hospitalized Patients with Heart Failure

• Published in: Journal of the American Dietetic Association Vol. 109; no. 8; pp. 1406 - 1410
• Main Authors: Keith, Mary E., PhD, RD, Walsh, Natalie A., MSc, Darling, Pauline B., PhD, RD, Hanninen, Stacy A., MSc, RD, Thirugnanam, Subarna, MD, Leong-Poi, Howard, MD, Barr, Aiala, PhD, Sole, Michael J., MD, FRCPC, FACC
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.08.2009; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Chi-Square Distribution; congestive heart failure; Cross-Sectional Studies; Dietary Supplements; diuretics; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Heart; Heart failure; Heart Failure - blood; Heart Failure - epidemiology; Heart Failure - etiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; hospital diet; Hospitalization; Humans; Internal Medicine; Logistic Models; Male; Medical sciences; Metabolic diseases; Middle Aged; nutrient requirements; Nutritional Requirements; Nutritional Status; Odds Ratio; Ontario - epidemiology; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); patient care; Patients; Prevalence; renal function; Riboflavin - administration & dosage; Riboflavin - blood; Riboflavin Deficiency - blood; Riboflavin Deficiency - drug therapy; Riboflavin Deficiency - epidemiology; Risk Factors; Statistics, Nonparametric; Thiamine - administration & dosage; Thiamine - blood; Thiamine Deficiency - blood; Thiamine Deficiency - drug therapy; Thiamine Deficiency - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin B; Vitamin B 6 - administration & dosage; Vitamin B 6 - blood; Vitamin B 6 Deficiency - blood; Vitamin B 6 Deficiency - drug therapy; Vitamin B 6 Deficiency - epidemiology; vitamin B complex; vitamin deficiencies; Vitamin deficiency; water-soluble vitamins; Ontario; Human; Heart failure; Metabolic disorder; Heart disease; Nutrition disorder; Cardiovascular disease; Vitamin deficiency; Metabolic diseases; B-Vitamins; Malnutrition; Nutritional status
• ISSN: 0002-8223; 2212-2672; 1878-3570; 2212-2680
• DOI: 10.1016/j.jada.2009.05.011

Abstract The impact of heart failure and its treatment on specific nutrient requirements is unknown. Furthermore, depletion of water-soluble B vitamins that play key roles in the production of cellular energy in patients with heart failure can contribute to depletion of energy reserves observed in the failing heart. A cross-sectional study recently reported that approximately one third of hospitalized patients with heart failure had tissue levels suggestive of thiamin deficiency (vitamin B-1). Riboflavin (vitamin B-2) and pyridoxine (vitamin B-6) are similar to thiamin in that they are water-soluble, subject to renal excretion, have limited tissue storage, and are dependent on intake. Therefore, it was hypothesized that the status of these B vitamins may also be adversely affected by heart failure. As a result, the prevalence of patients at risk of vitamin B-2 (erythrocyte glutathione reductase activity coefficient ≥1.2) and B-6 deficiency (plasma B-6 ≤20 nmol/L) was determined in a cross-section of 100 patients hospitalized with heart failure between April 2001 and June 2002 as well as in a group of volunteers without heart failure. Twenty-seven percent of patients with heart failure had biochemical evidence of vitamin B-2 deficiency, while 38% had evidence of B-6 deficiency. These prevalence rates were significantly higher than those observed in the volunteers without heart failure (2% and 19%, respectively; P ≤0.02). Use of common B-vitamin−containing supplements by patients with heart failure did not significantly reduce deficiency rates in comparison with those who did not use supplements (B-2 P =0.38 or B-6 P =0.18)). Finally, while 80% of patients with heart failure took diuretics, neither the dose nor the duration of furosemide use was related to the presence of either B-2 or B-6 deficiency. Given the physiologic importance of these vitamins, further investigations aimed at determining the effect of heart failure on specific nutrient requirements as well as the safety and efficacy of B-vitamin supplementation are warranted.