BMI, NUTRITION, INFLAMMATION, AND HEART FAILURE OUTCOMES "AGAF"

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。我们的研究兴趣包括确定钠摄入量对心力衰竭（HF）结局的影响，并证明干预措施对改善饮食依从性的有效性。我们在研究中使用三天和四天的食物日记来测量钠和其他营养素的摄入量。考虑到有意或无意少报食物摄入量的可能性，需要一种验证食物日记准确性的方法来提高这些研究的有效性。钠或氮的24小时尿排泄量与饮食摄入量之间的比率通常用于验证食物饮食记录的准确性。使用尿液采集期间给药的对氨基苯甲酸（PABA）的尿液回收率验证24小时尿液采集的完整性。这些参数的值已在健康成人中确定，但在钠调节改变且经常患有肾功能不全的心力衰竭患者中尚未确定。因此，本研究的主要目的是确定钠和氮的尿排泄与饮食摄入的比率，以及PABA的尿排泄百分比，可用于验证HF患者食物日记的准确性。本研究将在综合临床研究中心（GCRC）进行。GCRC的可用资源和受控环境也为我们提供了一个理想的机会，以比较不同的方法来测量身体成分在这个人群中，并确定是否可以使用心率变异性的短期记录来测量自主神经系统的活动。本研究的次要目的是（1）比较1小时5分钟的心率变异性读数与24小时测量值，（2）比较3种测量身体成分的方法，（3）增加我们对HF患者生活感知和自我管理障碍的理解。20例性别和肾功能水平匹配的缺血性HF患者将在研究第一天前一晚到达GCRC接受一次约56小时的访视。患者将在第一天提供由营养师准备的2 gm钠饮食，并在第二天吃他们选择的饮食。他们将在第一天每餐服用80 mg PABA。将在两个研究日的每一天单独采集24小时尿液。将由经过培训的研究护士密切监测摄食量和尿液采集。此外，在第一天，患者将佩戴霍尔特监测仪，插入留置静脉导管以抽取去甲肾上腺素、B型利钠肽和肌酐，将进行5分钟的结构化呼吸练习，并填写一系列问卷。在第二天，他们将通过双X射线吸收测定法、多频生物电阻抗谱法和人体测量法测量身体成分。本研究收集的数据将为完善当前和未来的研究提供重要信息。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Our research interests include determining the effects of sodium intake on heart failure (HF) outcomes and demonstrating the effectiveness of interventions to improve dietary adherence. We are using three and four-day food diaries to measure intake of sodium and other nutrients in our studies. Given the potential for intentional or unintentional underreporting of food intake, a means of validating accuracy of food diaries is required to increase the validity of these studies. The ratio between 24-hour urinary excretion and dietary intake of sodium or nitrogen is commonly used to verify accuracy of food diet records. Urinary recovery of para-amino benzoic acid (PABA) administered during urine collection period is used verify completeness of 24-hour urine collection. Values for these parameters have been established in healthy adults, but not in patients with heart failure who have altered sodium regulation and frequently suffer from renal insufficiency. Therefore, the primary aim of this study is to determine the ratio of urine excretion to dietary intake of sodium and nitrogen, and the percent urinary excretion of PABA that can be used to verify the accuracy of food diaries in patients with HF. The study will be conducted in General Clinical Research Center (GCRC). The available resources and controlled environment of the GCRC also provide an ideal opportunity for us to compare different methods of measuring body composition in this population and to determine whether short-term recordings of heart rate variability can be used to measure autonomic nervous system activity. The secondary aims of this study are (1) to compare one hour and five minute readings of heart rate variability to 24 hour measurements, (2) to compare three methods of measuring body composition, and (3) to increase our understanding of patient perceptions of living with HF and barriers to self-management. Twenty patients with HF of ischemic origin matched for gender and level of renal function will be admitted to the GCRC for one visit of approximately 56 hours arriving the night before the first study day. Patients will be provided a 2 gm sodium diet prepared by the dietician on the first day and will eat a diet of their choosing on the second day. They will take 80 mg of PABA with each meal on Day One. Separate 24-hour urines will be collected for each of the two study days. Food intake and urine collection will be closely monitored by trained research nurses. Additionally on Day One, patients will wear a Holter monitor, have an indwelling intravenous catheter inserted for drawing norepinephrine, B-type natriuretic peptide, and creatinine, will perform a five minute structured breathing exercise, and fill out a series of questionnaires. On Day Two, they will have body composition measured by dual x-ray absorptiometry, multi-frequency bioelectrical impedance spectroscopy, and athropometrics. The data collected in this study will provide essential information to refine current and future research studies.