The role of micronutrients in heart failure

Heart failure is a common condition in the Western world, particularly among elderly persons and with an ever-aging population, the incidence is expected to increase. Diet in the setting of heart failure is important--patients with this condition are advised to consume a low-salt diet and monitor their weight closely. Nutritional status of patients with heart failure also is important--those with poor nutritional status tend to have a poor long-term prognosis. A growing body of evidence suggests an association between heart failure and micronutrient status. Reversible heart failure has been described as a consequence of severe thiamine and selenium deficiency. However, contemporary studies suggest that a more subtle relationship may exist between micronutrients and heart failure. This article reviews the existing literature linking heart failure and micronutrients, examining studies that investigated micronutrient intake, micronutrient status, and the effect of micronutrient supplementation in patients with heart failure, and focusing particularly on vitamin A, vitamin C, vitamin E, thiamine, other B vitamins, vitamin D, selenium, zinc, and copper.     

Acculturation and sociocultural influences on dietary intake and health status among Puerto Rican adults in Massachusetts

BackgroundPrevious studies have shown the negative consequences of acculturation on lifestyle factors, health status, and dietary intake of Hispanic immigrants in the United States. Despite prevalent type 2 diabetes and low socioeconomic status among Puerto Rican adults living on the US mainland, little is known about acculturation in this group.ObjectiveWe investigated associations among acculturation, lifestyle characteristics, health status, and carbohydrate nutrition in Puerto Rican adults. A secondary objective was to investigate possible confounding and/or effect modification on these associations by socioeconomic status.DesignCross-sectional data from the Boston Puerto Rican Health Study, which included 1,219 Puerto Ricans in the Boston area, aged 45 to 75 years.Statistical analysesCharacteristics were compared using analysis of covariance, linear trend, and Pearson's χ² tests across quartiles of acculturation. Tests for interaction by poverty status were conducted. Proportional contributions of foods to intake of total carbohydrate and fiber were assessed using SAS RANK (version 9.1.3, 2002-2003, SAS Institute, Cary, NC).ResultsLevels of acculturation were low, despite young age at first arrival to the US mainland (25.4±12.3 years) and long length of stay (34.2±12.2 years). Greater English language use was associated with higher socioeconomic status, alcohol consumption, physical activity, better perceived health, and less central obesity. Acculturation was associated with lower legume fiber and greater cereal fiber intake. Among those above the poverty threshold, acculturation was associated with lower dietary glycemic index and starch intake, and greater fruit and nonstarchy vegetable intake.ConclusionsIn contrast to studies with Mexican Americans, the association of acculturation with dietary quality in these Puerto Rican adults was mixed, but tended toward better carbohydrate quality. Dietary recommendations should include maintenance of traditional, healthful dietary practices, including consumption of legumes, but also reduction in refined grains, and greater inclusion of fruit, nonstarchy vegetables, and whole grains. Interventions to improve access to better quality carbohydrate sources are necessary for this group disproportionately affected by diabetes.     

Predicted 25-hydroxyvitamin D score and change in fasting plasma glucose in the Framingham offspring study

Data on the association between vitamin D status and actual change in glycemic measures are limited. We examined the prospective association between a predicted 25-hydroxyvitamin D (25(OH)D) score and change in fasting plasma glucose concentration over a mean follow-up of 7 years, in 2571 men and women (mean age 54 years) without diabetes in the Framingham Offspring Study cohort. After adjustment for age, sex, body mass index and fasting plasma glucose at baseline, higher predicted 25(OH)D score at baseline was associated with a smaller 7-year increase in fasting plasma glucose concentrations (0.23?mmol/l versus 0.35?mmol/l for highest versus lowest tertile of 25(OH)D score, respectively, P-trend=0.002). Vitamin D status may be an important determinant for change in fasting plasma glucose concentration among middle-aged and older adults without diabetes.     

Religiosity,spirituality and antenatal anxiety in Southern U.S. women

Summary Introduction: We investigated the association between religiosity, spirituality, and anxiety in pregnant women, taking into account potential confounders. Materials and methods: From September 2005 through March 2006, pregnant women in three obstetrics practices in the American South were included in a cross-sectional study. The anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety. Results: Of the 344 participating women, 23 screened positive for moderate to severe anxiety (HADS [anxiety] score greater than 10). Overall religiosity or spirituality (odds ratio [OR], 0.53; p = 0.006) and social support (OR, 0.42; p < 0.0001) were significantly associated with significantly lower odds of a positive anxiety screen. Among the specific measures of religiosity or spirituality, self-rated religiosity, self-rated spirituality, and participation in nonorganizational religious activities were significantly associated with lower odds of moderate to severe anxiety symptoms. Discussion and conclusions: Religiosity and spirituality are associated with reduced anxiety in pregnant women. Additional study is needed to evaluate whether the association is causal. Correspondence: Joshua Mann, MD, MPH, Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203, U.S.A.     

Experiencing restraint: A dialogic narrative inquiry from a service user perspective

In recent decades concerns about violence and programs for the minimization of physical restraint, amongst other restrictive practices, have proliferated within mental health policy and practice. Whilst nurses are often called upon when violence occurs within mental health care settings, they often find themselves having the conflicting roles of caring and controlling. Within such situations it is service users, who are experts by experience, who perhaps can offer more meaningful insight into being restrained and thus provide a more appropriate approach in dealing with mental distress. This paper presents the findings of a narrative study of individuals' experiences of physical restraint within the mental health care system. In total 11 mental health service users, who had experienced physical restraint, were interviewed. Frank's (2010, Letting stories breathe: a socio-narratology) guiding questions were used to undertake a dialogical narrative analysis of each story. For the purpose of this paper, four of the 11 stories are presented as these are representative of Frank's ‘quest narrative’. However, whilst studies from the service user perspective regarding restraint are scarce, findings are discussed in relation to the grand narrative of restraint. The dialogical relationship between individual stories and the dominant grand narrative implies that the former has the capacity to shape and review the latter within mental health care. Adding to the growing body of evidence of restraint from service users' perspectives could enable nurses to provide more appropriate and meaningful mental health care in times of mental distress. [238].