Nutrition and Cognition in Older Adults With Heart Failure: A Systematic Review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Heart failure and cognitive impairment. Intervention: Nutritional habits (dietary intake of sugary beverages, snack foods, dairy, fruits/vegetables) and nutritional biomarkers (hemoglobin/anemia, sodium, potassium, glucose, albumin) vs. Better nutritional habits or normal biomarker levels. Primary outcome: Cognitive function and impairment across global cognition, attention, executive functioning, language, and memory.

Q: What does this research mean for the field?

Poorer nutritional habits and abnormal nutritional biomarkers are associated with cognitive impairment in older adults with heart failure. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mara W. Stewart; Abigail C. Traylor; Lisa C. Bratzke

doi:10.3928/00989134-20151015-06

October 27, 2015Journal of Gerontological NursingOpen Access

Nutrition and Cognition in Older Adults With Heart Failure: A Systematic Review

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Key result

Poor nutrition and related biomarker abnormalities are linked to worse cognitive function in heart failure.

Why the study?

Are nutritional habits and nutritional biomarkers associated with cognitive function in older adults with heart failure?

Key Points

To examine the relationship between nutrition, nutritional biomarkers, and cognitive function in older adults diagnosed with heart failure.
Systematic literature review searching PubMed, PsycINFO, CINAHL, and Web of Science through August 2015.
Evaluated diet quality via assessment tools (such as the Starting the Conversation tool) and nutritional biomarkers (hemoglobin, sodium, potassium, glucose, and albumin) against cognitive test batteries.
Poorer nutritional habits—including greater consumption of sugary beverages, snack chips, crackers, and dairy—were associated with worse performance in attention, executive functioning, and memory.
Nutritional biomarkers indicative of physiological deficiency or dysregulation, specifically anemia, hyponatremia, hypokalemia, hyperglycemia, and hypoalbuminemia, were associated with cognitive impairment.
Hemoglobin levels >15 g/dL and the in-hospital normalization of glucose, potassium, and hemoglobin levels were associated with preserved or improved global cognitive performance.

Study Design

Type

Systematic Review

Structured PICO

Are nutritional habits and nutritional biomarkers associated with cognitive function in older adults with heart failure?

P

Population

Older adults (aged 50-85 years) with heart failure across 4 quantitative observational studies (individual study sample sizes ranging from 86 to 1,511; 33.1% to 46.3% female).

E

Exposure

Nutritional exposures including dietary habits (assessed via Starting the Conversation diet assessment tool and abbreviated dairy intake form) and serum nutritional biomarkers (hemoglobin/anemia, sodium, potassium, glucose, and albumin).

C

Comparator

Better nutritional habits (higher consumption of fruit, vegetables, beans, chicken, and fish; lower score on Starting the Conversation tool) or normal/normalized biomarker levels (e.g., absence of anemia, hemoglobin >15 g/dL, normalization of glucose, potassium, and hemoglobin).

O

Outcome

Cognitive function and global cognitive impairment assessed across domains of attention, working memory, learning, language, memory, executive function, and psychomotor speed using standardized neuropsychological batteries (e.g., MMSE, Hodkinson Abbreviated Mental Test, Trail Making Test A and B, California Verbal Learning Test II, Frontal Assessment Battery).surrogate

This systematic review demonstrates that poor dietary habits and common nutritional or electrolyte abnormalities (anemia, hyponatremia, hypokalemia, hyperglycemia, and hypoalbuminemia) are associated with cognitive dysfunction in older adults with heart failure, highlighting a need for prospective nutritional intervention trials.

Limitations

Lack of meta-analyses and well-designed randomized controlled trials (all 4 included studies were non-experimental with an evidence grade of C)
Selection bias due to restricting inclusion to studies published in English
Reliance on self-reported dietary intake in two studies, which is prone to misreporting
Cross-sectional design in two studies precluded inference of causality or directionality
Potential differences in nutritional risks and needs between community-dwelling and hospitalized patients
All 4 included studies used non-experimental designs (two cross-sectional, one prospective, one secondary analysis) representing Grade C evidence with no RCTs
Potential selection bias because only studies published in the English language were included
Two studies relied on self-reported nutritional habits, which may limit validity due to dietary misreporting
Cross-sectional design of two studies prevents inference of causality or directionality
Heterogeneity between hospitalized and community-dwelling heart failure populations

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Implication

May warrant nutritional assessment in HF patients with cognitive concerns; leaves open whether interventions improve cognition.

Abstract

Cognitive impairment is commonly observed in older adults with heart failure; nutrition is a possible contributing factor. The purpose of the current systematic review is to examine the relationship between nutrition and cognition in older adults with heart failure. A literature review was performed through August 2015 that examined published, peer-reviewed studies from PubMed, PsycINFO, CINAHL, and Web of Science. Four articles were selected for inclusion. Findings revealed that poorer nutritional habits were associated with poorer attention, executive functioning, and memory in older adults with heart failure. Nutritional biomarkers, including anemia, hyponatremia, hypokalemia, hyperglycemia, and hypoalbuminemia, were also associated with cognitive impairment. More research is needed to explore the relationship between nutrition and cognition in this population. Descriptive studies will inform scientists as they design and test nutritional interventions to optimize cognitive function in older adults with heart failure.

Discussion

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Cite This Study

Stewart et al. (2015) conducted a systematic review in Heart failure and cognitive impairment. Nutritional habits (dietary intake of sugary beverages, snack foods, dairy, fruits/vegetables) and nutritional biomarkers (hemoglobin/anemia, sodium, potassium, glucose, albumin) vs. Better nutritional habits or normal biomarker levels was evaluated on Cognitive function and impairment across global cognition, attention, executive functioning, language, and memory. Poorer nutritional habits and biomarker abnormalities (anemia, hyponatremia, hypokalemia, hyperglycemia, hypoalbuminemia) were associated with worse cognition across 4 studies of heart failure.

synapsesocial.com/papers/6a776534a0f93219c4ec4c6f https://doi.org/10.3928/00989134-20151015-06

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Nutrition and Cognition in Older Adults With Heart Failure: A Systematic Review

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Nutrition and Cognition in Older Adults With Heart Failure: A Systematic Review

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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