B-vitamin deficiency in hospitalized patients with heart failure.
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 > or = 1.2) and B-6 deficiency (plasma B-6 < or = 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 < or = 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.
Keith
Mary E
ME
Keenan Research Centre, Li Ka Shing Knowledge Institute, and Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada. keithm@smh.toronto.on.ca
Walsh
Natalie A
NA
Darling
Pauline B
PB
Hanninen
Stacy A
SA
Thirugnanam
Subarna
S
Leong-Poi
Howard
H
Barr
Aiala
A
Sole
Michael J
MJ
D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D009752:Nutritional Status; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012256:Riboflavin / Q000008:administration & dosage / Q000097:blood; D012257:Riboflavin Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013831:Thiamine / Q000008:administration & dosage / Q000097:blood; D013832:Thiamine Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D025101:Vitamin B 6 / Q000008:administration & dosage / Q000097:blood; D026681:Vitamin B 6 Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*
D025101:Vitamin B 6; D012256:Riboflavin; D013831:Thiamine