title: Using growth mixture modeling to identify classes of sodium adherence in adults with heart failure.
abstract: BACKGROUND
  The prevention of fluid retention is important to reduce hospitalizations in patients with heart failure (HF). Following a low-sodium diet helps to reduce fluid retention.
  
  
  OBJECTIVE
  The primary objective of this study was to use growth mixture modeling to identify distinct classes of sodium adherence-characterized by shared growth trajectories of objectively measured dietary sodium. The secondary objective was to identify patient-level determinants of the nonadherent trajectory.
  
  
  METHODS
  This was a secondary analysis of data collected from a prospective longitudinal study of 279 community-dwelling adults with previously or currently symptomatic HF. Growth mixture modeling was used to identify distinct trajectories of change in 24-hour urinary sodium excretion measured at 3 time points over 6 months. Logistic modeling was used to predict membership in observed trajectories.
  
  
  RESULTS
  The sample was predominantly male (64%), had a mean age of 62 years, was functionally compromised (59% New York Heart Association class III), and had nonischemic HF etiology. Two distinct trajectories of sodium intake were identified and labeled adherent (66%) and nonadherent (34%) to low-sodium diet recommendations. Three predictors of the nonadherent trajectory were identified, confirming our previous mixed-effect analysis. Compared with being normal weight (body mass index <25 kg/m2), being overweight and obese was associated with a 4-fold incremental increase in the likelihood of being in the nonadherent trajectory (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.66-12.91; P < .002). Being younger than 65 years (OR, 4.66; 95% CI, 1.04-20.81; P = .044) or having diabetes (OR, 4.15; 95% CI, 1.29-13.40; P = .016) were both associated with more than 4 times the odds of being in the nonadherent urine sodium trajectory compared with being older than 65 years or not having diabetes, respectively.
  
  
  CONCLUSIONS
  Two distinct trajectories of sodium intake were identified in patients with HF. The nonadherent trajectory was characterized by an elevated pattern of dietary sodium intake shown by others to be associated with adverse outcomes in HF. Predictors of the nonadherent trajectory included higher body mass index, younger age, and diabetes.
authors: Ruth Masterson Creber, MSc, RN PhD Student, School of Nursing, University of Pennsylvania, Philadelphia. Christopher S. Lee, PhD, RN Assistant Professor, Oregon Health & Science University, Portland. Terry A. Lennie, PhD, RN, FAHA, FAAN Professor, College of Nursing, University of Kentucky, Lexington. Maxim Topaz, MA, RN PhD Student, School of Nursing, University of Pennsylvania, Philadelphia. Barbara Riegel, DNSc, RN, FAHA, FAAN Professor, School of Nursing, University of Pennsylvania, Philadelphia.
authors: Ruth
authors: R
authors: Masterson Creber
authors: Christopher S
authors: CS
authors: Lee
authors: Terry A
authors: TA
authors: Lennie
authors: Maxim
authors: M
authors: Topaz
authors: Barbara
authors: B
authors: Riegel
mesh_terms: D000328:Adult; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004039:Diet, Sodium-Restricted; D005260:Female; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D010349:Patient Compliance; D011446:Prospective Studies; D012964:Sodium / Q000652:urine
chemical_list: D012964:Sodium