Objectives: To investigate total daily energy expenditure in chronic obstructive pulmonary disease (COPD) patients during a rehabilitation programme. Design: Observational study involving a case and a control group. Subjects: Ten COPD patients (six with body mass index (BMI) < 18.5 kg=m 2 and four with BMI > 18.5 kg=m 2 ) were evaluated for their energy expenditure profile. Four additional healthy age-matched volunteers were also included for methodology evaluation.Interventions: Measurements of total daily energy expenditure (TEE), resting energy expenditure (REE) and diet-induced thermogenesis (DIT) and energy intake were undertaken by indirect calorimetry and bicarbonate -urea methods and dietary records. Results: REE in COPD patients was not significantly different from that predicted by the Harris -Benedict equation. Before the exercise day the mean TEE was 1508 kcal=day and physical activity level (PAL as calculated by TEE=REE) was 1.52. On the exercise day the TEE increased to 1568 kcal=day and PAL was 1.60, but neither of these changes were significant. The energy cost of increased physical activity during rehabilitation exercise was estimated to be 191 kcal=day. No significant change was found in DIT between the two patient groups. However, overall energy balances were found to be negative ( 7 363 kcal=day). Conclusion: The rehabilitation programme did not cause a significant energy demand in COPD patients. TEE in COPD patients was not greater than in free-living healthy subjects. Patients, who were underweight, did not have a higher TEE than patients with normal weight. This suggested that malnutrition in COPD patients was not due to an increased energy expenditure. On the other hand, a significant negative energy balance due to insufficient energy intake was found in seven out of 10 patients. Sponsorship: The project was inpart supported by the Bristol Myers Squibb Unrestricted Nutrition Grant.

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Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Nursing Research grant Background Medication adherence is essential to improve health outcomes in patients with heart failure (HF). Depressive symptoms contribute to decrease adherence behaviors. Although social support is helpful to improving medication adherence, perceived social support (PSS) may differ by living arrangement. How social support and living arrangement contribute to the relationship between depressive symptoms and medication adherence is not well understood in patients with heart failure. Purpose The purpose of this study was to determine whether perceived social support and living arrangement moderated the association between depressive symptoms and medication adherence. Methods This was a secondary analysis from outpatients with HF. Depressive symptoms were measured by the Patient Health Questionnaire-9. Perceived social support was assessed using Multidimensional Scale of Perceived Social Support, and patients were grouped into high and low PSS groups using a score of 79, the upper tertile value. Medication adherence was measured objectively by a medication event monitoring system for 3-months. Living arrangement was classified as (1) living with a spouse, (2) living with non-spouse family or friend, or (3) living alone. Moderated moderation analysis was conducted using PROCESS macro (Model 3) in SPSS with 5,000 bootstrap samples. Results Of the total of 208 patients (mean age = 61 ± 11.5 years, 64% male), 60% lived with spouse, 22% lived with non-spousal family or friend, and 26% lived alone. Three-way interaction (depressive symptoms*living arrangement*PSS) was significant (p = 0.0324, Figure 1). The effect of depressive symptoms on medication adherence was only significant for two groups (Figure 2): the living alone group with high PSS (effect = - 4.1855, p = 0.0021), and the living with a non-spousal family group with low PSS (effect = -1.0180, p = 0.0349). For these groups, their depressive symptoms were inversely associated with medication adherence. Conclusions: These results suggest that living arrangement and perceived social support are factors to be considered in medication adherence when planning care for patients with depressive symptoms. Future research is needed to explore whether the combined intervention of improving depressive symptoms and social support focusing on instrumental social support effectively increases medication adherence.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): National Institutes of Health (NIH) Background The poor taste foods in a low sodium diet and patients’ preferences for salty foods are known barriers to sodium restricted diet (SRD) adherence. Older adults may experience less enjoyment of SRD due to decreased sense of taste. However, little is known about how age is associated with sodium intake, preference for salt, and enjoyment of SRD in patients with heart failure (HF). Purpose The purpose of this study was to examine effect of age on dietary sodium intake through their preference for salt and enjoyment of SRD in patients with HF. Methods  In this cross-sectional study, we used baseline data from participants in a randomized controlled trial of a SRD intervention for patients with HF and their caregivers. Patients were asked to collect 24-hour urine to measure dietary sodium intake. Preference for salty food and enjoyment of SRD were assessed using a question on an 11-point numeric scale (range 0 to 10). Parallel mediation analyses were conducted using the PROCESS macro program in SPSS with 5,000 bootstrap samples. Results A total of 136 patients with HF (64% male, mean age = 60.3 ± 14.4, range 27 to 90, 80.1% white) had a mean 24-hr urine sodium of 4320mg (SD = 2053, range: 1553 mg – 11495 mg) with most (71%) having a 24-hr urine sodium &gt; 3000mg. The mean preference for salty food was 5.3 (SD = 2.8) on a scale from 0 to 10 with 10 indicating greater preference and enjoyment of SRD was 4.4 (SD = 2.5) on the same scale. Age was significantly associated with sodium intake in that older patients were more likely to eat less sodium (effect= -40.3236, 95% CI= [-63.7151, -16.9321]). The indirect effects of age on sodium intake through preference of salty food (effect= .7033, 95% CI = [-2.3361, 4.5357]) and enjoyment of SRD (effect = -.0271, 95% CI = [ -3.2736, 2.2213]) were not significant, indicating that these factors did not mediate the relationship between age and dietary sodium consumption. When we controlled gender, education, and ethnicity, age was also associated with sodium intake, but the two indirect effects were not significant. Conclusion Although most patients consumed foods high in sodium, older patients were more likely to consume foods lower in salt. However, contrary to what we expected, preference for salty foods and enjoyment of SRD did not play mediator roles in the association of age with salt consumption. The findings suggest that older adults may need different types of intervention to promote adherence than younger patients. Further research is needed to explore other factors related to SRD (e.g., efficacy of SRD or perceived control of diet behaviors) that affect sodium intake in patients with HF.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): National Institutes of Health R01 NR 009280 & P20 NR 010679 Background Poor appetite is commonly reported in patients with heart failure, which may lead to a diet with limited food variety. Limited food variety, in turn, can result in dietary nutritional insufficiencies. Purpose The purpose of the study was to determine whether the relationship between appetite and dietary nutritional insufficiencies was mediated through diet variety. Methods In this secondary analysis, patients with heart failure rated appetite on a 10-point visual analog scale from 1 to 10. Nutritional insufficiency and diet variety were assessed by a four-day food diary analyzed by Nutrition Data Systems. Nutrition insufficiency was defined as the total number of 18 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. A mediation analysis was conducted controlling for age, gender, New York Heart Association (NYHA), and body mass index using the PROCESS v3.5 macro program with 5,000 bootstrap samples in SPSS. Results A total of 238 patients (mean age 61, SD = 12; male n = 164, 69%; NYHA III/IV, n = 107, 45%) were included. The mean body mass index was 30 kg/m2 (SD = 7). The mean appetite score was 7.5 (SD = 2.3). The mean number of micronutrient insufficiencies was 4.7 (SD = 3.5), and the mean diet variety score was 12.4 (SD = 2.6). Appetite was not directly associated with nutrition insufficiency (effect = -.1802; 95% CI = -.3715, .0111) controlling co-variates. However, there was a significant indirect effect of appetite on nutrition insufficiency through diet variety controlling for covariates (effect = -.0828: 95% CI = -.1585, -.0150). Conclusions Diet variety mediated the association between appetite and dietary micronutrient insufficiency in patients with heart failure. The findings suggest that dietary intervention aimed at increasing patients’ appetite may increase diet variety and enhance the nutritional quality of diets of patients with heart failure.