Food security, diet quality, nutritional knowledge, and attitudes towards research in adults with heart failure during the COVID‐19 pandemic

Abstract

Background: The impact of the novel coronavirus disease 2019 (COVID-19) pandemic on diet and nutrition among older adults with chronic medical conditions have not been well-described. Methods:We conducted a survey addressing (1) food access, (2) diet quality and composition, (3) nutritional understanding, and (4) attitudes towards research among adults with heart failure (HF) within an integrated health system. Adults (≥18 years) with diagnosed HF and at least one prior hospitalization for HF within the last 12 months were approached to complete the survey electronically or by mail.Outcomes included all-cause and HF-specific hospitalizations and all-cause death was ascertained via the electronic health record.Results: Among 1212 survey respondents (32.5% of eligible patients) between May 18, 2020 and September 30, 2020, mean ± SD age was 77.9 ± 11.4 years, 50.1% were women, and median (25th-75th) left ventricular ejection fraction was 55% (40%-60%). Overall, 15.1% of respondents were food insecure, and only 65% of participants answered correctly more than half of the items assessing nutritional knowledge. Although most respondents were willing to participate in future research, that number largely declined for studies requiring blood draws (32.2%), study medication (14.4%), and/or behavior change (27.1%). Food security, diet quality, and nutritional knowledge were not independently associated with outcomes at 90 or 180 days. Conclusion:In a cohort of older adults with HF and multiple comorbidities, a significant proportion reported issues with food access, diet quality, and nutritional knowledge during the COVID-19 pandemic. Future research should evaluate interventions targeting these domains in at-risk individuals.

Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial

“…Simultaneously, there was an increase in levels of a sedentary lifestyle in the general population [45], a decrease in access to health professionals/services, and an interruption of using some medication among individuals with chronic diseases [46]. When elderly people with multiple comorbidities were asked about their interest in participating in scientific research between May and September 2020, 32% did not have it for studies that required blood collection and 27% for those whose intervention was related to behavior change [43]. Among individuals with hypertension and/or dyslipidemias interviewed in the same year, 10% reported paying less attention to their health in that period, 25% decreased adherence to treatment, and a negative association was observed between undergoing more complex treatments and quality of life [47].…”

“…The COVID-19 pandemic has affected food security and access to food in low-income and middle-income countries with a consequent reduction in diet quality [43][44][45], impacting more women and individuals with low socioeconomic status [44]. Simultaneously, there was an increase in levels of a sedentary lifestyle in the general population [45], a decrease in access to health professionals/services, and an interruption of using some medication among individuals with chronic diseases [46].…”

Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults

“… 1 , 2 Furthermore, older adults and those with multimorbidity are at higher risk for food insecurity, lower diet quality and associated worse health status, and excess resource utilization. 2 – 5 …”

“…1,2 Furthermore, older adults and those with multimorbidity are at higher risk for food insecurity, lower diet quality and associated worse health status, and excess resource utilization. [2][3][4][5] These challenges, combined with the growing national burden of diet-related chronic diseases, have prompted efforts in collaboration with health care providers to develop foodbased and nutrition-based interventions based on the hypothesis of "food is medicine." 6 Providing medically tailored meals (MTMs) at no or low cost is considered an intervention focused on high-risk patients with one or more complex chronic conditions who may have difficulty accessing or preparing nutritious food.…”

“…The coronavirus disease (COVID-19) pandemic and associated public health responses (eg, shelter-in-place orders) and subsequent supply chain disruptions have acutely exacerbated pre-existing food insecurity and potentially contributed to worsening nonadherence to nutritional recommendations among at-risk individuals nationally 1,2. Furthermore, older adults and those with multimorbidity are at higher risk for food insecurity, lower diet quality and associated worse health status, and excess resource utilization 2–5…”