Nutritional status in pulmonary arterial hypertension

Abstract

Nutritional deficiencies have been described in patients with pulmonary arterial hypertension (PAH), such as in iron and vitamin D. However, an extensive description of vitamin and mineral status is lacking and until now there is no data on dietary intake in PAH patients. We analyzed blood samples and determined nutritional intake using a food frequency questionnaire (HELIUS) in a cohort of prevalent PAH patients at a single center in Amsterdam, the Netherlands. Quality of life (QoL) was assessed by the SF-36 questionnaire. In total, 37 patients were included (6 males, 31 females; 48 ± 16 years). The dietary intake of sugar was above 25 g in 87% of the patients and fluid intake was above 1500 ml in 78% of the patients. Sodium intake was below 1800 mg in the majority (56%) of the patients. Sugar and fluid intake were linear related. We confirm previously observed deficiencies of iron and vitamin D in our study population. In addition, we observed a functional vitamin B12 deficiency in 29% of patients, which coincided with an increased expression of methylmalonic acid. 60% of patients had a low vitamin K1 status (<0.8 nmol/L). Finally, 40% of patients had selenium levels below <100 μg/L and low selenium levels associated with reduced vitality in these patients.Besides the known deficiencies in iron and vitamin D levels, we observed in a subset of patients signs of vitamin B12, vitamin K1 and selenium deficiencies.There is room for improving dietary intake. Future research aims to demonstrate the clinical importance and reveal the effect of nutritional interventions.

The UPHILL study: A nutrition and lifestyle intervention to improve quality of life for patients with pulmonary arterial hypertension

“…During e‐learning and dietary intervention there was a relation between fluid and sugar intake. This confirms a previously found correlation between these two nutrients in PAH patients 6 …”

“… 25 After the e‐learning and until end of study there was only in 12% of our population deficiencies in vitamin K1 plasma levels, which is remarkable since previous research showed a vitamin K1 deficiency in 60% of the PAH patients. 6 …”

“…A recent study described the nutritional status in PAH, highlighted by a suboptimal nutritional intake and newly found deficiencies. 6 In a few review papers, the potential role for nutrition in PAH is discussed. 7 , 8 , 9 Furthermore, dietary reimbursement is not a worldwide privilege in this group of patients.…”

Connexin43, A Promising Target to Reduce Cardiac Arrhythmia Burden in Pulmonary Arterial Hypertension

“…Moreover, nutritional deficiencies, such as those of iron, vitamins D, B12, K1 and selenium [ 181 ], have been found in patients with PAH. The improvement of dietary intake and future research to demonstrate the clinical importance of nutritional interventions are ongoing tasks.…”

“…Altogether, nutrition and lifestyle interventions may not only improve the quality of life of patients with PAH [ 181 , 182 ], but most likely also prevent development of the disease.…”