심부전 환자의 나트륨 섭취와 건강관련 삶의 질
Dietary Sodium Intake and Health-Related Quality of Life in Patients with Stable Heart Failure
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배경: 삶의 질 향상을 위해 나트륨 제한 식이는 심부전환자의 자가간호 행위로 강조되고 있지만, 심부전 환자의나트륨 섭취량이 삶의 질에 미치는 영향을 살펴본 연구는드물다. 방법: 본 연구는 서울소재 일 대학병원에서 실시된 전향적 조사연구로서, 1년의 추적관찰기간 동안 재입원하거나사망하지 않은 심부전 환자들을 대상으로, 기초조사 시 3일간의 식이일지를 분석하여 하루 나트륨 섭취량을 측정하였으며, Minnesota Living with Heart Failure Questionnaire 를 이용하여 삶의 질을 기초조사 시점과 1년 후, 2회 측정하였다. 결과: 총 106명의 대상자 중 37명(35%)이 하루 3 g 이상의 나트륨을 섭취하고 있었다. 위계적 선형 회귀분석 결과,하루 4 g을 넘는 나트륨 섭취는 기초조사 시점과 1년 후가장 낮은 삶의 질을 예측하고 있었다(F=3.15, P=0.028;F=4.33, P=0.006). 위계적 다중 로지스틱 회귀분석 결과, 나트륨을 하루 4 g 이상 섭취하는 심부전 환자는 하루 2 g 미만을 섭취하는 환자보다 1년 후 삶의 질이 더 낮아질 가능성이 약 5.2배 증가하는 것으로 나타났다(P=0.040). 결론: 본 연구결과, 하루 4 g 이상의 나트륨 섭취는 심부전 환자의 삶의 질에 부정적인 영향을 미치고 있음을 확인하였다.
Abstract
Background: Dietary sodium restriction is an essential component of self-care behavior for improved health-related quality of life (HRQoL) in patients with heart failure (HF). However, there is little direct evidence about the impact of dietary sodium restriction on HRQoL. The purpose of this study was to determine the impact of dietary sodium intake on HRQoL in HF patients with no cardiac events over 1-year of follow-up. Methods: A total of 106 patients with HF completed a 3-day food diary to estimate daily sodium intake. Patients were divided into 4 groups (＜2 g, 2-3 g, 3-4 g, and ＞4 g). The Minnesota Living with Heart Failure Questionnaire was used to assess HRQoL at baseline and one year later. Hierarchical linear and logistic regressions were used to determine the relationship between dietary sodium intake and HRQoL. Results: Thirty-seven (35%) patients had a daily sodium intake ＞3 g. Greater than 4 g of daily sodium intake was independently associated with a worse HRQoL at baseline and one year later (F=3.15, P=0.028; F=4.33,P=0.006) and an almost 5.2 times higher risk of a worsening HRQoL at one year follow-up (P=0.040) after controlling for age, gender, etiology, body mass index, New York Heart Association class, ejection fraction, total comorbidity score, and use of beta blockers. Conclusions: This finding provides additional evidence that greater than 4 g of daily sodium intake is associated with worsening HRQoL in stable HF patients who are free from cardiac events.
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