dietary antioxidant insufficiency, heart failure, inflammatory marker, nutrition, quality of life



  1. Wu, Jia-Rong PhD, RN
  2. Song, Eun Kyeung PhD, RN
  3. Moser, Debra K. PhD, RN
  4. Lennie, Terry A. PhD, RN


Background: Antioxidant insufficiency, elevated inflammatory markers, and poor health-related quality of life (HRQOL) are prevalent in patients with heart failure (HF).


Objective: The objective of this study was to examine the associations among dietary antioxidant intake, inflammatory markers, and HRQOL in patients with HF.


Methods: This was a secondary analysis of 265 patients with HF who completed a 4-day food diary. We assessed intake of 10 antioxidants: alpha carotene, beta carotene, beta cryptoxanthin, lutein, zeaxanthin, lycopene, vitamins C and E, zinc, and selenium. Antioxidant insufficiency was reflected by a measured level for each antioxidant that was below the estimate average requirement or lower than median for antioxidants without an estimate average requirement. Inflammatory markers including serum C-reactive protein, cytokines (interleukins 6 and 10), tumor necrosis factor-alpha, and soluble receptors (sTNFR1 and sTNFR2) were assessed with enzyme immunoassay. Health-related quality of life was measured using the Minnesota Living with Heart Failure at 12 months.


Results: Dietary antioxidant insufficiency predicted C-reactive protein ([beta] = 0.135, P = .032) and interleukin 10 ([beta] = -.155, P = .027). Patients with higher antioxidant insufficiency had higher C-reactive protein and lower interleukin 10. Both antioxidant insufficiency ([beta] = 0.13, P = .049) and higher C-reactive protein ([beta] = 0.16, P = .019) were independently associated with poorer HRQOL while adjusting for covariates.


Conclusions: Dietary antioxidant insufficiency was associated with increased markers of inflammation and poorer HRQOL. Improvement of diet quality among patients with HF may be a fruitful area of research for enhancing HRQOL.