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Overweight and obesity are paradoxically associated with better survival in patients with heart failure (HF). This association is poorly understood, in part because the impact of diabetes (DM) on survival of overweight and obese HF patients has not been considered. Inflammation may contribute to worse survival in overweight and obese HF patients with DM, and levels of inflammation may be associated with fruit and vegetable consumption. However, neither of these relationships has been investigated in patients with HF. The purposes of this dissertation were to a) examine the effect of DM on survival of overweight and obese patients with HF, b) explore potential inflammatory-related factors that underlie differences in survival of overweight and obese HF patients with and without DM and c) examine the association between nutrition and inflammation in patients with HF. To address these purposes three investigations were conducted: 1) comparison of event-survival (the combined endpoint of all cause hospitalization and death) of normal weight HF patients without DM to overweight and obese HF patients with and without DM 2) comparison of levels of inflammatory markers in overweight and obese patients with DM to normal weight, overweight and obese patients without DM 3) determination of the association of fruit and vegetable consumption with levels of inflammatory markers in patients with HF. In the presence of DM, patients who were overweight and obese had increased risk of all cause hospitalization and death. Obese patients without DM had similar risk as normal weight patients without DM. Overweight and obese patients with DM had higher levels of some, but not all, inflammatory markers compared with normal weight, overweight and obese patients without DM. Higher vegetable, but not fruit consumption was associated with lower levels of some inflammatory markers. This dissertation has addressed an important gap in the current evidence by demonstrating the contribution of DM to all cause hospitalization and death in overweight and obese patients with HF. This investigation has also demonstrated that higher levels of inflammation may contribute to differences in survival between these groups. Increasing vegetable consumption may be one avenue to lowering inflammation in patients with HF.

Lycopene is a antioxidant found in natural and processed foods. The connection between antioxidants and heart disease has been explored in several observational studies1-4, yet very few investigators have examined the impact of dietary antioxidants in patient with advanced heart disease such as heart failure (HF). A novel strategy for preventing or delaying the complications of HF related to inflammation and oxidative stress may be to increase dietary lycopene. The purpose of this dissertation was to test the impact of dietary intervention consisting of lycopene (V8® juice) on biomarkers of inflammation and oxidative stress in patients with HF; Prior to testing the dietary intervention, preliminary work was conducted: 1) a review of the literature on dietary lycopene interventions in patients with HF and 2) a longitudinal study to examine whether lycopene and sodium intake interact to produce an effect on event-free survival in patients with HF. Forty patients with HF were randomly assigned to one of two treatment groups (intervention and usual care). The intervention group received 24 mg of lycopene by drinking 11.5 ounces of V8®100% vegetable juice daily for 30 days. The usual care group continued their usual diet. Serum levels of uric acid and C-reactive protein were obtained to determine the impact of the lycopene dietary intervention. Patients in the intervention group had higher levels of plasma lycopene after one month drinking V8® juice. We also found a significant decrease in plasma CRP levels among women in the intervention group, while there was no change in CRP levels among men in the intervention group. This dissertation has provided insight about lycopene as a potential nutritional intervention for patients with HF, aimed at reducing inflammation and oxidative stress. This dietary intervention is practical, easy to replicate, cost effective and is safe for patients with HF. Additional research is needed to determine the effects of long-term outcomes of dietary antioxidants in patients with HF.

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Exercising at an appropriate training intensity for individuals is important for improvement of cardiorespiratory fitness. The American College of Sports Medicine (ACSM) has recommended that healthy adults exercise at an intensity of 60-80% maximal heart rate reserve (MHRR). The ventilatory threshold (VT) has also been recommended for use to determine intensity for exercise prescription. The purpose of this study was to compare the heart rate at the VT (VTHR) and at 60-80% MHRR. A secondary purpose was to determine the relationship, if any, between age, gender, height, weight, body mass index, percent body fat, resting heart rate, physical activity status (PAS), smoking history, and rating of perceived exertion (RPE) at 60 and 80% Hrmax and the difference between the VTHR and 60% MHRR. Subjects were 373 apparently healthy or high risk (as defined by ACSM, 2) individuals (209 men, 164 women), ages 19-77 (46.1+12.8 yr.), from the Ball State University Adult Physical Fitness Program who performed a maximal treadmill test between 1992-1994. VT was selected using a computerized V-slope method by the SensorMedics 2900TI Metabolic Measurement Cart. The VTHR (125.2+16.9) was significantly lower than the 60-80% MHRR (133.1+10.8 to 154.5+12.7) (p<0.05). Two hundred and sixty two subjects (70.1%) were below 60% MHRR and 3 subjects (0.8%) were above 80% MHRR at the VTHR. Multiple regression analysis explained 11.2% of the variance in the difference between the VTHR and 60% MHRR using RPE at 60% HR,,,, PAS, and smoking history. For the majority (70.2%) of the adults in this study, the VTHR falls below the traditional THR of 60-80% MHRR. The 60-80% MHRR would appear to be an appropriate exercise training intensity for cardiorespiratory benefit and therefore the %MHRR range alone would seem to be an adequate training intensity. Further study related to the VTHR is warranted to determine its application, if any, to exercise prescription intensity. / School of Physical Education