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.

With the aging population on the rise, the prevalence of heart failure is expected to increase in the coming years. Heart failure is independently correlated with cognitive decline and has a negative impact on quality of life, morbidity and mortality. Reduced cardiac output (Q) and cerebral blood flow (CBF) are proposed mechanistic links between heart failure and cognitive decline; however, reports are limited to the supine position and the response to an everyday upright posture is unknown. The purpose of this thesis was to primarily investigate the CBF response to a common upright seated position encountered in daily life in heart failure patients compared to healthy age- and sex-matched controls. Furthermore, we sought to determine whether cognitive performance or cognitive-activated hemodynamics were posture-dependent in the heart failure group. The secondary objective of this thesis was to be inclusive to patients that represent those encountered in clinical practice???specifically to include patients with higher left ventricular ejection fractions (LVEF) and atrial fibrillation with co-existing heart failure. Our findings confirmed greater cognitive impairments and a low supine CBF and Q in heart failure compared to controls and importantly, for the first time, a greater reduction in CBF with an upright seated position compared to healthy age- and sex- matched controls. When a cognitive task was performed supine and seated, performance outcomes were independent of posture in heart failure patients. However, mean flow velocity through the middle cerebral artery (MFV_MCA) increased less in response to the cognitive task seated. With regard to our secondary objectives, the results suggest that those with higher LVEF are equally at risk for cognitive decline and cerebral hypoperfusion due to a low Q. Furthermore, high variability in Q and MFV_MCA were detected in association with the beat-to-beat variation inherent to atrial fibrillation and suggest that this may be an underappreciated pathway to cognitive impairments in this sub-group. Together, these results suggest that upright cerebral hypoperfusion throughout the day may contribute to cognitive decline in heart failure and create a basis for further work to be done with larger sample sizes. Moreover, cerebral hypoperfusion with higher LVEF and the blood flow variation in atrial fibrillation represent important pathways contributing to cognitive decline in these under investigated sub-groups.

Thesis (Ph. D.)--Virginia Commonwealth University, 2007. / Prepared for: School of Nursing. Bibliography: leaves 120-145. Also available online.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Thesis (M.A.)--Northern Kentucky University, 2009. / Made available through ProQuest. Publication number: AAT 1462459. ProQuest document ID: 1689611981. Includes bibliographical references (p. 37-38)

Thesis (M.S.)--Cornell University, May, 2008. / Vita. Includes bibliographical references (leaves 102-120).

Thesis (M.S.)--Ball State University, 2008. / Title from PDF t.p. (viewed on Aug. 21, 2009). Research paper (M.S.), 3 hrs. Includes bibliographical references (p. 68-74).