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Terry Lennie: Taking a Low-Sodium Diet to Heart

by Jeff Worley

Doctors can give patients all sorts of good advice to improve their health, but how many patients, for one reason or another, simply don't follow doctor's orders?

This is a central question in Terry Lennie's work on heart failure patients and nutrition, research he began at Ohio State in 1995. The Wisconsin native joined UK's College of Nursing faculty last year.

"Doctors have been suggesting sodium restriction for heart failure patients for 50 years, but nobody's ever known whether or not patients are actually restricting their intake of sodium," says Lennie, an associate professor whose primary field of study is neurobehavior. "It's been suspected for a long time that lack of compliance is responsible for the high number of re-admissions of these patients with heart problems. But, surprisingly, almost nothing is known about the degree of compliance."

So three years ago Lennie and two other researchers set out to determine the factors that influence patients with heart failure to follow or fail to follow a low-sodium diet. The team also wanted to determine the relationship between self-reported adherence to a prescribed low-sodium diet and actual sodium use, and to determine the nutritional adequacy of this diet. This last issue is an important one, Lennie says, because many nutritionists and physicians have expressed concern that patients who do follow such a diet could suffer nutritional setbacks that counterbalance any positive effects of the low-sodium diet.

Here's how the study worked. Thirty men and 20 women, recruited from three Midwestern heart-failure clinics, filled out a questionnaire about their ability to follow a low-sodium diet and factors that kept them from doing this. Thirty days later, they filled out a four-day food diary and gave urine samples that were used to measure sodium. Sodium intake was 2.6 grams for those who followed the diet "most of the time" and 4.1 grams for those who never followed it.

"The factors reported most to hinder ability to follow the diet were that friends and relatives don't serve low-sodium foods, and that it was difficult to find appetizing low-sodium food, to keep track of sodium intake, and to identify low-sodium food in restaurants," says Lennie. Some patients, he adds, were able to limit sodium intake, but actual sodium use was not related to their perceived ability to follow the diet nor to self-reported adherence. The data gleaned from this study provide, for the first time, Lennie says, specific targets for interventions to increased adherence to low-sodium diets for patients with heart failure.

One of the co-authors of this study was Lennie's former office mate at Ohio State Debra Moser, now a full professor in UK's College of Nursing and Linda C. Gill Chair in Nursing. "She had heart-failure patients, and I was interested in nutrition and weight loss, so we decided to collaborate," Lennie says. The two have collaborated many times in the past seven years, on publications, presentations and abstracts. Their most recent research pairing is on a grant titled "Nutrition, Inflammation and Obesity in Patients with Heart Failure," funded last year by a UK New Faculty Grant, awarded by the office of the executive vice president for research.

Moser left Ohio State for UK in 1999 and soon realized the support for research at UK into cardiovascular disease prevention and treatment was strong. "I recruited Terry to come here because we have always worked well together and our research interests are similar enough to be synergistic, but different enough so that each of us can follow unique pathways in cardiovascular research," says Moser, whose research was featured in the Spring 2002 issue of Odyssey. "He has some very innovative ideas about the role of nutrition and inflammation in heart failure, and his research in this area is really exciting. He is exceptional to work with."

Lennie and Moser have taken their collaboration to the next level by starting a new initiative at the university, called the Rich Heart Program. "We're trying to develop a program focused on cardiovascular nursing research," says Lennie. "Right now it's the two of us, a nurse research scientist and postdoctoral fellow. We are expecting a third faculty member to be appointed next year. The college has provided us fertile ground to begin developing this program."

Through this program Lennie and Moser have recently submitted an NIH grant that relates to obesity and heart failure. "If funded, this may prove to be a very interesting study," Lennie says. "We know people who are obese are at higher risk for cardiovascular disease, and have a high risk for developing heart failure. But surprisingly, a number of observational studies that have just come out have shown that once they have heart failure, patients who are obese actually do better. They live longer and have fewer complications. This is very counter-intuitive—nobody has thought this was the case."

Lennie explains that the reason for a more robust response by this group may be that they have larger metabolic reserves that help them, or maybe some "down regulation" of inflammation. "We don't know for sure what's going on, but if obese people do better after having heart failure, it may be the case that we don't want these people to lose weight at all after a heart attack—which would contradict the dominant paradigm."

Now very much at home at UK, Lennie has also impressed other new colleagues. "Since Dr. Lennie has come to the College of Nursing, the amount of cardiovascular research has increased exponentially," says Lynne Hall, assistant dean for research and director of graduate studies for the Ph.D. program. "His work is groundbreaking and his mentorship of graduate students and ability to collaborate successfully with other College of Nursing researchers are wonderful assets."