Healthy diet coupled with at-home training can improve life with PAH
Small study mixes educational videos, guidance with 2 diet plans
Tailored educational videos on healthy eating coupled with online instruction led to helpful dietary changes in a group of pulmonary arterial hypertension (PAH) patients and the likelihood of a better quality of life, a pilot trial in the Netherlands reports.
People assigned to one of two diet plans continued to show “high adherence” over six months of follow-up, its researchers noted.
“This pilot study showed that e‐learning modules on nutrition provide [a] unique opportunity to change nutritional intake in PAH patients and by that improve [quality of life],” they wrote.
The study, “The UPHILL study: A nutrition and lifestyle intervention to improve quality of life for patients with pulmonary arterial hypertension,” was published in the journal Pulmonary circulation.
Patients assigned for three months to a low-fat or high-fat, low-carb diet
PAH is characterized by the narrowing of pulmonary arteries, the blood vessels that transport blood through the lungs. This restricts blood flow, causing high blood pressure — hypertension — and making the heart work harder to pump blood.
Despite various PAH treatments aiming to manage symptoms, the disease can considerably limit patients’ quality of life.
To understand whether nutrition and lifestyle interventions can improve life quality among adults with PAH, researchers enrolled 37 patients, ages 18 to 80, from a single Amsterdam center into the UPHILL study. All had stable disease for at least three months, as determined by assessments of exercise capacity and kidney function.
For eight weeks, they were given weekly e-learning videos on healthy nutrition, largely tailored for PAH. Each roughly 25-minute video was followed by assignments — like specifying at least one “concrete” dietary goal — so that each session lasted 40 to 45 minutes in total.
“Patient empowerment,” the researchers wrote, was “most important component. Through assignments and information, patients were made aware of their personal behavior … [with] content focussed on a positive approach on dietary intake, stressing beneficial nutritional options rather than limitations.”
A weekly mandatory video conference also was organized by the investigator, and included discussions of homework assignments, compliance, and recommendations.
A total of 25 patients completed the study, with adherence required to a given diet for three months and limited “cheat days” allowed. Seventeen patients — mean age of 45.3 and mostly women (88%) — were assigned either to a low-fat diet (seven people) or to a high-fat and low-carb diet (10 people; maximum of 125 g of carbs per day). Eight others were without a diet plan, serving as controls.
“Both diets are healthy diets with overlapping features from the Mediterranean [diet] and the so-called DASH diet, but also with significant differences,” the researchers wrote. Both limited sugar, alcohol, and red meat consumption, emphasizing fish, vegetables, and vegetarian meals, but the high-fat group ate “exclusively full-fat products” rather than low-fat ones.
Dietary adherence and life quality changes were measured using questionnaires.
Significant rise in amount of eggs eaten noted early in study
During the video e-learning months, researchers saw adjustments in patients’ nutritional intake, mainly a significant increase of 42% in egg consumption, and more vegetables with meals. There were also trends toward lesser sugar consumption and fluid intake.
Here, patients reported improvements in quality of life.
During the three-month dietary intervention, nutritional changes were largely by group — with more low-fat or high-fat foods consumed accordingly. People in both groups ate more vegetables (8.9% increase low-fat group; 43.8% high-fat group) and less starch (27% and 21% less).
“This reduction [in starch] may have been due to a higher intake of other products, such as vegetables and eggs, which provide fiber and protein, resulting in greater satiation,” the researchers wrote.
Those in the high-fat diet also increased their consumption of sugar by 20% and of fluids by 1%, while the low-fat group consumed less sugar (33% decrease) and fluids (11%).
No changes in life quality in either group were reported during these months.
However, a “high adherence to the respective intervention” was seen over the following six months, with intervention patients making “no adjustments in vegetable, egg or fluid intake,” and reporting “relatively similar” quality of life scores.
Blood tests also showed minimal changes in vitamin and mineral levels, with numbers comparing well with the control group, the researchers noted.
“We provide an overview of the effect of diverse innovative nutritional interventions in PAH, highlighted by nutritional adaptations of sugar, fluid, dairy, vegetables, starch, and eggs during e‐learning,” the team wrote. “The combination of active learning and dietary advice in this study led to long-term compliance.”
Study limitations were its small size and the small of patients who completed the assigned questionnaires.
“For a larger cohort a simplified method on assessing nutritional intake and [quality of life] must be considered, and different options such as an app should be explored,” the researchers wrote.