Elsevier

Journal of Cardiac Failure

Volume 21, Issue 12, December 2015, Pages 954-958
Journal of Cardiac Failure

Research Methodology
Psychometric Evaluation of Two Appetite Questionnaires in Patients With Heart Failure

https://doi.org/10.1016/j.cardfail.2015.10.006Get rights and content

Highlights

  • The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) have sound psychometric properties in patients with heart failure (HF).

  • CNAQ and SNAQ are unidimensional measures of appetite that are sensitive to HF severity.

  • CNAQ and SNAQ are associated with symptoms of depression supporting construct validity.

Abstract

Background

Decreased appetite in heart failure (HF) may lead to undernutrition which could negatively influence prognosis. Appetite is a complex clinical issue that is often best measured with the use of self-report instruments. However, there is a lack of self-rated appetite instruments. The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are validated instruments developed primarily for elderly people. Yet, the psychometric properties have not been evaluated in HF populations. The aim of the present study was to evaluate the psychometric properties of CNAQ and SNAQ in patients with HF.

Methods and Results

A total of 186 outpatients with reduced ejection fraction and New York Heart Association (NYHA) functional classifications II–IV were included (median age 72 y; 70% men). Data were collected with the use of a questionnaire that included the CNAQ and SNAQ. The psychometric evaluation included data quality, factor structure, construct validity, known-group validity, and internal consistency. Unidimensionality was supported by means of parallel analysis and confirmatory factor analyses (CFAs). The CFA results indicated sufficient model fit. Both construct validity and known-group validity were supported. Internal consistency reliability was acceptable, with ordinal coefficient alpha estimates of 0.82 for CNAQ and 0.77 for SNAQ.

Conclusions

CNAQ and SNAQ demonstrated sound psychometric properties and can be used to measure appetite in patients with HF.

Section snippets

Sample and Procedure

Data were obtained from a consecutive sample of patients diagnosed with reduced ejection fraction (HFrEF) who had a New York Heart Association (NYHA) functional classification of II–IV, were ≥18 years old, and were familiar with the Swedish language. Patients with renal failure on dialysis and patients with advanced cancer were excluded. A total of 316 patients were invited to participate in the study, of whom 186 accepted (59%). A comparison of nonparticipants and participants revealed no

Demographic and Clinical Characteristics

The majority of the 186 included patients were men (70%). The overall average age was 70 years (median 72, interquartile range [IQR] 65–78, range 31–89). Most patients cohabited with someone else (67%) and had HF symptoms (NYHA II 61%). The median body mass index was 28 kg/m2 (IQR 25–32). Ninety-four percent were being treated with beta-blocker, 60% with angiotensin-converring enzyme inhibitor, and 41% with angiotensin receptor blocker.

Data Quality and Item-Total Correlations

There were no missing responses for any of the items. All

Discussion

This is the 1st study to evaluate the psychometric properties of self-rating scales for measuring appetite in patients with HF. In this sample, we found that the CNAQ and SNAQ had sound psychometric properties regarding construct validity, known-group validity, and internal consistency. Appetite is an important variable to assess because it is related to undernutrition and survival. Having a valid appetite questionnaire is important for evaluating both changes of appetite over time and effects

Study Limitations

One study limitation is that a majority of the sample had mild HF symptoms, which might affect the generalizability to patients with severe HF symptoms. Nonetheless, the findings support that CNAQ and SNAQ are sensitive to symptom severity and probably can be used regardless of HF symptoms. The number of nonparticipants was relatively high and they were significantly older compared with the participants. However, no sex differences were detected and the sample included a wide age span.

Conclusion

Early detection of poor appetite in HF may prevent undernutrition. Both CNAQ and SNAQ are short instruments with sound psychometric properties. They can therefore be relevant tools for routine assessments of appetite in both HF care as well as in research. Even though SNAQ is shorter than CNAQ, we recommend that, where possible, the entire CNAQ scale be used owing to its greater reliability.

Disclosures

None.

References (15)

There are more references available in the full text version of this article.

Funding: Center for Clinical Research, Sörmland County Council, Sweden, Swedish Heart and Lung Foundation, King Gustaf V and Queen Victoria's Freemason Foundation, and Medical Research Council of Southeast Sweden. Dr Sawatzky holds a Canada Research Chair (Tier 2) funded by the Canadian Institutes of Health Research.

See page 958 for disclosure information.

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