Abstract Body (Do not enter title and authors here): Background: As heart failure (HF) becomes more prevalent, early intervention in its preclinical stages is essential to reduce morbidity and mortality. Heart-healthy diet adherence is low and shaped by individual (e.g., nutrition knowledge), sociocultural (e.g., race), and environmental (e.g., food access) factors. Income is a key structural determinant that may modify the impact of other factors on diet quality.

Research Question: What individual, sociocultural, and environmental factors are associated with diet quality in high- and low-income groups with preclinical HF?

Methods: Preclinical HF was defined by AHA criteria as having at least one condition: hypertension, diabetes, obesity, or atherosclerotic cardiovascular disease. We surveyed 400 adults aged ≥40 with preclinical HF from high- and low-income groups (based on 200% of the federal poverty level) using the YouGov panel in South Atlantic states. Diet quality was assessed with the mini-EAT, and behavioral factors (smoking, physical activity, sleep, and alcohol use), socioeconomic status (SES: education and employment), and other factors were measured using nationally representative NHANES and USDA questionnaires. LASSO regression and backward selection models (SAS v9.4) were used to identify factors associated with diet in high- and low-income groups and in the overall population.

Results: Compared to the low-income group, those with high income had better diet quality and consumed more vegetables and legumes. They were more likely to be male (55 vs. 45%) and in excellent health (29 vs 23%). They had higher scores on SES (1.9 vs. 1.6 out of 5), food accessibility (9.1 vs. 7.0 out of 12), and availability (2.5 vs. 2.0 out of 4). They had high social connection (42.0 vs. 19.5%), felt safe (70.5 vs 48.5%), and bought their food from supermarkets (65.5 vs 46.5%).
In the overall population and income subgroups, multivariable models showed that individual factors (Table) were associated with diet quality. In the high-income group, diet was associated with behavioral factors (p<0.01) and SES (p<0.01). In the low-income group, diet was associated with general health (p<0.01), nutrition knowledge (p=0.02), and being male (p=0.01)

Conclusion: Income plays a significant role in diet quality. Although individual factors were linked to diet in both income groups, the specific factors differed by income level, underscoring the importance of income-specific interventions in individuals with preclinical HF.