Prevalence and prognostic importance of malnutrition,as assessed by four different scoring systems,in elder patients with heart failure
Affiliation:
1. Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China;2. Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, No.167 Beilishi Road, 10037, Beijing, China;1. Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, China;2. NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University, China;1. Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China;2. Department of Prevention and Healthcare, Affiliated Zhongshan Hospital of Dalian University, Dalian, China;3. Department of Medical Record and Statistics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China;1. School of Education, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, United States;2. Department of Kinesiology, University of Connecticut, Storrs, CT 06269, United States;3. Department of Kinesiology, University of Rhode Island, Independent Square, Kingston, RI 02881, United States;4. Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, United States;1. The Department of Health Statistics, School of Public Health, Dalian Medical University, No. 9 South Road, Lvshun District, Dalian City, Liaoning Province, 116044, PR China;2. Department of Hospital Infection Control, First Affiliated Hospital of Nanchang University, Nanchang University, No. 17 Yong wai zheng street, Nanchang City, Jiangxi Province, 330006, PR China;1. Postgraduate Programme in Nutrition and Health, State University of Ceará, Fortaleza, Brazil;2. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece;3. Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 382 21 Volos, Greece;4. Department of Pediatrics, Medical School, University of Pécs, 7623 Pécs, Hungary;5. Council for Agricultural Research and Economics, Research Center on Food and Nutrition, Rome, Italy;6. Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN)—CSIC, 28040 Madrid, Spain;7. Inserm, U1286—INFINITE—Clinical Investigation Center—Institute for Translational Research in Inflammation and CIC 1403, University Lille, CHU Lille, F-59000 Lille, France;8. Division of Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;9. Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain;10. Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain;11. Department of Public Health and Primary Care, Ghent University, Ghent, Belgium;12. Growth, Exercise, Nutrition and Development (GENUD) Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain;13. Postgraduate Program in Collective Health State University of Ceara, Fortaleza, Brazil;1. School of Chemistry and Environment, Yunnan Minzu University, Kunming, Yunnan, 650500, People''s Republic of China;2. Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People''s Republic of China
Abstract:
Background and aimsThe lack of standard diagnostic criteria in elder patients with heart failure (HF) makes it challenging to diagnose and manage malnutrition. We aimed to explore the prevalence of malnutrition, its associations and prognostic significance among elder patients with HF using four different nutritional scoring systems.Methods and resultsConsecutively presenting patients aged ⩾65 years, diagnosed with HF, and admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) were assessed for nutritional indices. In total, 1371 patients were enrolled (59.4% men; mean age 72 years; median NT-proBNP 2343 ng/L). Using scores for the prognostic nutritional index (PNI) ≤38, controlling nutritional status (CONUT) score >4, geriatric nutritional risk index (GNRI) ≤91, and triglycerides, total cholesterol, and body weight index (TCBI) ≤1109, 10.4%, 18.3%, 9.2%, and 50.0% of patients had moderate or severe malnutrition, respectively. There was a strong association between worse scores and lower body mass index, more severe symptoms, atrial fibrillation, and anemia. The mortality over a median follow-up of 962 days (interquartile range (IQR): 903–1029 days) was 28.3% (n = 388). For those with moderate or severe condition, 1-year mortality was 35.2% for PNI, 28.3% for CONUT, 28.0% for GNRI, and 19.1% for TCBI. Malnutrition, defined by any of the included indices, showed added prognostic value when incorporated into a model and included preexisting prognostic factors (C-statistic: 0.711). However, defining malnutrition by the CONUT score yielded the most significant improvement in the prognostic predictive value (C-statistic: 0.721; p < 0.001).ConclusionMalnutrition is prevalent among elder patients with HF and confers increased mortality risk. Among the nutritional scores studied, the CONUT score was most effective in predicting the mortality risk.Clinical trial registrationURL: ClinicalTrials.gov; Unique Identifier: NCT02664818.
