Nutrition Assessment – ABC CARDIOL

Original Article

Malnutrition in Outpatients with Heart Failure: Prevalence, Associated Factors and 6-Month Impact

Leonardo Akira Gondo et al. Lidia Ana Zytynski Moura Marcely Gimenes Bonatto Victoria Marzagao Ribeiro Pagliosa … Giovanna Voigt Machado Flavia Centenaro de Oliveira Angela Guzzo Lemke Amanda Licheski Contini Ana Karyn Ehrenfried de Freitas

Abstract

Background

Malnutrition is common in heart failure with reduced ejection fraction (HFrEF) and may negatively affect prognosis.

Objective

To determine the prevalence of malnutrition in outpatients with HFrEF, identify associated clinical factors, and evaluate its impact on mortality and clinical outcomes at 6 months.

Methods

Prospective observational cohort study including 118 outpatients with HFrEF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the Subjective Global Assessment (SGA). Six-month follow-up documented mortality, hospitalizations, and emergency department visits.

Results

The prevalence of malnutrition was 21.2% (25/118). Malnourished patients were older (68 ± 12 vs. 60 ± 10 years; p=0.001), had a higher prevalence of NYHA functional class III–IV (45% vs. 15%; p=0.002) and atrial fibrillation (44% vs. 25%; p=0.048), and achieved a lower percentage of target beta-blocker dose (57.9% vs. 79.8%; p=0.002). No statistically significant difference in 6-month mortality was observed between the groups, although it was numerically higher in the malnourished group (14% vs. 4%; p=0.082). No differences were observed in hospitalization rates (p=0.94) or emergency department visits (p=0.97).

Conclusion

Malnutrition is present in approximately one in five outpatients with HFrEF, more common in the elderly and those with atrial fibrillation and was associated with a trend towards higher mortality in 6 months.

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IJCS

Review Article

Unconventional Anthropometric Indicators: Foundations, Applicability, and Validity as Predictors of Health Conditions

Haroldo da Silva Ferreira et al. Antonio Fernando Silva Xavier Júnior Élison Ruan da Silva Almeida Tainá Cardoso Caminha-Uchôa … Andressa Bruna Batista de Verçoza Hitalo de Moraes Vieira

Abstract

Several anthropometric parameters have been proposed as indicators of health conditions. Some have achieved wide acceptance and applicability. Others, although grounded in solid theoretical frameworks and demonstrating good diagnostic validity, have not gained the same level of recognition. These are referred to here as “unconventional anthropometric indicators”. This article aims to provide a descriptive and conceptual synthesis of these measures, addressing their nuances and applicability. It is a narrative review that discusses the following indicators: Head-to-height index (HHI), Waist-to-Height Ratio (WHtR), Conicity Index (C-Index), Waist-to-Hip Ratio (WHR), A Body Shape Index (ABSI), Neck Circumference (NC), and Adductor Pollicis Muscle Thickness (APMT). WHtR, C-Index, WHR, and ABSI are based on the identification of abdominal fat accumulation and its association with cardiometabolic risks. However, for this purpose, waist circumference stands out due to its methodological simplicity and predictive effectiveness. NC is an indicator of subcutaneous fat, whose excess increases disease risk and is not influenced by factors that alter abdominal volume. APMT identifies muscle depletion and is comparable to other anthropometric predictors of malnutrition risk. HHI was proposed to identify individuals who experienced undernutrition early in life. Grounded in a robust theoretical foundation, it is a promising tool for advancing research on the Developmental Origins of Health and Disease (DOHaD). The indicators analyzed are valuable for monitoring cardiometabolic risk factors, each with its unique characteristics. Understanding these particularities is essential for selecting the most appropriate indicators for different contexts, thus enabling more effective interventions.

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ABC

Editorial

Nutritional Indices and Postoperative Atrial Fibrillation: The Triglyceride-Cholesterol-Body Weight Index

Zulkif Tanriverdi

Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery and the most common cause of secondary atrial fibrillation (AF). Although it occurs at different rates depending on the type of cardiac operation, it has been reported to occur in approximately 20% of patients after coronary artery bypass grafting (CABG). Despite technological advances and all the preventive strategies developed, it is still relatively common.^, POAF increases the length and cost of hospitalization and is associated with increased morbidity and mortality. It may also be a predictor of non-surgical AF development in the years after the cardiac surgery. Therefore, it is important to anticipate patients who may develop POAF after the cardiac surgery.

To date, many serum biomarkers have been investigated to identify patients at risk for POAF. Recently, it has been demonstrated that malnutrition is prevalent in hospitalized patients, and malnutrition has been found to be associated with a higher incidence of AF and adverse cardiac outcomes due to slowing down the recovery process and increasing the risk of complications.^, Many different nutritional screening tools, from very simple to quite complex, are available to assess malnutrition in daily clinical practice. Some novel nutritional indices have been developed by objectively measurable parameters such as triglyceride, total cholesterol, body weight, albumin, lymphocyte, and additional laboratory variables to identify nutritional status. Although various systems and scores have been assessed in clinical studies, 4 objective nutritional indices have commonly been proposed for the evaluation of malnutrition as follows: geriatric nutritional risk index (GNRI), prognostic nutrition index (PNI), triglyceride-cholesterol-body weight Index (TCBI) and controlling nutritional status score.

[…]

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Original Article

Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion

Kerim Esenboga et al. Alparslan Kurtul Yakup Yunus Yamanturk Volkan Kozluca Eralp Tutar

Abstract

Background:

Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals.

Objective:

To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS.

Methods:

A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses.

Results:

The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC.

Conclusion:

The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

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Original Article

Undernutrition and Cachexia in Patients with Decompensated Heart Failure and Chagas Cardiomyopathy: Occurrence and Association with Hospital Outcomes

Larissa Candido Alves Tavares et al. Silvia Helena Gelás Lage Edimar Alcides Bocchi Victor Sarli Issa

Abstract

Background

Nutritional disorders are common among patients with heart failure (HF) and associated with poor prognosis. Importantly, some populations of patients, like the ones with Chagas disease, are frequently excluded from most analyses.

Objective

We sought to study the occurrence of undernutrition and cachexia in patients with Chagas disease during episodes of decompensated HF (DHF) as compared to other etiologies, and to investigate the influence of these findings on hospital outcomes.

Methods

We performed a consecutive case series study with patients hospitalized with DHF. Patients underwent the Subjective Global Assessment of nutritional status (SGA), besides anthropometric and laboratorial measures, and were evaluated for the occurrence of cachexia, low muscle mass and strength. We studied the occurrence of death or urgent heart transplantation during hospitalization.

Results

Altogether, 131 patients were analyzed and 42 (32.1%) had Chagas disease. Patients with Chagas disease had lower Body Mass Index (BMI) (22.4 kg/m²[19.9-25.3] vs. 23.6 kg/m2 [20.8-27.3], p=0.03), higher frequency of undernutrition (76.2% vs 55.1%, p=0.015) and higher occurrence of death or transplant (83.3% vs. 41.6%, p<0.001). We found that, in patients with Chagas etiology, the occurrence of death or cardiac transplantation were associated with undernutrition (3 [42.9%] patients with hospital discharge vs 29 [82.9%] patients with death or heart transplant, p=0.043).

Conclusions

Taken together, our results indicate that patients with Chagas disease hospitalized with DHF often present with nutritional disorders, especially undernutrition; importantly, this finding was associated with the occurrence of death and heart transplant during hospitalization.

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IJCS

Original Article

Adductor Pollicis Muscle Thickness as a Marker of Nutritional Status in Heart Failure

Fabiane da Silva Rosário et al. Denise Tavares Giannini Viviane de Oliveira Leal Ricardo Mourilhe-Rocha

Abstract

Background:

Malnutrition is associated with morbidity and mortality in patients with heart failure (HF). Thus, it is essential to apply reliable indicators to assess the nutritional status of these individuals.

Objective:

To evaluate the thickness of the adductor pollicis muscle (APM) in patients with HF as an indicator of somatic protein status and correlate the obtained values with conventionally used parameters and electrical bioimpedance (EBI) markers.

Methods:

Cross-sectional study with patients with HF undergoing regular outpatient treatment. APM thickness was measured in the dominant arm, and the values obtained were classified according to gender and age. The anthropometric parameters assessed included the body mass index (BMI) and specific parameters to assess the muscle (arm muscle circumference [AMC] and arm muscle area [AMA]). Values of phase angle (PA), standard PA (SPA), and lean mass were obtained by EBI. Statistical analyses were performed with the software Statistical Package for the Social Sciences, version 19, using unpaired Student’s t, Mann-Whitney, or one-way analysis of variance (ANOVA) tests for comparisons between groups, as appropriate. The correlation between variables of interest was performed using Pearson’s or Spearman’s correlation coefficient, as adequate. The level of significance was set at 5%.

Results:

About 70% of the 74 patients evaluated were classified as malnourished according to the APM thickness. Values of AMC, AMA, and lean mass correlated positively with APM thickness (p < 0.005). The APM thickness also correlated positively with PA and SPA (r = 0.49, p < 0.001 and r = 0.31, p = 0.008, respectively).

Conclusion:

Patients with HF presented a high frequency of protein malnutrition when APM thickness was used as an indicator of nutritional status. APM thickness values correlated with conventional measures of somatic protein evaluation and may be related to the prognosis of these patients, since they correlated positively with PA and SPA.

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Artigo Original

Subjective global assessment of nutritional status in cardiac patients

Aurea Kaoru Yamauti et al. Marcelo Eidi Ochiai Paula Sofia Bifulco Moab Alves de Araújo … Rosiris Roco Alonso Regina Helena Cunha Ribeiro Antonio Carlos Pereira-Barretto

OBJECTIVE: To analyze the performance of Subjective Global Assessment of Nutritional Status (SGA) in diagnosing malnutrition in patients with heart disease. METHODS: One hundred and six hospitalized patients (53 with heart failure) completed an SGA questionnaire on their nutritional history (changes in body weight, dietary intake, gastrointestinal symptoms, functional capacity, and diagnosis) and underwent physical examination. Then, anthropometric measurements were obtained (body weight, mid-arm circumference, triceps skinfold thickness, and arm muscle circumference). Serum albumin, total lymphocyte count and anthropometric measurements were determined for the objective assessment of patients with congestive heart failure. An ROC curve was used to analyze sensitivity, specificity and accuracy of SGA compared to the objective assessment. RESULTS: Patients’ age was 57.7 ± 15.7, and the majority was male (67.9%). The ROC curve showed score 16 as SGA cut-off point with the highest sensitivity (62.2%) and specificity (55.7%). The area under the curve was 0.601 (95% CI: 0.487 – 0.715). Anthropometric assessment showed malnutrition prevalence at 51.9% by SGA and 42.5% by, with accuracy of 65.3% in men and 44.1% in women. In patients with congestive heart failure, SGA assessed malnutrition prevalence was 60.4%, while objective assessment was 32.1% with accuracy of 67.6% in men and 31.3% in women. CONCLUSION: SGA detected a greater number of malnourished patients than the objective evaluation. Its performance in identifying malnutrition was better in men. It also detected cardiac patients at nutritional risk.

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