Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications

• Published in: ESC Heart Failure Vol. 6; no. 5; pp. 953 - 964
• Main Authors: Chien, Shih‐Chieh, Lo, Chi‐In, Lin, Chao‐Feng, Sung, Kuo‐Tzu, Tsai, Jui‐Peng, Huang, Wen‐Hung, Yun, Chun‐Ho, Hung, Ta‐Chuan, Lin, Jiun‐Lu, Liu, Chia‐Yuan, Hou, Charles Jia‐Yin, Tsai, I‐Hsien, Su, Cheng‐Huang, Yeh, Hung‐I, Hung, Chung‐Lieh
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.10.2019; John Wiley and Sons Inc; Wiley
• Subjects: Acute Disease; Aged; Aged, 80 and over; Albumin; Anemia - epidemiology; Asian Continental Ancestry Group; Biomarkers - blood; Body Mass Index; C-Reactive Protein - analysis; Cardiovascular disease; Diabetes; Ejection fraction; Exercise; Family medical history; Female; Geriatric Assessment - methods; Geriatrics; Heart failure; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure with preserved ejection fraction; Hospitalization - trends; Hospitals; Humans; Hypertension; Laboratories; Leukocyte Count; Male; Malnutrition; Malnutrition - complications; Metabolism; Middle Aged; Morbidity; Mortality; Nutrition; Nutrition Assessment; Nutritional status; Nutritional Status - physiology; Obesity; Original; Original s; Peptides; Physical fitness; Population; Prognosis; Risk Factors; Serum Albumin - analysis; Stroke Volume - physiology; United States > US; Taiwan; Heart failure with preserved ejection fraction; Albumin; Body mass index; Mortality; Nutritional status
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.12501

Aims This study aimed to evaluate the prognostic significance of nutritional status in post‐discharge Asians with heart failure with preserved ejection fraction (HFpEF). Methods and results We examined the prognostic implications of body mass index (BMI) and nutritional markers among consecutive patients hospitalized for HFpEF. Nutritional metrics were estimated by serum albumin (SA), prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and geriatric nutritional risk index. Among 1120 patients (mean age: 77.2 ± 12.6 years, 39.4% men), mean SA levels, PNI, CONUT scores, and geriatric nutritional risk index were 3.3 ± 0.6 g/dL, 40.2 ± 8.7, 5.5 ± 2.1, and 95.9 ± 14.5, respectively. Lean body size, higher white blood cell counts and C‐reactive protein levels, anaemia, and lack of angiotensin blocker use were independently associated with malnutrition (defined by SA < 3.5 g/dL). Higher SA levels [hazard ratio (HR): 0.67 (95% confidence interval, CI: 0.53–0.85)], higher PNI [HR: 0.97 (95% CI: 0.95–0.99)], and higher geriatric nutritional risk index [HR: 0.98 (95% CI: 0.97–0.99)] (all P < 0.05) were all associated with longer survival, with higher CONUT score [HR: 1.08 (95% CI: 1.02–1.13)] exhibited higher mortality in Cox regression models and with higher SA levels/PNI but not BMI further contributing to the reduced rate of re‐hospitalization (both P < 0.05). Categorizing BMI (25 kg/m2 as cut‐off) and nutritional status showed significantly higher mortality rates among patients with lower BMI/malnutrition than among those with BMI/better nutrition (SA level, PNI, and CONUT score, all P < 0.01). Restricted cubic spline regression revealed a marked survival benefit of better nutrition with increasing BMI (adjusted Pinteraction for both SA level and PNI: <0.001; adjusted Pinteraction for CONUT score: 0.046). Conclusions Malnutrition was frequently and strongly associated with systemic inflammation in Asian patients hospitalized for acute HFpEF. Our findings also indicate that nutrition may play a pivotal role in metabolic protection in this population.