Malnutrition, congestion and mortality in ambulatory patients with heart failure

Sze, Shirley; Pellicori, Pierpaolo; Zhang, Jufen; Clark, Andrew L.

doi:10.1136/heartjnl-2018-313312

Cited by 58 publications

(47 citation statements)

References 28 publications

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“…In most patients, a loss of this amount of weight is quite significant and will be noted by patients and relatives. Since any weight loss, according to former studies is associated with negative outcomes [5,11,13,25,26]. Moreover, we found significant risk factors associated to the two outcomes.…”

Section: Discussionsupporting

confidence: 61%

“…Malnutrition in hospitalized patients has been widely described and is known to have significant consequences for the course and outcome of treatment. Thus, a significant amount of research has underlined disease related malnutrition, as being associated with increased risk of infections, complications, need of prolonged care and decreased quality of life, as well as mortality [1][2][3][4][5][6][7]. Malnutrition is defined as a consequence of inadequate intake of proteins and energy, which, in combination with increased requirements due to the stressed metabolism, can lead to a reduction of appetite and less food intake, forming a negative energy balance, leading to weight loss [8].…”

Section: Introductionmentioning

confidence: 99%

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Disease Related Malnutrition in Hospital Outpatients, - Time for Action

Holst¹,

Zacher²,

Østergaard³

et al. 2019

IJFSNR

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Background: Malnutrition is common in hospitalized patients, and is known to have negative consequences on the course and outcome of treatment. As the proportion and burden of disease is increasing in the outpatient setting, a focus on malnutrition in the overall outpatient setting may be required. Aim: This study aimed to investigate the prevalence of unintended weight loss and associated risk factors in outpatients visiting five different specialties. Methods: In this cross sectional study, data regarding weight loss during the past three months, "eaten less" the past week and associated risk factors, was collected consecutively through a one-page questionnaire, for a full week in each of five ambulatories at Aalborg University Hospital, Denmark. Descriptive analysis, Chi 2-analysis and multiple logistic regression analysis were used for statistical analysis. Results: Of the 713 participants, 26% had an unintended weight loss within the last three months and 21% had eaten less than usual over the past week. Patients >80 years [CI95%: 1.496;4.358] and underweight patients [CI95%: 1.766;8.884] had significant increased odds for "unintended weight loss", while women [CI 95%: 1.216;2.542], patients from the department of medical gastroenterology [CI95%:1.499;4.205], department of gastrointestinal surgery [CI95%: 1.289;3.797] and department of lung medicine [CI95%: 1.353;4.129] as well as underweight patients [CI95% 1.202;4.742] showed increased odds for "eaten less". Conclusion: Based on the statistical analysis, there is a high risk of unintended weight loss in outpatient clinics. Therefore, guidelines for handling disease related under nutrition in outpatient settings are required.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Disease Related Malnutrition in Hospital Outpatients, - Time for Action

Holst¹,

Zacher²,

Østergaard³

et al. 2019

IJFSNR

View full text Add to dashboard Cite

show abstract

“…Malnutrition is a factor that defines vital prognosis in patients with heart failure [1][2][3]. In patients with right heart failure, intestinal edema leads to malabsorption DOI: 10.1159/000507355 and increased gut permeability [4,5].…”

Section: Introductionmentioning

confidence: 99%

Energy Metabolism and Nutritional Status in Hospitalized Patients with Chronic Heart Failure

et al. 2020

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Introduction: Malnutrition is a factor that defines vital prognosis in chronic heart failure. Objective: This study investigated nutritional and metabolic disorders in patients with heart failure by examining the association of severity of heart failure with inflammatory cytokines, appetite-regulating hormones, and energy metabolism. Methods: Subjects were 50 patients with heart failure. On admission, nutritional status was assessed, and biochemical blood tests were performed, including for serum tumor necrosis factor-α, interleukin-6, ghrelin, and leptin levels. Resting energy expenditure (REE) was also measured by indirect calorimetry to examine its association with severity of heart failure and levels of inflammatory cytokines and appetite-regulating hormones. Results: There were significant associations between serum brain natriuretic peptide (BNP) level and nutrition indices, indicating that nutritional status was worse when heart failure was more severe. Inflammatory cytokine levels showed significant positive correlations with BNP level. Measured REE/bodyweight was not associated with severity of heart failure, but was negatively correlated with body fat percentage and leptin levels. Conclusions: Energy metabolism was not associated with serum BNP level among patients with heart failure with New York Heart Association functional class up to III. Body fat percentage and leptin levels may be a good predictor of energy metabolism in patients with heart failure.

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“…A decline in nutritional status, namely malnutrition, is a common but easily neglected complication of patients with HF and it is significantly associated with the risk of death (Sze et al., 2018). Malnutrition was an independent predictor of all‐cause mortality in patients with HF and after adjusting other variables, it increased the risk of death by 2.32 times (Sze, Pellicori, Zhang, & Clark, 2019). Patients with HF and poor nutritional status are generally characterized by lower body weight and functional impairment (Gastelurrutia et al., 2015; Matsuo, Yoshimura, Fujita, & Maeno, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with HF and poor nutritional status are generally characterized by lower body weight and functional impairment (Gastelurrutia et al., 2015; Matsuo, Yoshimura, Fujita, & Maeno, 2019). In addition, deterioration of nutritional status is thought to be associated with the origin of cachexia, which can cause overall aggravation of body function and lead to an adverse prognosis in patients with HF (Rahman et al., 2016; Sze et al., 2019). A significant correlation between malnutrition and depressive symptoms has been confirmed in previous studies on cancer, hemodialysis patients and community elderly population, (Duc et al., 2017; Gerogianni, Kouzoupis, & Grapsa, 2018; Wei et al., 2018) whereas little is known about their relationship in patients with HF.…”

Section: Introductionmentioning

confidence: 99%

Functional status mediates the association of nutritional status with depressive symptoms in patients with heart failure

Zhang

Zou

Hou

et al. 2020

Journal of Advanced Nursing

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Aims The decline of nutritional status and depressive symptoms are pandemic in heart failure patients and functional status may play a pivotal role between these. This study aimed to determine whether nutritional status is associated with depressive symptoms and whether functional status mediates this relationship in heart failure patients. Design This was a secondary analysis of a cross‐sectional study. Methods The data were collected from November 2015–April 2016. Heart failure patients (N = 254) being hospitalized were included in this secondary analysis. The Depression Sub‐Scale of the Hospital Anxiety and Depression Scale and the Duke Activity Status Index were used to assess patients' depressive symptoms and functional status. The nutritional status of patients was calculated using the Geriatric Nutritional Risk Index. Results In this study, the average scores of depressive symptoms, nutritional status and functional status were 4.91 (SD 3.12), 102.38 (SD 6.57) and 20.58 (SD 8.96) respectively. Out of the 254 patients, 46 patients (18.1%) had significant depressive symptoms (the score of Depression Sub‐Scale of the Hospital Anxiety and Depression Scale ≥ 8) and 55 (21.7%) suffered from malnutrition (the score of Geriatric Nutritional Risk Index ≤ 98). In the multiple regression analyses, nutritional status was negatively associated with depressive symptoms (β = −0.142, p = .02) and functional status mediated the relationship between nutritional status and depressive symptoms. Conclusions Many patients with heart failure have malnutrition and depressive symptoms. Functional status plays a mediating role in the relationship between nutritional status and depressive symptoms. Impact To relieve depressive symptoms in patients with heart failure, it is of importance to improve the functional status, especially for those with poor nutritional status.

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Malnutrition, congestion and mortality in ambulatory patients with heart failure

Abstract: Malnutrition and congestion are modestly correlated and each is independently associated with increased mortality in patients with CHF. Patients with HF with both malnutrition and congestion as evidenced by right heart dysfunction should be managed with additional vigilance.

Cited by 58 publications

References 28 publications

Disease Related Malnutrition in Hospital Outpatients, - Time for Action

Disease Related Malnutrition in Hospital Outpatients, - Time for Action

Energy Metabolism and Nutritional Status in Hospitalized Patients with Chronic Heart Failure

Functional status mediates the association of nutritional status with depressive symptoms in patients with heart failure

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