Skip to main content
Log in

Nutritional state predicts all-cause death independent of comorbidities in geriatric patients with coronary artery disease

  • Published:
The journal of nutrition, health & aging

Abstract

Objective

To explore whether nutritional risk is associated with poor outcomes independent of complicated clinical status in older patients with coronary artery disease (CAD).

Design

Cohort study.

Setting

Patients referred for coronary angiography in West China Hospital, Sichuan University, China.

Participants

1772 patients with angiographic documented CAD whose age was above 65 years.

Measurements

Nutritional state was appraised using geriatric nutritional risk index (GNRI). Nutritional risk was defined as the GNRI below 98. The event rate of all-cause death was observed among patients with nutritional risk and those without.

Results

During a median follow-up period of 27 months, 224 patients died. Multivariate Cox regression analysis showed that nutritional risk was associated with all-cause death (adjusted hazard ratio 1.99; 95% confidence interval 1.35–2.95; P=0.001). Subgroup analysis verified the association between nutritional risk and death among patients with distinct clinical features, comorbidities, and medication. There was no interaction between nutritional risk and clinical characteristics with regard to all-cause death.

Conclusion

Nutritional state is independently associated with the risk of all-cause death in geriatric patients with CAD. Whether nutritional support in appropriate patients improves clinical outcomes deserves further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Spoon DB, Psaltis PJ, Singh M, Holmes DR, Jr., Gersh BJ, Rihal CS, Lennon RJ, Moussa ID, Simari RD, Gulati R. Trends in cause of death after percutaneous coronary intervention. Circulation 2014;129:1286–1294

    Article  PubMed  Google Scholar 

  2. Guigoz Y. Frailty and nutrition: what we have learned from research and clinical practice on the Mini Nutritional Assessment. J Frailty Aging 2012;1:52–55

    Google Scholar 

  3. Silva Rodrigues RA, Martinez Espinosa M, Duarte Melo C, Rodrigues Perracini M, Rezende Fett WC, Fett CA. New values anthropometry for classification of nutritional status in the elderly. J Nutr Health Aging 2014;18:655–661

    Article  CAS  PubMed  Google Scholar 

  4. Rasmussen HH, Kondrup J, Ladefoged K, Staun M. Clinical nutrition in danish hospitals: a questionnaire-based investigation among doctors and nurses. Clin Nutr 1999;18:153–158

    Article  CAS  PubMed  Google Scholar 

  5. Liang ZM, Chen W, Zhu SN, Yao C. Incidence of malnutrition and nutritional risk and nutritional support in the tertiary hospitals of the eastern, central, and western urban cities in China. Chinese Journal of Clinical Nutrition 2008;16:335–337

    Google Scholar 

  6. Huang BT, Peng Y, Liu W, Zhang C, Huang FY, Wang PJ, Zuo ZL, Liao YB, Chai H, Li Q, Zhao ZG, Luo XL, Ren X, Huang KS, Meng QT, Chen C, Huang DJ, Chen M. Subclassification of left ventricular hypertrophy based on dilation stratifies coronary artery disease patients with distinct risk. Eur J Clin Invest 2014;44:893–901

    Article  PubMed  Google Scholar 

  7. Huang BT, Peng Y, Liu W, Zhang C, Huang FY, Wang PJ, Zuo ZL, Liao YB, Chai H, Li Q, Zhao ZG, Luo XL, Ren X, Huang KS, Meng QT, Chen C, Huang DJ, Chen M. Inappropriate left ventricular mass and poor outcomes in patients with angina pectoris and normal ejection fraction. Coron Artery Dis 2015;26:163–169

    Article  PubMed  Google Scholar 

  8. Kinugasa Y, Kato M, Sugihara S, Hirai M, Yamada K, Yanagihara K, Yamamoto K. Geriatric nutritional risk index predicts functional dependency and mortality in patients with heart failure with preserved ejection fraction. Circ J 2013;77:705–711

    Article  CAS  PubMed  Google Scholar 

  9. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005;82:777–783

    CAS  PubMed  Google Scholar 

  10. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Jr., Ganiats TG, Holmes DR, Jr., Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;130:e344–426

    Article  PubMed  Google Scholar 

  11. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr., Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:e362–425

    Article  PubMed  Google Scholar 

  12. Tevik K, Thürmer H, Husby MI, de Soysa AK, Helvik AS. Nutritional risk screening in hospitalized patients with heart failure. Clin Nutr 2015;34:257–264.

    Article  PubMed  Google Scholar 

  13. Casaer MP, Van den Berghe G. Nutrition in the acute phase of critical illness. N Engl J Med 2014;370:1227–1236

    Article  CAS  PubMed  Google Scholar 

  14. Prasad A, Stone GW, Aymong E, Zimetbaum PJ, McLaughlin M, Mehran R, Garcia E, Tcheng JE, Cox DA, Grines CL, Gersh BJ. Impact of ST-segment resolution after primary angioplasty on outcomes after myocardial infarction in elderly patients: an analysis from the CADILLAC trial. Am Heart J 2004;147:669–675

    Article  PubMed  Google Scholar 

  15. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O’Leary D, Carr JJ, Goff DC, Greenland P, Herrington DM. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA 2012;308:788–795

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 2007;153:74–81

    Article  PubMed  Google Scholar 

  17. Ashrafian H, Frenneaux MP, Opie LH. Metabolic mechanisms in heart failure. Circulation 2007;116:434–448

    Article  CAS  PubMed  Google Scholar 

  18. van Bilsen M, Smeets PJ, Gilde AJ, van der Vusse GJ. Metabolic remodelling of the failing heart: the cardiac burn-out syndrome? Cardiovasc Res 2004;61:218–226

    Article  CAS  PubMed  Google Scholar 

  19. Corti MC, Salive ME, Guralnik JM. Serum albumin and physical function as predictors of coronary heart disease mortality and incidence in older persons. J Clin Epidemiol 1996;49:519–526

    Article  CAS  PubMed  Google Scholar 

  20. Nelson JJ, Liao D, Sharrett AR, Folsom AR, Chambless LE, Shahar E, Szklo M, Eckfeldt J, Heiss G. Serum albumin level as a predictor of incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol 2000;151:468–477

    Article  CAS  PubMed  Google Scholar 

  21. Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, Kumagai H. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 2008;87:106–113

    CAS  PubMed  Google Scholar 

  22. Cereda E, Klersy C, Pedrolli C, Cameletti B, Bonardi C, Quarleri L, Cappello S, Bonoldi A, Bonadeo E, Caccialanza R. The Geriatric Nutritional Risk Index predicts hospital length of stay and in-hospital weight loss in elderly patients. Clin Nutr 2015;34:74–78

    Article  PubMed  Google Scholar 

  23. Lee JS, Choi HS, Ko YG, Yun DH. Performance of the Geriatric Nutritional Risk Index in predicting 28-day hospital mortality in older adult patients with sepsis. Clin Nutr 2013;32:843–848

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mao Chen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, BT., Peng, Y., Liu, W. et al. Nutritional state predicts all-cause death independent of comorbidities in geriatric patients with coronary artery disease. J Nutr Health Aging 20, 199–204 (2016). https://doi.org/10.1007/s12603-015-0572-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-015-0572-2

Keywords

Navigation