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Nutritional status and its effects on muscle wasting in patients with chronic heart failure: insights from Studies Investigating Co-morbidities Aggravating Heart Failure

  • geriatrics: at crossroads of medicine
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Summary

Background

Inadequate nutritional status has been linked to poor outcomes in patients with heart failure (HF). Skeletal muscle wasting affects about 20% of ambulatory patients with HF. The impact of nutritional intake and appetite on skeletal muscle wasting has not been investigated so far. We sought to investigate the impact of nutritional status on muscle wasting and mortality in ambulatory patients with HF.

Methods

We studied 130 ambulatory patients with HF who were recruited as a part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) program. Muscle wasting was defined according to criteria of sarcopenia, i.e., appendicular skeletal muscle mass two standard deviations below the mean of a healthy reference group aged 18–40 years. Nutritional status was evaluated using the Mini-Nutritional Assessment—Short Form (MNA-SF). Functional capacity was assessed as peak oxygen consumption (peak VO2) by cardiopulmonary exercise testing, 6‑minute walk testing, and the Short Physical Performance Battery (SPPB).

Results

At baseline, 19 patients (15%) presented with muscle wasting. Patients with muscle wasting had significantly lower values of peak VO2, 6‑minute walk distance, SPPB, and MNA-SF score than patients without (all p < 0.05). In multivariate analysis, MNA-SF remained an independent predictor of muscle wasting after adjustment for age and New York Heart Association class (odds ratio [OR] 0.66; confidence interval [CI] 0.50–0.88; p < 0.01). A total of 16 (12%) patients died during a mean follow-up of 21 months. In Cox regression analysis, MNA-SF (OR 0.80, CI 0.64–0.99, p = 0.04), left ventricular ejection fraction (OR 0.93, CI 0.86–0.99, p = 0.05), and peak VO2 (OR 0.78, CI 0.65–0.94, p = 0.008) were predictors of death.

Conclusion

MNA-SF is an independent predictor of muscle wasting and mortality in ambulatory patients with HF. Nutritional screening should be included as a fundamental part of the overall assessment of these patients.

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Funding

This project was supported by the 7th framework program (FP7/2007/2013) under grant agreement number 241558 of the European Commission (SICA-HF). M.R.S. was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq 234052/2014-7). Part of the present work was additionally funded by a grant from the Innovative Medicines Initiative—Joint Undertaking (IMI–JU 115621, SPRINT-T).

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Authors and Affiliations

  1. Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany

    Masakazu Saitoh PhD, Marcelo Rodrigues dos Santos PhD, Nicole Ebner MSc, Amir Emami MD, Masaaki Konishi PhD, Junichi Ishida PhD, Miroslava Valentova MD, Anja Sandek MD, Stefan D. Anker MD PhD & Stephan von Haehling MD PhD

  2. Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil

    Marcelo Rodrigues dos Santos PhD

  3. Center for Stroke Research Berlin, and Department of Cardiology, Virchow Klinikum, Charité-Universitätsmedizin, Berlin, Germany

    Wolfram Doehner MD PhD

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  1. Masakazu Saitoh PhD
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  2. Marcelo Rodrigues dos Santos PhD
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  3. Nicole Ebner MSc
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  4. Amir Emami MD
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  5. Masaaki Konishi PhD
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  7. Miroslava Valentova MD
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  11. Stephan von Haehling MD PhD
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Correspondence to Masakazu Saitoh PhD.

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Conflict of interest

M. Saitoh, M.R. dos Santos, N. Ebner, A. Emami, M. Konishi, J. Ishida, M. Valentova, A. Sandek, W. Doehner, S.D. Anker, and S. von Haehling declare that they have no competing interests.

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Saitoh, M., dos Santos, M.R., Ebner, N. et al. Nutritional status and its effects on muscle wasting in patients with chronic heart failure: insights from Studies Investigating Co-morbidities Aggravating Heart Failure. Wien Klin Wochenschr 128 (Suppl 7), 497–504 (2016). https://doi.org/10.1007/s00508-016-1112-8

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