PMID- 33229242
OWN - NLM
STAT- MEDLINE
DCOM- 20211004
LR  - 20211004
IS  - 1532-1983 (Electronic)
IS  - 0261-5614 (Linking)
VI  - 40
IP  - 5
DP  - 2021 May
TI  - Is there an association between the nutritional and functional parameters and 
      congestive heart failure severity?
PG  - 3354-3359
LID - S0261-5614(20)30612-9 [pii]
LID - 10.1016/j.clnu.2020.11.008 [doi]
AB  - BACKGROUND & AIMS: The association between markers of nutritional status 
      (handgrip strength [HGS] and adductor pollicis muscle thickness [APMT]) and 
      clinical markers of congestive heart failure (CHF) severity is currently unclear. 
      The objective of this study was to evaluate the association between HGS, APMT, as 
      markers of nutritional status and CHF severity. METHODS: APMT and muscle strength 
      was measured in 500 CHF patients bilaterally. Nutritional status was assessed by 
      Subjective Global Assessment (SGA). Functional classification was performed 
      according to guidelines provided by the New York Heart Association (NYHA) and 
      ejection fraction (EF) was measured to classify CHF severity. Poisson regression, 
      adjusted for sex and age, was performed to verify the association between 
      nutritional factors and CHF severity markers. RESULTS: The majority of patients 
      (75.8%) were >/=60 years old and 53.6% were either overweight or obese. SGA 
      identified 42.2% of the patients as malnourished, 12.6% with low APMT, and 29.0% 
      with low HGS. Most of the patients were classified as NYHA III/IV (56.8%) and 
      almost one third of patients (31.1%) had EF </= 40%. HGS and APMT were 
      significantly lower in malnourished male patients and in male patients with a 
      lower EF or worse NYHA classification. Even after controlling for the EF, 
      malnourished patients showed a 2.5-fold increased risk of CHF severity by NYHA 
      classification and for each kilogram of increase in the HGS, there was a 
      significant decrease of 2% in the risk (RR: 0.98 p < 0.001). Malnourished 
      patients presented a 52% higher risk (RR: 1.52 p = 0.016) of having a low EF, 
      whereas for each APMT increase, there was a 5% decrease in the risk (RR: 0.95 
      p < 0.001), even after controlling for NYHA classification. CONCLUSIONS: 
      Malnutrition is highly prevalent among patients with CHF and it is associated 
      with the functional class and the severity of the disease. Objective markers of 
      strength (HGS) and muscle (APMT) are independently associated with the CHF 
      severity, assessed by NYHA classification and EF, respectively, even after 
      adjustment for other confounding variables. Thus, the implementation of these 
      nutritional assessment methods in hospital routines, either by SGA or by 
      objective methods, such as HGS and APMT, can configure effective measurements for 
      early detection of malnutrition in patients at higher risk, and possibly a way to 
      avoid their further functional decline.
CI  - Copyright (c) 2020 Elsevier Ltd and European Society for Clinical Nutrition and 
      Metabolism. All rights reserved.
FAU - Duarte, Rodrigo R P
AU  - Duarte RRP
AD  - Post-graduate Cardiology Institute of Rio Grande do Sul, Cardiology University 
      Foundation, Rio Grande do Sul, Brazil.
FAU - Gonzalez, M Cristina
AU  - Gonzalez MC
AD  - Post-graduate Program in Health and Behavior, Catholic University of Pelotas, RS, 
      Brazil. Electronic address: cristinagbs@hotmail.com.
FAU - Oliveira, Jacqueline F
AU  - Oliveira JF
AD  - Post-graduate Program in Nursing Federal University of Rio Grande, RS, Brazil.
FAU - Goulart, Maira Ribas
AU  - Goulart MR
AD  - Post-graduate Cardiology Institute of Rio Grande do Sul, Cardiology University 
      Foundation, Rio Grande do Sul, Brazil.
FAU - Castro, Iran
AU  - Castro I
AD  - Post-graduate Cardiology Institute of Rio Grande do Sul, Cardiology University 
      Foundation, Rio Grande do Sul, Brazil.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201111
PL  - England
TA  - Clin Nutr
JT  - Clinical nutrition (Edinburgh, Scotland)
JID - 8309603
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cross-Sectional Studies
MH  - Female
MH  - Hand Strength/*physiology
MH  - Heart Failure/complications/*epidemiology
MH  - Humans
MH  - Male
MH  - Malnutrition/complications/*epidemiology
MH  - Middle Aged
MH  - Muscle, Skeletal/physiology
MH  - Nutrition Assessment
MH  - Nutritional Status/*physiology
MH  - Young Adult
OTO - NOTNLM
OT  - Adductor pollicis muscle thickness
OT  - Handgrip strength
OT  - Heart failure
OT  - Malnutrition
OT  - Nutritional assessment
COIS- Conflict of interest The authors have no conflict of interest to declare.
EDAT- 2020/11/25 06:00
MHDA- 2021/10/05 06:00
CRDT- 2020/11/24 05:48
PHST- 2020/04/06 00:00 [received]
PHST- 2020/10/30 00:00 [revised]
PHST- 2020/11/05 00:00 [accepted]
PHST- 2020/11/25 06:00 [pubmed]
PHST- 2021/10/05 06:00 [medline]
PHST- 2020/11/24 05:48 [entrez]
AID - S0261-5614(20)30612-9 [pii]
AID - 10.1016/j.clnu.2020.11.008 [doi]
PST - ppublish
SO  - Clin Nutr. 2021 May;40(5):3354-3359. doi: 10.1016/j.clnu.2020.11.008. Epub 2020 
      Nov 11.