Malnutrition and Left Ventricular Systolic Function in Hospitalized Elderly Patients with and without Heart Failure

Authors

  • Elpidio Santillo Geriatrics-Rehabilitative Department, Italian National Research Centre on Ageing (I.N.R.C.A.), Fermo, Italy
  • Monica Migale Geriatrics-Rehabilitative Department, Italian National Research Centre on Ageing (I.N.R.C.A.), Fermo, Italy
  • Luca Fallavollita Geriatrics-Rehabilitative Department, Italian National Research Centre on Ageing (I.N.R.C.A.), Fermo, Italy
  • Luciano Marini Geriatrics-Rehabilitative Department, Italian National Research Centre on Ageing (I.N.R.C.A.), Fermo, Italy
  • Demetrio Postacchini Geriatrics-Rehabilitative Department, Italian National Research Centre on Ageing (I.N.R.C.A.), Fermo, Italy
  • Fabrizio Balestrini Geriatrics-Rehabilitative Department, Italian National Research Centre on Ageing (I.N.R.C.A.), Fermo, Italy
  • Raffaele Antonelli Incalzi Chair of Geriatrics - Biomedic Campus University, Rome, Italy

DOI:

https://doi.org/10.6000/1929-5634.2013.02.02.3

Keywords:

Heart failure, Malnutrition, Elderly, Albumin, Systolic function

Abstract

Heart failure (HF) is highly prevalent among older subjects and it is associated with poor prognosis. HF frequently coexists with malnutrition. Objectives of our work were to assess nutritional status of old inpatients with and without HF and to study the association of malnutrition markers with echocardiographic parameters of left ventricular function and geometry. We enrolled 165 patients (72 men, 93 women; mean age: 80±7 years) consecutively admitted to Cardiology ward of our geriatric research hospital. For all subjects we performed clinical examination, echocardiogram and laboratory tests. Nutritional status was assessed evaluating anthropometric and laboratory markers of malnutrition (BMI ≤ 24 kg/m2 and/or serum albumin ≤ 3.2 g/dL). We found high prevalence of HF (67.3%) and malnutrition (28.5%). Mean serum albumin and mean BMI were 3.6±0.5 g/dL and 25.8±5.2 kg/m2 respectively. T-Student tests showed lower values of serum albumin in patients with HF compared with patients without HF (3.5±0.6 g/dL vs 3.7±0.4 g/dL; p:0.043). Conversely BMI values were not significantly different. We found significant association between serum albumin and ejection fraction (EF) of left ventriculum (r:0.311; p:0.001). An independent correlation between EF and serum albumin was confirmed by multivariate analysis (β:0.301; p:0.027). Our study highlights that malnutrition is common among elderly inpatients with HF. Lower albumin was associated with worse systolic left ventricular function. Efforts should be made in the research setting to better understand the pathophysiology of malnutrition in HF and to identify useful management strategies for nutritional assessment and supplementation.

References

Cleland J, Khand A, Clark A. The heart failure epidemic: exactly how big is it? Eur Heart J 2001; 22: 623-26. http://dx.doi.org/10.1053/euhj.2000.2493 DOI: https://doi.org/10.1053/euhj.2000.2493

Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics - 2010 update: a report from the American Heart Association. Circulation 2010; 121: e46-e215. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192667 DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.192667

Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology. American Heart Association task force on practice guidelines (writing Committee to update the 2001 guidelines for the evaluation and management of heart failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112: e154-e235. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.167587

Carr JG, Stevenson LW, Walden JA, Heber D. Prevalence and hemodynamic consequences of malnutrition in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1989; 63: 709-13. http://dx.doi.org/10.1016/0002-9149(89)90256-7

Freeman LM, Roubenoff R. The nutrition implications of cardiac cachexia. Nutr Rev 1994; 52: 340-7. http://dx.doi.org/10.1111/j.1753-4887.1994.tb01358.x

Riley M, Elborn JS, McKane WR, Bell N, Stanford CS, Nicholls DP. Resting energy expenditure in chronic cardiac failure. Clin Sci 1991; 80: 633-9.

Pernenkil R, Vinson JM, Shah AS, Beckham V, Wittenberg C, Rich MW. Course and prognosis in patients > or = 70 years of age with congestive heart failure and normal versus abnormal left ventricular ejection fraction. Am J Cardiol 1997; 15; 79(2): 216-9. DOI: https://doi.org/10.1016/S0002-9149(96)00719-9

Heart Failure Society of America, Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM et. al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail 2010; 16(6): e1-194. Available from: http://download.journals.elsevierhealth.com/pdfs/journals/1071-9164/PIIS1071916410001739.pdf DOI: https://doi.org/10.1016/j.cardfail.2010.04.004

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF3rd, Feldman HI, et al. for the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med 2009; 150(9): 604-612. Erratum in: Ann Intern Med 2011; 155(6): 408. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2763564/ DOI: https://doi.org/10.7326/0003-4819-150-9-200905050-00006

Beck AM, Ovesen L. At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk? Clin Nutr 1998; 17(5): 195-98. http://dx.doi.org/10.7326/0003-4819-150-9-200905050-00006 DOI: https://doi.org/10.1016/S0261-5614(98)80058-7

Polge A, Bancel E, Bellex H, Strudel D, Poirex S, Peray P, Carlet C, Magnan De Bornier B. Plasma amino acid concentrations in elderly patients with protein energy malnutrition. Age Ageing 1997; 26: 457-62. http://dx.doi.org/10.1093/ageing/26.6.457 DOI: https://doi.org/10.1093/ageing/26.6.457

Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440-63. http://dx.doi.org/10.1016/j.echo.2005.10.005 DOI: https://doi.org/10.1016/j.echo.2005.10.005

Heymsfield SB, Smith J, Redd S, Whitworth Jr HB. Nutritional support in cardiac failure. Surg Clin North Am 1981; 61: 635-52. DOI: https://doi.org/10.1016/S0039-6109(16)42442-4

Carr JG, Stevenson LW, Walden JA, Heber D. Prevalence and hemodynamic correlates of malnutrition in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1989; 63: 709-13. http://dx.doi.org/10.1016/0002-9149(89)90256-7 DOI: https://doi.org/10.1016/0002-9149(89)90256-7

Cederholm T, Hellström K. Nutritional status in recently hospitalized and free-living elderly subjects. Gerontology 1992; 38: 105-10. http://dx.doi.org/10.1159/000213314 DOI: https://doi.org/10.1159/000213314

Cederholm T, Jägrén C, Hellström K. Nutritional status and performance capacity in internal medical patients. Clin Nutr 1993; 12: 8-14. http://dx.doi.org/10.1016/0261-5614(93)90138-T DOI: https://doi.org/10.1016/0261-5614(93)90138-T

Broqvist M, Arnqvist H, Dahlström U, Larsson J, Nylander E, Permert J. Nutritional assessment and muscle energy metabolism in severe chronic congestive heart failure—effects of long-term dietary supplementation. Eur Heart J 1994; 15: 1641-50. DOI: https://doi.org/10.1093/oxfordjournals.eurheartj.a060447

Anker S, Coats A. Cardiac cachexia. A syndrome with impaired survival and immune and neuroendocrine activation. Chest 1999; 115: 836-47. http://dx.doi.org/10.1378/chest.115.3.836 DOI: https://doi.org/10.1378/chest.115.3.836

Pointdexter SM, Dear WE, Dudrick SJ. Nutrition in congestive heart failure. Nutr Clin Pract 1986; 1: 83-8. DOI: https://doi.org/10.1177/088453368600100204

Cederholm T, Jägrén C, Hellström K. Outcome of protein-energy malnutrition in elderly medical patients. Am J Med 1995; 98: 67-74. http://dx.doi.org/10.1016/S0002-9343(99)80082-5 DOI: https://doi.org/10.1016/S0002-9343(99)80082-5

Anker S, Ponikowski P, Varney S, Chua TP, Clark AL, Webb-Peploe KM, et al. Wasting as independent risk factor of survival in chronic heart failure. Lancet 1997; 349: 1050-3. http://dx.doi.org/10.1016/S0140-6736(96)07015-8 DOI: https://doi.org/10.1016/S0140-6736(96)07015-8

Berkowitz D, Croll MN, Likoff W. Malabsorption as a complication of congestive heart failure. Am J Cardiol 1963; 11: 43-7. http://dx.doi.org/10.1016/0002-9149(63)90029-8 DOI: https://doi.org/10.1016/0002-9149(63)90029-8

Webb JG, Kiess MC, Chan-Yan CC. Malnutrition and the heart. Can Med Assoc J 1986; 135: 753-8. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1491347/pdf/cmaj00127-0035.pdf

Davis D, Baily R, Zelis R. Abnormalities in systemic norepinephrine kinetics in human congestive heart failure. Am J Physiol 1988; 254: E760-6. DOI: https://doi.org/10.1152/ajpendo.1988.254.6.E760

Riley M, Elborn JS, McKane WR, Bell N, Stanford CF, Nicholls DP. Resting energy expenditure in chronic cardiac failure. Clin Sci 1991; 80: 633-9. DOI: https://doi.org/10.1042/cs0800633

Freeman LM, Roubenoff R. The nutrition implications of cardiac cachexia. Nutr Rev 1994; 52: 340-7. http://dx.doi.org/10.1111/j.1753-4887.1994.tb01358.x DOI: https://doi.org/10.1111/j.1753-4887.1994.tb01358.x

Anker SD, Chua TP, Ponikowski P, Harrington D, Swan JW, Kox WJ, et al. Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia. Circulation 1997; 96: 526-34. http://dx.doi.org/10.1161/01.CIR.96.2.526 DOI: https://doi.org/10.1161/01.CIR.96.2.526

Swan JW, Anker SD, Walton C, Godsland IF, Clark AL, Leyva F, et al. Insulin resistance in chronic heart failure: relation to severity and etiology of heart failure. J Am Coll Cardiol 1997; 30: 527-32. http://dx.doi.org/10.1016/S0735-1097(97)00185-X DOI: https://doi.org/10.1016/S0735-1097(97)00185-X

Levine B, Kalman J, Mayer L, Fillit HM, Packer M. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 1990; 323: 236-41. http://dx.doi.org/10.1056/NEJM199007263230405

McMurray J, Abdullah I, Dargie HJ, Shapiro D. Increased concentrations of tumour necrosis factor in ‘cachectic’ patients with severe chronic heart failure. Br Heart J 1991; 66: 356-8. http://dx.doi.org/10.1136/hrt.66.5.356 DOI: https://doi.org/10.1136/hrt.66.5.356

Leyva F, Anker S, Swan JW, Godsland IF, Wingrove CS, Chua TP, et al. Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure. Eur Heart J 1997; 18: 858-65. http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a015352 DOI: https://doi.org/10.1093/oxfordjournals.eurheartj.a015352

Anker SD, Ponikowski P, Clark AL, Leyva F, Rauchaus M, Kemp M, et al. Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure. Eur Heart J 1999; 20: 683-93. http://dx.doi.org/10.1053/euhj.1998.1446 DOI: https://doi.org/10.1053/euhj.1998.1446

Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000; 15: 953-60. http://dx.doi.org/10.1093/ndt/15.7.953 DOI: https://doi.org/10.1093/ndt/15.7.953

Arques S, Ambrosi P. Human serum albumin in the clinical syndrome of heart failure. J Card Fail 2011; 17 (6): 451-8. http://dx.doi.org/10.1016/j.cardfail.2011.02.010 DOI: https://doi.org/10.1016/j.cardfail.2011.02.010

Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990; 15: 458-82. DOI: https://doi.org/10.1016/S0272-6386(12)70364-5

Kaysen G, Chertow GM, Adhikarla R, Young B, Ronco C, Levin NW. Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. Kidney Int 2001; 60: 333-40. http://dx.doi.org/10.1046/j.1523-1755.2001.00804.x DOI: https://doi.org/10.1046/j.1523-1755.2001.00804.x

Landi F, Zuccala G, Gambassi G, Incalzi RA, Manigrasso L, Pagano F, Carbonin P, Bernabei R. Body mass index and mortality among older people living in the community. JAGS 1999; 47: 1072-76. DOI: https://doi.org/10.1111/j.1532-5415.1999.tb05229.x

Lehmann AB, Bassey EJ, Morgan K, Dallosso HM. Normal values for weight, skeletal size and body mass indices in 890 men and women aged over 65 years. Clin Nutr 1991; 10, 18-22. http://dx.doi.org/10.1016/0261-5614(91)90076-O DOI: https://doi.org/10.1016/0261-5614(91)90076-O

Heymsfield SB, Bethel RA, Ansley JD, Gibbs DM, Felner JM, Nutter DO. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J 1978; 95: 584-94. http://dx.doi.org/10.1016/0002-8703(78)90300-9 DOI: https://doi.org/10.1016/0002-8703(78)90300-9

Levine B, Kalman J, Mayer L, Fillit HM, Packer M. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 1990; 323: 236-41. http://dx.doi.org/10.1056/NEJM199007263230405 DOI: https://doi.org/10.1056/NEJM199007263230405

Feldman AM, Combes A, Wagner D, Kadakomi T, Kubota T, Li YY, et al. The role of tumor necrosis factor in the pathophysiology of heart failure. J Am Coll Cardiol 2000; 35: 537-44. http://dx.doi.org/10.1016/S0735-1097(99)00600-2 DOI: https://doi.org/10.1016/S0735-1097(99)00600-2

Aronson D, Mittleman MA, Burger AJ. Interleukin-6 levels are inversely correlated with heart rate variability in patients with decompensated heart failure. J Cardiovasc Electrophys 2001; 12: 294-300. http://dx.doi.org/10.1046/j.1540-8167.2001.00294.x DOI: https://doi.org/10.1046/j.1540-8167.2001.00294.x

Grossman W, Braunwald E. High cardiac output states. In Braunwald E, Ed. Heart Disease, Saunders, Toronto 1984: 807-822.

Frustaci A, Pennestri F, Scoppetta C. Myocardial damage due to hypokalemia and hypophosphatemia. Postgrad Med J 1984; 60: 679-81. http://dx.doi.org/10.1136/pgmj.60.708.679 DOI: https://doi.org/10.1136/pgmj.60.708.679

Potts JL, Dalakos TG, Streeten DHP, Jones T. Cardiomyopathy in an adult with Bartter's syndrome and hypokalemia. Am J Cardiol 1977; 40: 995-99. http://dx.doi.org/10.1016/0002-9149(77)90051-0 DOI: https://doi.org/10.1016/0002-9149(77)90051-0

O'Connor LR, Wheeler WS, Bethune JE. Effect of hypophosphatemia on myocardial performance in man. N Eng J Med 1977; 297: 901-903. http://dx.doi.org/10.1056/NEJM197710272971702 DOI: https://doi.org/10.1056/NEJM197710272971702

Keshan Disease Research Group of the Chinese Academy of Medical Sciences, Beijing: Observations on effect of sodium selenite in prevention of Keshan disease. Chin Med J[Engl] 1979; 92: 471-76.

Johnson RA, Baker SS, Fallon JT, Maynard EP 3rd, Ruskin JN, Wen Z, et al. An occidental case of cardiomyopathy and selenium deficiency. N Eng J Med 1981; 304: 1210-12. http://dx.doi.org/10.1056/NEJM198105143042005 DOI: https://doi.org/10.1056/NEJM198105143042005

Quercia RA, Korn S, O'Neill D, Dougherty JE, Ludwig M, Schweizer R, et al. Selenium deficiency and fatal cardiomyopathy in a patient receiving long-term home parenteral nutrition. Clin Pharm 1984; 3: 531-35. DOI: https://doi.org/10.1093/ajhp/41.11.2498a

Fleming CR, Lie JT, McCall JT, O'Brien JF, Baillie EE, Thistle JL. Selenium deficiency and fatal cardiomyopathy in a patient on home parenteral nutrition. Gastroenterology 1982; 83: 689-93. DOI: https://doi.org/10.1016/S0016-5085(82)80208-4

Stenvinkel P. The role of inflammation in the anaemia of end-stage renal disease. Nephrol Dial Transplant 2001; 16(Suppl 7): 36-40. http://dx.doi.org/10.1093/ndt/16.suppl_7.36 DOI: https://doi.org/10.1093/ndt/16.suppl_7.36

Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomyopathy, morbidity and mortality in endstage renal disease. Am J Kidney Dis 1996; 28: 53-61. http://dx.doi.org/10.1016/S0272-6386(96)90130-4 DOI: https://doi.org/10.1016/S0272-6386(96)90130-4

Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal Syndrome. JACC 2008: 52: 1527-39. Available from: http://ac.els-cdn.com/S0735109708027617/1-s2.0-S0735109708027617-main.pdf?_tid=79424284-b890-11e2-b1ec-00000aacb35d&acdnat=1368094322_1ebb009f65fc 75cd1911a44339a9a796

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2013-06-30

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Santillo, E., Migale, M., Fallavollita, L., Marini, L., Postacchini, D., Balestrini, F., & Incalzi, R. A. (2013). Malnutrition and Left Ventricular Systolic Function in Hospitalized Elderly Patients with and without Heart Failure. Journal of Nutritional Therapeutics, 2(2), 80–88. https://doi.org/10.6000/1929-5634.2013.02.02.3

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