University of Michigan, Ann Arbor, Michigan.
Columbia University, New York, New York.
JACC Heart Fail. 2020 Sep;8(9):756-764. doi: 10.1016/j.jchf.2020.04.004. Epub 2020 Jul 8.
The purpose of this study was to evaluate the relationship between calorie intake and post-discharge outcomes in hospitalized patients with heart failure (HF).
Malnutrition increases adverse outcomes in HF, and dietary sodium restriction may inadvertently worsen nutritional intake.
In a dietary intervention trial, baseline nutritional intake in HF inpatients was estimated using the Block Food Frequency Questionnaire (FFQ), and the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs, and a 15-point micronutrient deficiency score was created. Adjusted linear, logistic, and negative binomial regression were used to evaluate associations between insufficient calorie intake and quality of life (using the Kansas City Cardiomyopathy Questionnaire Clinical Summary [KCCQ-CS]), readmission risk, and days rehospitalized over 12 weeks.
Among 57 participants (70 ± 8 years of age; 31% female; mean body mass index 32 ± 8 kg/m); median sodium and calorie intake amounts were 2,987 mg/day (interquartile range [IQR]: 2,160 to 3,540 mg/day) and 1,602 kcal/day (IQR: 1,201 to 2,142 kcal/day), respectively; 11% of these patients were screened as malnourished by the NRI. All patients consuming <2,000 mg/day sodium had insufficient calorie intake; this group also more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient calorie intake had less improvement in the KCCQ-CS score (β = -14.6; 95% confidence interval [CI]: -27.3 to -1.9), higher odds of readmission (odds ratio: 14.5; 95% CI: 2.2 to 94.4), and more days rehospitalized (incident rate ratio: 31.3; 95% CI: 4.3 to 229.3).
Despite a high prevalence for obesity and rare overt malnutrition, insufficient calorie intake was associated with poorer post-discharge quality of life and increased burden of readmission in patients with HF. Inpatient dietary assessment could improve readmission risk stratification and identify patients for nutritional intervention. (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure [GOURMET-HF] NCT02148679).
本研究旨在评估住院心力衰竭（HF）患者热量摄入与出院后结局的关系。
营养不良增加 HF 的不良结局，而膳食钠限制可能无意中导致营养摄入恶化。
在一项饮食干预试验中，使用 Block 食物频率问卷（FFQ）估计 HF 住院患者的基线营养摄入，并计算营养风险指数（NRI）。热量摄入不足定义为<90%的代谢需求，创建 15 分微量营养素缺乏评分。使用调整后的线性、逻辑和负二项回归评估热量摄入不足与生活质量（使用堪萨斯城心肌病问卷临床总结[KCCQ-CS]）、再入院风险和 12 周内再住院天数之间的关系。
在 57 名参与者（70 ± 8 岁；31%女性；平均体重指数 32 ± 8kg/m²）中；中位钠和热量摄入量分别为 2987mg/天（四分位距[IQR]：2160 至 3540mg/天）和 1602kcal/天（IQR：1201 至 2142kcal/天）；11%的患者通过 NRI 筛查为营养不良。所有摄入<2000mg/天钠的患者均存在热量摄入不足；该组也更频繁地出现膳食微量营养素和蛋白质缺乏。在 12 周时，热量摄入不足的患者 KCCQ-CS 评分改善较少（β=-14.6；95%置信区间[CI]：-27.3 至-1.9），再入院的可能性更高（比值比：14.5；95%CI：2.2 至 94.4），再住院天数更多（发病率比：31.3；95%CI：4.3 至 229.3）。
尽管肥胖患病率高，且明显营养不良罕见，但 HF 患者热量摄入不足与出院后生活质量下降和再入院负担增加相关。住院患者的膳食评估可改善再入院风险分层，并识别需要营养干预的患者。（老年心力衰竭院外随机膳食试验[GOURMET-HF]NCT02148679）。
