Department of Nursing, Kagoshima Medical Association Hospital, Kagoshima, Japan.
Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Clin Nutr ESPEN. 2023 Jun;55:364-372. doi: 10.1016/j.clnesp.2023.04.006. Epub 2023 Apr 19.
Evidence for the influence of resting energy expenditure (REE)-based energy intake on the outcomes of patients with heart failure (HF) is scarce. This study evaluates the relationship between REE-based energy intake sufficiency and clinical outcomes in hospitalized HF patients.
This prospective observational study included newly admitted patients with acute HF. REE was measured using indirect calorimetry at baseline and total energy consumption (TEE) was calculated by multiplying REE with activity index. Energy intake (EI) was recorded, and the patients were classified into two groups, namely, the energy intake sufficiency (i.e., EI/TEE ≥1) and energy intake deficiency groups (i.e., EI/TEE <1). The primary outcome was the performance of activities of daily living, assessed using the Barthel Index, at discharge. Other outcomes included dysphagia at discharge and all-cause 1-year mortality following discharge. Dysphagia was defined as a Food Intake Level Scale (FILS) score of <7. Multivariable analyses and Kaplan-Meier estimates were used to determine the association of energy sufficiency both at baseline and at discharge with the outcomes of interest.
The analysis included 152 patients (mean age, 79.7 years; 51.3% women); of them, 40.1% and 42.8% had inadequate energy intake both at baseline and at discharge, respectively. In multivariable analyses, energy intake sufficiency at discharge was significantly associated with the BI (β = 0.136, p = 0.002) and FILS score (odds ratio = 0.027, p < 0.001) at discharge. Moreover, energy intake sufficiency at discharge was associated with 1-year mortality after discharge (p < 0.001).
Adequate energy intake during hospitalization was associated with improved physical and swallowing functions and 1-year survival in HF patients. Adequate nutritional management is essential for hospitalized HF patients, suggesting that adequate energy intake may lead to optimal outcomes.
关于静息能量消耗（REE）为基础的能量摄入对心力衰竭（HF）患者结局影响的证据有限。本研究评估了住院 HF 患者中 REE 为基础的能量摄入充足与临床结局之间的关系。
这是一项前瞻性观察性研究，纳入了新入院的急性 HF 患者。在基线时使用间接热量测定法测量 REE，并通过将 REE 乘以活动指数来计算总能量消耗（TEE）。记录能量摄入（EI），并将患者分为两组，即能量摄入充足组（EI/TEE≥1）和能量摄入不足组（EI/TEE＜1）。主要结局为出院时日常生活活动能力的表现，采用巴氏指数（Barthel Index）评估。其他结局包括出院时的吞咽困难和出院后 1 年的全因死亡率。吞咽困难定义为食物摄入水平量表（Food Intake Level Scale，FILS）评分＜7。采用多变量分析和 Kaplan-Meier 估计来确定基线和出院时能量充足与相关结局的关联。
分析纳入了 152 名患者（平均年龄 79.7 岁，51.3%为女性）；其中，基线和出院时分别有 40.1%和 42.8%的患者能量摄入不足。在多变量分析中，出院时的能量摄入充足与 BI（β=0.136，p=0.002）和 FILS 评分（比值比=0.027，p＜0.001）在出院时显著相关。此外，出院时的能量摄入充足与出院后 1 年死亡率相关（p＜0.001）。
住院期间摄入充足的能量与 HF 患者的身体和吞咽功能改善以及 1 年生存率相关。充足的营养管理对住院 HF 患者至关重要，提示摄入充足的能量可能会带来最佳结局。
