Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Cordoba, Spain.
Nuclear Medicine Service, Reina Sofia University Hospital, 14004 Cordoba, Spain.
Nutrients. 2024 May 20;16(10):1535. doi: 10.3390/nu16101535.
Although malnutrition is frequently observed in patients with heart failure (HF), this diagnosis should be performed carefully since HF itself is associated with increased inflammatory activity, which affects body weight, functionality, and some nutritional parameters; thus, its isolated interpretation can erroneously identify surrogate markers of severity as markers of malnutrition. In this context, we aimed to evaluate the prevalence of malnutrition using different classification systems and perform a comprehensive nutritional evaluation to determine the reliability of different diagnostic techniques.
Eighty-three patients with a recent hospital admission due to HF were evaluated. GLIM diagnosis criteria and subjective global assessment (SGA) were performed; a comprehensive anthropometric, functional, and biochemical nutritional evaluation was performed, in which bioelectrical impedance analysis (BIA), nutritional ultrasound, and dual-energy X-ray absorptiometry (DXA) were performed. Additionally, mortality and additional admissions due to HF were determined after a mean follow up of 18 months.
Malnutrition according to the GLIM criteria (54%) accurately distinguished patients with impaired functionality, lower lean mass, skeletal mass index, and appendicular muscle mass (BIA), as well as lower trunk fat mass, trunk lean mass, fat-free mass (DXA), and decreased albumin and increased C-reactive protein serum levels. According to SGA, there were significant changes in body composition parameters determined by BIA, muscle ultrasound, and functional tests between well-nourished patients and patients with risk of malnutrition (53.7%) or who had malnutrition (7.1%), but not when the last two groups were compared. BIA and DXA showed strong correlations when evaluating muscle and fat mass in HF patients, but correlations with nutritional ultrasound were limited, as well as functional tests. A multivariate analysis showed that no significant association was observed between body composition and mortality, but preperitoneal fat was associated with an increased risk of new hospital admissions (OR: 0.73).
GLIM criteria identified a lower percentage of patients with HF and malnutrition compared with SGA; thus, SGA could have a role in preventing malnutrition in HF patients. Nutritional evaluation with BIA and DXA in patients with HF showed reliable results of body composition parameters in HF, and both help with the diagnosis of malnutrition according to the GLIM or SGA criteria and could provide complementary information in some specific cases.
尽管心力衰竭（HF）患者经常出现营养不良，但应谨慎进行这一诊断，因为 HF 本身与炎症活性增加有关，这会影响体重、功能和一些营养参数；因此，将其孤立地解释可能会错误地将严重程度的替代标志物识别为营养不良的标志物。在这种情况下，我们旨在使用不同的分类系统评估营养不良的患病率，并进行全面的营养评估，以确定不同诊断技术的可靠性。
评估了 83 名因 HF 最近住院的患者。进行了 GLIM 诊断标准和主观整体评估（SGA）；进行了全面的人体测量、功能和生化营养评估，其中进行了生物电阻抗分析（BIA）、营养超声和双能 X 射线吸收法（DXA）。此外，在平均 18 个月的随访后，确定了死亡率和因 HF 再次入院的情况。
根据 GLIM 标准（54%）诊断的营养不良准确地区分了功能受损、瘦体重、骨骼质量指数和四肢肌肉质量（BIA）较低的患者，以及躯干脂肪质量、躯干瘦体重、无脂肪质量（DXA）较低的患者，以及白蛋白降低和 C 反应蛋白血清水平升高的患者。根据 SGA，在 BIA、肌肉超声和功能测试确定的体成分参数方面，营养良好的患者与营养不良风险（53.7%）或营养不良（7.1%）的患者之间存在显著变化，但后两组之间没有变化。BIA 和 DXA 显示出 HF 患者肌肉和脂肪质量评估之间的强相关性，但与营养超声的相关性有限，与功能测试的相关性也有限。多变量分析显示，体成分与死亡率之间没有显著相关性，但腹膜前脂肪与新住院的风险增加相关（OR：0.73）。
与 SGA 相比，GLIM 标准识别出 HF 和营养不良患者的比例较低；因此，SGA 可能在预防 HF 患者的营养不良方面发挥作用。HF 患者的 BIA 和 DXA 营养评估显示 HF 患者体成分参数的可靠结果，两者均有助于根据 GLIM 或 SGA 标准诊断营养不良，并在某些特定情况下提供补充信息。
