Prokopidis Konstantinos, Chen Yang, Liu Yang, Zhong Ziyi, Morwani-Mangnani Jordi, Cuthbertson Daniel J, Sankaranarayanan Rajiv, Lip Gregory Y H, Isanejad Masoud
Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
ESC Heart Fail. 2025 Mar 12. doi: 10.1002/ehf2.15263.
Malnutrition is increasingly recognized as a significant factor influencing the clinical outcomes of patients with heart failure (HF). Diabetes exacerbates risks like hospitalizations and mortality due to cardiovascular complications. The aim of this study was to explore the association of malnutrition with diabetes and its prognostic impact on all-cause and cardiovascular mortality in patients with HF, using the nutritional assessment tools, controlling nutritional status (CONUT) score and geriatric nutritional risk index (GNRI).
Data were obtained from the National Health and Nutrition Examination Survey (1999-2018). Malnutrition was assessed using the CONUT score and GNRI. Multivariate logistic regression models were used to assess the association between malnutrition and diabetes. And Cox proportional hazards models were used to assess the risk of death from malnutrition combined with or without diabetes in HF separately. In addition, propensity score matching and inverse probability weighting were used to adjust for confounders for logistic regression model and Cox proportional hazards model analyses. Finally, subgroup analyses were performed. This study included 1501 HF participants (median age 70.0 years; 43.8% females), including 586 (39.0%) with diabetes. Continuous CONUT was significantly associated with diabetes in HF (OR 1.19, 95% CI: 1.08-1.32, P < 0.001) and remained significant after propensity score matching and inverse probability weighting. Similar relationships exist for categorized CONUT, but GNRI was not associated with diabetes in HF. Then, 1500 participants completed follow-up (5.6 [2.8-9.7] years). Elevated continuous CONUT was related to higher all-cause (HR = 1.18, 95% CI: 1.09-1.29, P < 0.001) and cardiovascular mortality (HR = 1.26, 95% CI: 1.12-1.42, P < 0.001) in HF patients with diabetes. And increased continuous CONUT was linked to higher all-cause (HR = 1.12, 95% CI: 1.03-1.22, P < 0.001) and cardiovascular mortality (HR = 1.20, 95% CI: 1.07-1.35, P < 0.001) in HF patients without diabetes. Similar relationships exist for categorized CONUT.
Malnutrition assessed by CONUT is linked to higher diabetes prevalence in HF, influenced by altered albumin, cholesterol and lymphocyte levels. CONUT also predicts all-cause and cardiovascular mortality in HF with and without diabetes. Future research should consider dietary assessments and body composition analysis to assess malnutrition in HF patients.
营养不良日益被视为影响心力衰竭（HF）患者临床结局的重要因素。糖尿病会加剧因心血管并发症导致的住院和死亡等风险。本研究的目的是使用营养评估工具——控制营养状况（CONUT）评分和老年营养风险指数（GNRI），探讨营养不良与糖尿病的关联及其对HF患者全因死亡率和心血管死亡率的预后影响。
数据来自国家健康与营养检查调查（1999 - 2018年）。使用CONUT评分和GNRI评估营养不良情况。采用多变量逻辑回归模型评估营养不良与糖尿病之间的关联。并使用Cox比例风险模型分别评估合并或不合并糖尿病的HF患者因营养不良导致的死亡风险。此外，使用倾向评分匹配和逆概率加权对逻辑回归模型和Cox比例风险模型分析中的混杂因素进行调整。最后进行亚组分析。本研究纳入了1501名HF参与者（中位年龄70.0岁；43.8%为女性），其中586名（39.0%）患有糖尿病。HF患者中，CONUT连续评分与糖尿病显著相关（OR = 1.19，95%CI：1.08 - 1.32，P < 0.001），在倾向评分匹配和逆概率加权后仍具有显著性。分类后的CONUT也存在类似关系，但GNRI与HF患者的糖尿病无关。然后，1500名参与者完成了随访（5.6[2.8 - 9.7]年）。在患有糖尿病的HF患者中，CONUT连续评分升高与全因死亡率（HR = 1.18，95%CI：1.09 - 1.29，P < 0.001）和心血管死亡率（HR = 1.26，95%CI：1.12 - 1.42，P < 0.001）较高相关。在无糖尿病的HF患者中，CONUT连续评分升高与全因死亡率（HR = 1.12，95%CI：1.03 - 1.22，P < 0.001）和心血管死亡率（HR = 1.20，95%CI：1.07 - 1.35，P < 0.001）较高相关。分类后的CONUT也存在类似关系。
通过CONUT评估的营养不良与HF患者中较高的糖尿病患病率相关，这受到白蛋白、胆固醇和淋巴细胞水平变化的影响。CONUT还可预测合并或不合并糖尿病的HF患者的全因死亡率和心血管死亡率。未来的研究应考虑进行饮食评估和身体成分分析，以评估HF患者的营养不良情况。
