Body mass index, body fat, and nutritional status of patients with heart failure: The PLICA study

Summary Background & aims Nutritional assessment may help to explain the incompletely understood obesity paradox in patients with heart failure (HF). Currently, obesity is usually identified by body mass index (BMI). Our objective was to assess the prognostic influence of undernourishment in HF...

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Published in:Clinical nutrition (Edinburgh, Scotland) Scotland), 2015-12, Vol.34 (6), p.1233-1238
Main Authors: Gastelurrutia, Paloma, Lupón, Josep, de Antonio, Marta, Zamora, Elisabet, Domingo, Mar, Urrutia, Agustín, Altimir, Salvador, Coll, Ramon, Díez, Crisanto, Bayes-Genis, Antoni
Format: Article
Language:English
Subjects:
Adiposity
Aged
Aged, 80 and over
Body Mass Index
Female
Follow-Up Studies
Gastroenterology and Hepatology
Heart failure
Heart Failure - physiopathology
Humans
Male
Malnutrition - diagnosis
Malnutrition - physiopathology
Middle Aged
Nutrition Assessment
Nutritional assessment
Nutritional Status
Obesity - physiopathology
Obesity paradox
Outpatients
Overweight - physiopathology
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Undernourishment
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Summary:Summary Background & aims Nutritional assessment may help to explain the incompletely understood obesity paradox in patients with heart failure (HF). Currently, obesity is usually identified by body mass index (BMI). Our objective was to assess the prognostic influence of undernourishment in HF outpatients. Methods Two published definitions of undernourishment were used to assess 214 ambulatory HF patients. Definition 1 included albumin, total lymphocyte count, tricipital skinfold (TS), subscapular skinfold, and arm muscle circumference (AMC) measurements (≥2 below normal considered undernourishment). Definition 2 included TS, AMC, and albumin (≥1 below normal considered undernourishment). Patients were also stratified by BMI and body fat percentage and followed for 2 years. All-cause death or HF hospitalization was the primary endpoint. Results Based on BMI strata, among underweight patients, 60% and 100% were undernourished by Definitions 1 and 2, respectively (31% and 44% among normal-weight, 4% and 11% among overweight, and 0% and 3% among obese patients, respectively, according to the two definitions). The most prevalent undernourishment type was marasmus-like (18% of the total cohort). Undernourishment by both definitions was significantly associated with lower event-free survival. Following multivariable analysis, age, NYHA functional class, NTproBNP, and undernourishment (hazard ratio [HR] 2.25 [1.11–4.56] and 2.24 [1.19–4.21] for Definitions 1 and 2, respectively) remained in the model. In this cohort, BMI and percentage of body fat did not independently predict 2-year event-free survival. Conclusions Nutritional status is a key prognostic factor in HF above and beyond BMI and percentage of body fat. Patients in normal BMI range and even in overweight and obese groups showed undernourishment. The high mortality observed in undernourishment, infrequent in high BMI patients, may help to partly explain the obesity paradox. Proper undernourishment assessment should become routine in patients with HF.
ISSN:0261-5614
1532-1983
DOI:10.1016/j.clnu.2014.12.013