title: Nutritional status of geriatric outpatients with systolic heart failure and its prognostic value regarding death or hospitalization, biomarkers and quality of life.
abstract: BACKGROUND
  The prevalence of malnutrition in ambulatory patients with heart failure is difficult to determine, depending on the timing and methodology.
  
  
  OBJECTIVE
  To determine the nutritional status of outpatients with systolic heart failure with the Mini Nutritional Assessment (MNA) full and short-form versions, and evaluate its relationship with the short-term prognosis, biomarkers and quality of life.
  
  
  METHODS
  Fifty consecutive (70% male), geriatric (74.3+ 6.2years old) stable outpatient with heart failure (NYHA class II 68%, III 32%) and left ventricular ejection fraction of 26.7 +11.5% were included and followed during 12 months. At a routine visit to the heart failure clinic, the MNA, the Minnesota Living with Heart Failure questionnaire (MLHFQ) were applied. According to the MNA screening score the nutritional status was classified using the MNA full (MNA-F) and the short-form (MNA-F) versions of the questionnaire. The recorded events were death and hospitalization.
  
  
  METHODS
  The survival and hospitalizations curves were evaluated with the Log-Rank test and Cox Regression analysis. The association between parameters was analyzed with the Pearson and Spearmann correlation coefficient.
  
  
  RESULTS
  (1) The mortality and hospitalization rates were 12% and 42%, respectively. (2) With the MNA-SF 7.6% of the patients had malnutrition and 20% were at risk of malnutrition. There was a good agreement (90%) between the MNA-SF and the MNA-F classifications. (3) There was a significant relationship between the MNA screening score and the MLHFQ (rs= -0.592 p<0.001), Nt-ProBNP (rs= -0.49 p<0.001) and total plasma protein (r= 0.672 p=0.006); (3) The MNA-SF nutritional classification was associated with the 12 months survival (Log-Rank p=0.044) and hospitalization (Log-Rank p=0.005) curves. (4) Those patients with malnutrition by the MNA-SF were at greater risk of death (HR= 8.0 p=0.059) and hospitalization (HR 8.1 p=0.008).
  
  
  CONCLUSIONS
  The MNA is useful for the evaluation of the nutritional status of elderly outpatients with systolic heart failure. It is a good predictor of the short-term outcome and is also associated with the quality of life and Nt-ProBNP.
authors.affiliation: Heart Failure unit, Cardiology department, Pulido Valente Hospital, Lisbon north Hospital Centre, Lisbon, Portugal. luissargento@netcabo.pt
authors.forename: L
authors.initials: L
authors.lastname: Sargento
authors.forename: M
authors.initials: M
authors.lastname: Satendra
authors.forename: I
authors.initials: I
authors.lastname: Almeida
authors.forename: C
authors.initials: C
authors.lastname: Sousa
authors.forename: S
authors.initials: S
authors.lastname: Gomes
authors.forename: F
authors.initials: F
authors.lastname: Salazar
authors.forename: N
authors.initials: N
authors.lastname: Lousada
authors.forename: R
authors.initials: R
authors.lastname: Palma Dos Reis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D005853:Geriatrics; D054143:Heart Failure, Systolic / Q000150:complications / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D015596:Nutrition Assessment; D009752:Nutritional Status; D010045:Outpatients; D010446:Peptide Fragments / Q000097:blood; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
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