title: Functional status and heart rate variability in end-stage liver disease patients: association with nutritional status.
abstract: OBJECTIVE
  Muscle dysfunction and reduced heart rate variability (HRV) are common in patients with advanced liver disease, and both are related to poor outcomes. Malnutrition is also highly prevalent in these patients, however, the association between the malnutrition and HRV has not yet been assessed. The aim of this study was to evaluate the short-term HRV, functional and nutritional statuses in patients with advanced liver disease.
  
  
  METHODS
  The nutritional and functional statuses were determined by subjective global assessment, handgrip strength (dynamometer, JAMAR) and gait speed during a 6-minute walk text (6MWT), respectively. The cardiac workload index (CWI) was used to evaluate the cardiac response to the 6MWT. The time domain (SD of all normal-to-normal intervals [SDNN]) and very-low, low-, and high-frequency domains of short-term HRV were evaluated with RS800 CX (Polar, Finland) and Cardioseries software (Brazil).
  
  
  RESULTS
  The study evaluated 42 patients with liver disease (62% men) and malnutrition was found in 62% of this population. The malnourished participants presented with reduced functional status, 41% decreased SDNN, and 14% greater CWI compared with well-nourished individuals (P < 0.05). Additionally, the CWI was negatively associated to SDNN (r = 0.414; P < 0.05) and gait speed (r = 0.598; P < 0.05), especially in malnourished individuals (r = 0.650; P < 0.05). These data indicate that malnourished patients with liver disease have higher cardiovascular risk related to reduced functional status, which may be associated to poor outcomes during the course of the disease before and after transplant. Another relevant aspect is that the 6MWT associated to HRV could be a useful tool to screen liver disease patients who have a higher risk for cardiovascular complications.
authors.affiliation: Department of Surgery, Medical School, Federal University of Minas Gerais, Brazil; Department of Food Science, Pharmacy School, Federal University of Minas Gerais, Brazil. Electronic address: dcarvalholima@gmail.com.
authors.forename: Daniel Carvalho
authors.initials: DC
authors.lastname: de Lima
authors.affiliation: Department of Surgery, Medical School, Federal University of Minas Gerais, Brazil.
authors.forename: Helem Sena
authors.initials: HS
authors.lastname: Ribeiro
authors.affiliation: Department of Nutrition, Nursing School, Federal University of Minas Gerais, Brazil.
authors.forename: Rafaelly
authors.initials: R
authors.lastname: Cristina
authors.affiliation: Department of Nutrition, Nursing School, Federal University of Minas Gerais, Brazil.
authors.forename: Michelle
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Department of Nutrition, Nursing School, Federal University of Minas Gerais, Brazil.
authors.forename: Simone de Vasconcelos
authors.initials: Sde V
authors.lastname: Generoso
authors.affiliation: Department of Surgery, Medical School, Federal University of Minas Gerais, Brazil.
authors.forename: Agnaldo Soares
authors.initials: AS
authors.lastname: Lima
authors.affiliation: Department of Surgery, Medical School, Federal University of Minas Gerais, Brazil.
authors.forename: Maria Isabel Toulson Davisson
authors.initials: MI
authors.lastname: Correia
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D058625:End Stage Liver Disease / Q000150:complications*; D005260:Female; D018737:Hand Strength; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D009752:Nutritional Status; D012307:Risk Factors; D016138:Walking
keywords: Cardiac risk; Handgrip strength; Liver transplantation; Malnutrition; Morbidity; Six-minute walk test