title: Nutritional Status is Associated with Inflammation and Predicts a Poor Outcome in Patients with Chronic Heart Failure.
abstract: OBJECTIVE
  Malnutrition has been identified to be an independent predictor of morbidity and mortality in patients with chronic heart failure (CHF). However, the pathophysiological mechanisms underlying this pathway remain unclear.
  
  
  METHODS
  Nutritional screening was performed using the controlling nutritional status (CONUT) score, which was calculated using the serum albumin and total cholesterol levels and lymphocyte number, in 114 CHF patients with a mean left ventricular ejection fraction of 26.6%±6.4%. The carotid intima-media thickness (CIMT) is correlated with carotid atherosclerosis and is a significant predictor of future cardiovascular events. Peripheral blood mononuclear cells (PBMCs) were isolated, and the production of monocyte tumor necrosis factor (TNF)-α was measured and expressed as mean±SD (pg/mL/10(6) PBMCs).
  
  
  RESULTS
  A multivariate linear regression analysis showed that the production of monocyte TNF-α (β coefficient=0.434, p＜0.001) and mean CIMT (β coefficient=0.204, p=0.006) were independent determinants of the CONUT score. During a median follow-up of 67.5 months, 45 patients experienced cardiac events, including 16 cardiac deaths and 29 readmissions for worsening CHF. A multivariate Cox hazard analysis demonstrated that a monocyte TNF-α level of ≥4.1 pg/mL/10(6) PBMCs (hazard ratio (HR), 14.10; 95% confidence interval (CI), 2.55-77.92; p=0.002) and CONUT score of ≥3 (HR, 11.97; 95% CI, 2.21-64.67; p=0.004) were independently associated with the incidence of cardiac events.
  
  
  CONCLUSIONS
  These data indicate that a poor nutritional status as assessed using the CONUT score and atherosclerosis as indicated by CIMT is significantly associated with inflammation and predicts poor outcomes in patients with CHF.
authors.affiliation: Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakagomi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kohashi
authors.forename: Taichirou
authors.initials: T
authors.lastname: Morisawa
authors.forename: Munenori
authors.initials: M
authors.lastname: Kosugi
authors.forename: Ikuko
authors.initials: I
authors.lastname: Endoh
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kusama
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Atarashi
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D059168:Carotid Intima-Media Thickness; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D007963:Leukocytes, Mononuclear / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism / Q000473:pathology*; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha