title: Nutritional status and its effects on muscle wasting in patients with chronic heart failure: insights from Studies Investigating Co-morbidities Aggravating Heart Failure.
abstract: BACKGROUND
  Inadequate nutritional status has been linked to poor outcomes in patients with heart failure (HF). Skeletal muscle wasting affects about 20% of ambulatory patients with HF. The impact of nutritional intake and appetite on skeletal muscle wasting has not been investigated so far. We sought to investigate the impact of nutritional status on muscle wasting and mortality in ambulatory patients with HF.
  
  
  METHODS
  We studied 130 ambulatory patients with HF who were recruited as a part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) program. Muscle wasting was defined according to criteria of sarcopenia, i.e., appendicular skeletal muscle mass two standard deviations below the mean of a healthy reference group aged 18-40 years. Nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Functional capacity was assessed as peak oxygen consumption (peak VO2) by cardiopulmonary exercise testing, 6‑minute walk testing, and the Short Physical Performance Battery (SPPB).
  
  
  RESULTS
  At baseline, 19 patients (15%) presented with muscle wasting. Patients with muscle wasting had significantly lower values of peak VO2, 6‑minute walk distance, SPPB, and MNA-SF score than patients without (all p < 0.05). In multivariate analysis, MNA-SF remained an independent predictor of muscle wasting after adjustment for age and New York Heart Association class (odds ratio [OR] 0.66; confidence interval [CI] 0.50-0.88; p < 0.01). A total of 16 (12%) patients died during a mean follow-up of 21 months. In Cox regression analysis, MNA-SF (OR 0.80, CI 0.64-0.99, p = 0.04), left ventricular ejection fraction (OR 0.93, CI 0.86-0.99, p = 0.05), and peak VO2(OR 0.78, CI 0.65-0.94, p = 0.008) were predictors of death.
  
  
  CONCLUSIONS
  MNA-SF is an independent predictor of muscle wasting and mortality in ambulatory patients with HF. Nutritional screening should be included as a fundamental part of the overall assessment of these patients.
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany. msaitoh@shi.heart.or.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Saitoh
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.|Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Marcelo Rodrigues
authors.initials: MR
authors.lastname: Dos Santos
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ebner
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Amir
authors.initials: A
authors.lastname: Emami
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Konishi
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishida
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Valentova
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Sandek
authors.affiliation: Center for Stroke Research Berlin, and Department of Cardiology, Virchow Klinikum, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, Göttingen, 37099, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002100:Cachexia / Q000175:diagnosis* / Q000401:mortality*; D015984:Causality; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000401:mortality*; D009752:Nutritional Status; D010809:Physical Fitness; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis* / Q000401:mortality*; D017678:Sex Distribution; D015996:Survival Rate; D055815:Young Adult
keywords: Heart failure; Malnutrition; Mini-nutritional assessment; Mortality; Muscle wasting