Diagnostic performance of nutritional indicators in patients with heart failure

Abstract

Aims The aim of this study was to compare the diagnostic performance of the nutritional indicators, the mini nutritional assessment‐short form (MNA‐SF), the geriatric nutritional risk index (GNRI), and the controlling nutritional status (CONUT), in heart failure (HF) patients. Methods and results Nutritional status was prospectively assessed by the aforementioned three nutritional indicators in 150 outpatients with HF who were then followed for 1 year. The prevalence of patients with the nutritional risk as assessed by the MNA‐SF, GNRI, and CONUT scores was 50.0%, 13.3%, and 54.0%, respectively. There was slight agreement of nutritional risk assessment between the MNA‐SF and GNRI scores (κ coefficient = 0.16), as well as the GNRI and CONUT scores (κ = 0.11), but poor agreement between the MNA‐SF and CONUT scores (κ = −0.09). The CONUT score had the lowest area under the curve (AUC) for the identification of low body weight, low muscle mass, and low physical function among the three indicators (all P < 0.05). Compared with the MNA‐SF score, both the GNRI and CONUT scores had lower AUCs for the identification of reduced dietary intake and weight loss (all P < 0.05). There was no significant difference in predicting all‐cause mortality or HF rehospitalization among the three indicators. The prescription of statins reduced the diagnostic performance of the CONUT score, as the CONUT score includes cholesterol level assessment. Conclusions Of the three indicators, the diagnostic ability of the MNA‐SF score was the highest, and that of the CONUT score was the lowest, for the assessment of HF patient nutritional status. The CONUT score may misrepresent nutritional status, particularly in patients receiving statins.

Prevalence and impact of malnutrition on readmission among hospitalized patients with heart failure in China

“…Second, some of the patients with HF were treated with statins, which can influence the cholesterol levels. A recent study suggests that statin use affects the efficacy of CONUT, 40 but previous findings are inconsistent. The results of the present study suggest that the effect of statins on CONUT was less, probably because statins were used in similar proportions in all groups in relation to the indications of patients with ischaemic heart disease.…”

The controlling nutritional status score and clinical outcomes in patients with heart failure: Pool analysis of observational studies

“…However, the cut-point for malnutrition by the PNI was inconsistent in different studies, which would hamper its wildly clinical use ( 48 ). It had been cautious that the total cholesterol level was included as a component in calculating the CONUT score, which would overestimate the prevalence of malnutrition in patients with HF, as most of them may receive statins treatment and resulted in a lower total cholesterol level ( 5 ). In the same cohort of patients, it had been shown that the prevalence of malnutrition would be up to 54% when defined by the CONUT, while only 8% when defined by the PNI ( 45 ).…”

“…Early detection of malnutrition in HF would be useful for identifying patients at high risk of poor clinical outcomes and recommending nutritional interventions to improve prognosis (7). Many tools and indexes had been proposed for screening malnutrition; however, no consensus had been made on which to use in patients with HF (5,(8)(9)(10).…”

“…Malnutrition is very common in patients with HF and is associated with a higher risk of mortality and re-hospitalization ( 5 , 6 ). Early detection of malnutrition in HF would be useful for identifying patients at high risk of poor clinical outcomes and recommending nutritional interventions to improve prognosis ( 7 ).…”

Malnutrition and infection lead to poor prognosis and heavy financial burden of patients with chronic heart failure

“…Pharmacotherapy is recommended as the first line therapy on CHF (8,9). But in recent years, some researchers have focused on factors other than pharmacotherapy, for instance nutrition and infection (10)(11)(12). For patients with CHF, Gastrointestinal edema caused by fluid retention often leads to in appetence, and energy intake reduction over a long period of time leads to malnutrition.…”