Energy Metabolism and Nutritional Status in Hospitalized Patients with Chronic Heart Failure

Abstract

Introduction: Malnutrition is a factor that defines vital prognosis in chronic heart failure. Objective: This study investigated nutritional and metabolic disorders in patients with heart failure by examining the association of severity of heart failure with inflammatory cytokines, appetite-regulating hormones, and energy metabolism. Methods: Subjects were 50 patients with heart failure. On admission, nutritional status was assessed, and biochemical blood tests were performed, including for serum tumor necrosis factor-α, interleukin-6, ghrelin, and leptin levels. Resting energy expenditure (REE) was also measured by indirect calorimetry to examine its association with severity of heart failure and levels of inflammatory cytokines and appetite-regulating hormones. Results: There were significant associations between serum brain natriuretic peptide (BNP) level and nutrition indices, indicating that nutritional status was worse when heart failure was more severe. Inflammatory cytokine levels showed significant positive correlations with BNP level. Measured REE/bodyweight was not associated with severity of heart failure, but was negatively correlated with body fat percentage and leptin levels. Conclusions: Energy metabolism was not associated with serum BNP level among patients with heart failure with New York Heart Association functional class up to III. Body fat percentage and leptin levels may be a good predictor of energy metabolism in patients with heart failure.

Nutritional status and body composition of patients hospitalized due to exacerbated heart failure

“…These data corroborate previously published results [3,4,6]. Yasuhara et al [5] concluded in their study that body fat percentage (in BIA) might be a good predictor of energy metabolism and prognosis in CHF patients. Multifactorial analysis by Thomas et al [11] found that a higher body fat mass index (BFMI = FM / body surface area) determined using BIA was an independent prognostic factor of five-year survival in CHF patients (an 11% decrease in mortality risk for every 1 kg/m 2 increase in BFMI), and the combination of low BFMI and lean body mass index increased the risk of all-cause mortality in CHF patients by nearly five times.…”

“…Therefore, it is very important to recognize all the factors that may potentially affect the course of CHF, in order to prevent its exacerbation and reduce the need for hospitalization [1,2]. One of multiple such factors seems to be patients' nutritional status [1][2][3][4][5][6], and especially that the provision of nutritional support can improve the outcomes of patients with CHF [7]. In CHF patients, assessing nutritional status on the basis of anthropometric parameters is not reliable, i.a.…”

Association of Serum Adipokines and Resting Energy Expenditure in Patients with Chronic Kidney Disease

“…However, IL-6 appeared not to be associated with REE in our cohort, as has been reported in patients with HF. 27 We consider that a relatively lower IL-6 level (median, 4.0 pg/mL; range, 2.4-9.5 pg/mL) in our cohort, compared with patients with lung cancer 15 and in ammatory-bowel disease, 53 represents a stable clinical state, which may mask a potential relationship between IL-6 and REE.…”

“…33 A positive association between REE and leptin was observed in cross-sectional studies involving 40 to 50 patients with chronic obstructive pulmonary disease (COPD) 17 or heart failure (HF). 27 Leptin administration in obese or normal participants increased energy expenditure and food intake. Conversely, leptin receptor antagonists reduced REE in patients with lipodystrophy.…”

“…38 However, observational studies involving patients with COPD, HF, and obesity have shown inconsistent ndings on the association between REE and adiponectin values. 17,27,39 On the basis of myriad pathologies of diseases, we need to explore whether using adiponectin as an agonist or antagonist can modulate energy expenditure in each speci c disease. Although our data did not support an independent effect of adiponectin on energy expenditure, we still cannot exclude the possibility that adiponectin plays a role in energy balance through its modulating effect via other pathways (e.g., food intake) in CKD.…”