Increased Resting Metabolic Rate in Patients with Congestive Heart Failure

Poehlman, Éric T.; Scheffers, Jolanda; Gottlieb, Stephen S.; Fisher, Michael L.; Vaitekevicius, Peter

doi:10.7326/0003-4819-121-11-199412010-00006

Cited by 194 publications

(132 citation statements)

References 0 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…Recent reports from our laboratory (Poehlman et al, 1994;Obisesan et al, 1996) and others (Riley et al, 1991) showed elevations in resting energy expenditure in stabilized heart failure patients. Additionally, we reported that resting energy needs increased with symptom severity (Obisesan et al, 1996).…”

Section: Discussionmentioning

confidence: 83%

“…Methods for the timing of tests has been previously described (Poehlman et al, 1994;Obisesan et al, 1996). In the morning (0830 h), after a 12 h overnight fast in a darkened and temperature controlled room, resting energy expenditure was measured for 45 min.…”

Section: Testingmentioning

confidence: 99%

“…Regression equations used to predict resting energy expenditure in heart failure patients, unfortunately, have been determined from data collected in healthy individuals (Harris & Benedict, 1919). Recently, we showed that present caloric guidelines underestimated daily caloric needs in heart failure patients (Poehlman et al, 1994) and that daily energy needs are in¯uenced by symptom severity in heart failure (Obisesan et al, 1996). Thus, equations developed in healthy individuals and applied to heart failure patients are probably inaccurate and may compromise nutritional status.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prediction of resting energy needs in older men with heart failure

1997

View full text Add to dashboard Cite

Objectives: Patients with congestive heart failure are often undernourished. The measurement of resting energy expenditure has served as the basis upon which estimates of daily caloric needs have been developed. Resting energy needs, however, in heart failure patients are unknown. We have developed a new equation to predict resting energy needs in heart failure patients that takes into account easily measured clinical variables and symptom severity. Design: Observational. Setting: Baltimore VA Medical Center. Subjects: Forty male patients with heart failure aged, 57±85 y; (27 Class II; 13 Class IV). Measurements: Resting metabolic rate was measured by indirect calorimetry, fat-free mass and fat mass by dual energy X-ray absorptiometry, peak VO 2 by a treadmill test. Symptom severity was measured by the New York Heart Association classi®cation. Ejection fraction, plasma albumin and plasma glucose were also assessed. Results: Stepwise regression analysis showed that body weight, fasting glucose, plasma albumin and New York Heart Association classi®cation accounted for 83% of the variation in resting energy needs. The regression equation had a root mean square error of 130 kcal (544 kJ) per day. The equation is: RMR (kcal/d) 12.2 (wt, kg) 1.6 (glucose, gm/dl) 103 (NYHA; III, IV) 7 144 (albumin, mg/dl) 755. Moreover, prediction equations based on observations in healthy individuals signi®cantly underestimated resting energy needs in heart failure patients. Conclusion: We offer a new equation to predict resting energy needs in heart failure patients based upon readily available clinical measurements. Further studies are needed to cross-validate our equation.

show abstract

Section: Discussionmentioning

confidence: 83%

Section: Testingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of resting energy needs in older men with heart failure

1997

View full text Add to dashboard Cite

show abstract

“…Increased sympathetic activity can contribute to cachexia by increasing total body energy expenditure,13 which can be reduced with β‐blockade,14 and by exerting direct myotoxic effects on skeletal muscle,15, 16 again attenuated by beta‐blockade 18. Blockade of β 2 ‐receptors seems to have a more profound effect than blockade of β 1 ‐receptors 5, 18.…”

Section: Discussionmentioning

confidence: 99%

Effect of beta‐adrenergic blockade with carvedilol on cachexia in severe chronic heart failure: results from the COPERNICUS trial

Clark

Coats

Krum

et al. 2017

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

BackgroundCardiac cachexia frequently accompanies the progression of heart failure despite the use of effective therapies for left ventricular dysfunction. Activation of the sympathetic nervous system has been implicated in the pathogenesis of weight loss, but the effects of sympathetic antagonism on cachexia are not well defined.MethodsWe prospectively evaluated changes in body weight in 2289 patients with heart failure who had dyspnoea at rest or on minimal exertion and a left ventricular ejection fraction <25%. Patients were randomly assigned (double‐blind) to receive either placebo (n = 1133) or carvedilol (n = 1156) and were followed for the occurrence of major clinical events for up to 29 months (COPERNICUS trial). Patients were not enrolled if they had signs of clinically significant fluid retention due to heart failure.ResultsPatients in the carvedilol group were 33% less likely than patients in the placebo group to experience a further significant loss of weight (>6%) (95% confidence interval: 14–48%, P = 0.002) and were 37% more likely to experience a significant gain in weight (≥5%) (95% confidence interval: 12–66%, P = 0.002). Carvedilol's ability to prevent weight loss was most marked in patients with increased body mass index at baseline, whereas its ability to promote weight gain was most marked in patients with decreased body mass index at baseline. Increases in weight were not accompanied by evidence of fluid retention. Baseline values for body mass index and change in body weight were significant predictors of survival regardless of treatment.ConclusionsCarvedilol attenuated the development and promoted a partial reversal of cachexia in patients with severe chronic heart failure, supporting a role for prolonged sympathetic activation in the genesis of weight loss.

show abstract

“…Another factor that could favour ketogenesis in CHF is an imbalance between the supply and need of calories. Malnutrition is not rare and is thought to reflect reductions in food intake and absorption as well as increased basal metabolism and possibly cellular hypoxia [2,3,4,[20][21][22]. Increased secretion of tumour necrosis factor may also contribute [23,24].…”

Section: Discussionmentioning

confidence: 99%

Heart failure ketosis

Lommi¹,

Koskinen²,

Näveri³

et al. 1997

Journal of Internal Medicine

View full text Add to dashboard Cite

Abstract. Lommi J, Koskinen P, Näveri M, Härkönen M, Kupari M (Helsinki University Central Hospital, Helsinki, Finland). Heart failure ketosis. J Intern Med 1997; 242: 231-8.Objective. To assess whether blood ketone bodies are increased in congestive heart failure (CHF). Methods. Thirteen patients with CHF and 11 cardiac patients without CHF took part in the study. Blood acetoacetate and b-hydroxybutyrate levels and the pertinent metabolic and hormonal milieu were measured during 20 h fast and after 2 h glucose infusion. Results. The averaged blood ketone body and free fatty acid levels were significantly higher during the fast and also remained higher after glucose infusion in patients with CHF than in the control group. The areas under ketone body concentration time curve over the last 8 h of the fast were 3522 Ϯ 662 mol L Ϫ1 h Ϫ1 (SE) and 1789 Ϯ 192 mol L Ϫ1 h Ϫ1 in patients with and without CHF, respectively (P = 0.022). Circulating noradrenaline and growth hormone were higher but glucagon lower in patients with CHF than in the controls (P Ͻ 0.05 for all differences) whereas the glucose and insulin concentrations were comparable in the study groups. At the time of peak ketonaemia, the glucagon-to-insulin ratio was lower in patients with CHF than in patients without CHF (P ϭ 0.04). Conclusions. These data suggest that severe CHF is a ketosis-prone state. Augmented supply of free fatty acids for ketogenesis due to increased stress hormone-related lipolysis is one likely mechanism.

show abstract

Increased Resting Metabolic Rate in Patients with Congestive Heart Failure

Cited by 194 publications

References 0 publications

Prediction of resting energy needs in older men with heart failure

Prediction of resting energy needs in older men with heart failure

Effect of beta‐adrenergic blockade with carvedilol on cachexia in severe chronic heart failure: results from the COPERNICUS trial

Heart failure ketosis

Contact Info

Product

Resources

About