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Cited by 37Heart Failure Treatment and ManagementNutrition and Health in AgingClinical Nutrition and Gastroenterology

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Energy intake during hospital stay predicts all-cause mortality after discharge independently of nutritional status in elderly heart failure patients

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Katano, Satoshi, Yano, Toshiyuki, Kouzu, Hidemichi, Ohori, Katsuhiko, Shimomura, Kanako, Honma, Suguru, Nagaoka, Ryohei, Inoue, Takuya, Takamura, Yuhei, Ishigo, Tomoyuki, Watanabe, Ayako, Koyama, Masayuki, Nagano, Nobutaka, Fujito, Takefumi, Nishikawa, Ryo, Ohwada, Wataru, Hashimoto, Akiyoshi, Katayose, Masaki, Miura, Tetsuji·2021·Clinical Research in Cardiology
DOI 10.1007/s00392-020-01774-yPMC PMC8318973
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Abstract

Objective: Malnutrition is associated with an increased risk of mortality in heart failure (HF) patients. Here, we examined the hypothesis that assessment of energy intake in addition to nutritional status improves the stratification of mortality risk in elderly HF patients. Methods: We retrospectively examined 419 HF patients aged ≥ 65 years (median 78 years, 49% female). Nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF), and daily energy intake was calculated from intake during 3 consecutive days before discharge. Results: During a median 1.52-year period (IQR 0.96–2.94 years), 110 patients (26%) died. Kaplan–Meier survival curves showed that patients with low tertile of daily energy intake had a higher mortality rate than did patients with high or middle tertile of daily energy intake. In multivariate Cox regression analyses, low daily energy intake was independently associated with higher mortality after adjustment for the model including age, sex, BNP, Charlson Comorbidity Index, history of HF hospitalization, and cachexia in addition to MNA-SF. Inclusion of both MNA-SF and energy intake into the adjustment model improved the accuracy of prediction of the mortality after discharge (continuous net reclassification improvement, 0.355, p = 0.003; integrated discrimination improvement, 0.029, p = 0.003). Results of a fully adjusted dose-dependent association analysis showed that risk of all-cause mortality was lowest among HF patients who consumed 31.5 kcal/kg/day of energy. Conclusions: Energy intake during hospital stay is an independent predictor of the mortality in elderly HF patients, and its assessment together with established predictors improves the mortality risk stratification. Graphic abstract:

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Fig. 1 Flow chart of the inclusion of the study subjects
Fig. 1 Flow chart of the inclusion of the study subjectsCC BY · PubMed Central
Fig. 2 Distribution of MNA-SF scores (a) and daily energy intake levels (b). Energy intake (kcal/kg/day) was calculated by dividing energy intake per day by actual body weight. MNA-SF the Mini Nutritional Assessment Short Form
Fig. 2 Distribution of MNA-SF scores (a) and daily energy intake levels (b). Energy intake (kcal/kg/day) was calculated by dividing energy intake per day by actual body weight. MNA-SF the Mini Nutritional Assessment Short FormCC BY · PubMed Central
Fig. 3 Kaplan-Meier survival curves showing impact of nutritional status (a–b) and energy intake (c) on all-cause mortality in HF patients. a HF patients were subdivided into tertile groups (low MNA-SF, ≤ 6; mid MNA-SF, 7–9; high MNA-SF, ≥ 10) according to MNA-SF scores. b HF patients were subdivided according to the standard categorization of nutritional status by MNA-SF scores: normal nutritional status, 12–14; at risk of malnutrition, 8–11; malnutrition, 0–7. c HF patients were subdivided into tertile groups (low EI, ≤ 23.9 kcal/kg/day; mid EI, 24.0–29.8; high EI, ≥ 29.9) according to energy intake per actual body weight. MNA-SF the Mini Nutritional Assessment Short Form
Fig. 3 Kaplan-Meier survival curves showing impact of nutritional status (a–b) and energy intake (c) on all-cause mortality in HF patients. a HF patients were subdivided into tertile groups (low MNA-SF, ≤ 6; mid MNA-SF, 7–9; high MNA-SF, ≥ 10) according to MNA-SF scores. b HF patients were subdivided according to the standard categorization of nutritional status by MNA-SF scores: normal nutritional status, 12–14; at risk of malnutrition, 8–11; malnutrition, 0–7. c HF patients were subdivided into tertile groups (low EI, ≤ 23.9 kcal/kg/day; mid EI, 24.0–29.8; high EI, ≥ 29.9) according to energy intake per actual body weight. MNA-SF the Mini Nutritional Assessment Short FormCC BY · PubMed Central
Fig. 4 Forest plots of hazard ratios and 95% confidence intervals for the all-cause mortality according to nutritional status (a, b) and energy intake (c) in HF patients. All analyses were adjusted for age, gender, log BNP, NYHA functional class, Charlson Comorbidity Index score, history of HF hospitalization, and cachexia. a HF patients were subdivided into tertile groups (low MNA-SF, ≤ 6; mid MNA-SF, 7–9; high MNA-SF, ≥ 10) according to MNA-SF scores. b HF patients were subdivided according to the standard categorization of nutritional status by MNA-SF scores: normal nutritional status, 12–14; at risk of malnutrition, 8–11; malnutrition, 0–7. c HF patients were subdivided into tertile groups (low EI, ≤ 23.9 kcal/kg/day; mid EI, 24.0–29.8; high EI, ≥ 29.9) according to energy intake per actual body weight. d, e Adjusted dose-dependent association of energy intake and all-cause mortality in HF patients. The dotted line represents a hazard ratio of 1.0, the red line represents hazard ratios, and the light red areas represent 95% confidence intervals. Rug plots are shown along the x-axes of the graphs to depict the distributions of daily energy intake levels. All analyses were adjusted for age, gender, log BNP, NYHA functional class, Charlson Comorbidity Index score, history of HF hospitalization, and cachexia. MNA-SF the Mini Nutritional Assessment Short Form, EI daily energy intake, BNP B-type natriuretic peptide, NYHA New York Heart Association, HF heart failure
Fig. 4 Forest plots of hazard ratios and 95% confidence intervals for the all-cause mortality according to nutritional status (a, b) and energy intake (c) in HF patients. All analyses were adjusted for age, gender, log BNP, NYHA functional class, Charlson Comorbidity Index score, history of HF hospitalization, and cachexia. a HF patients were subdivided into tertile groups (low MNA-SF, ≤ 6; mid MNA-SF, 7–9; high MNA-SF, ≥ 10) according to MNA-SF scores. b HF patients were subdivided according to the standard categorization of nutritional status by MNA-SF scores: normal nutritional status, 12–14; at risk of malnutrition, 8–11; malnutrition, 0–7. c HF patients were subdivided into tertile groups (low EI, ≤ 23.9 kcal/kg/day; mid EI, 24.0–29.8; high EI, ≥ 29.9) according to energy intake per actual body weight. d, e Adjusted dose-dependent association of energy intake and all-cause mortality in HF patients. The dotted line represents a hazard ratio of 1.0, the red line represents hazard ratios, and the light red areas represent 95% confidence intervals. Rug plots are shown along the x-axes of the graphs to depict the distributions of daily energy intake levels. All analyses were adjusted for age, gender, log BNP, NYHA functional class, Charlson Comorbidity Index score, history of HF hospitalization, and cachexia. MNA-SF the Mini Nutritional Assessment Short Form, EI daily energy intake, BNP B-type natriuretic peptide, NYHA New York Heart Association, HF heart failureCC BY · PubMed Central
Fig. 5 Kaplan-Meier survival curves showing impact of energy intake on the all-cause mortality in HF patients subdivided according to tertile groups of MNA-SF scores (a) and the standard categorization of nutritional status by MNA-SF scores (b). MNA-SF the Mini Nutritional Assessment Short Form, EI total energy intake
Fig. 5 Kaplan-Meier survival curves showing impact of energy intake on the all-cause mortality in HF patients subdivided according to tertile groups of MNA-SF scores (a) and the standard categorization of nutritional status by MNA-SF scores (b). MNA-SF the Mini Nutritional Assessment Short Form, EI total energy intakeCC BY · PubMed Central

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Metadata

Authors
Katano, S., Yano, T., Kouzu, H., Ohori, K., Shimomura, K., Honma, S., Nagaoka, R., Inoue, T., Takamura, Y., Ishigo, T., Watanabe, A., Koyama, M., Nagano, N., Fujito, T., Nishikawa, R., Ohwada, W., Hashimoto, A., Katayose, M., & Miura, T.
Affiliations
  • Sapporo Medical University Hospital (JP)
  • Sapporo Medical University (JP)
  • Hakodate Goryoukaku Hospital (JP)
  • Hokuto Hospital (JP)
Corresponding author
Yano, Toshiyuki
ORCID
Venue
Clinical Research in Cardiology
Publisher
Springer Science and Business Media LLC
Published
2021-01-05
Volume
110
Issue
8
Pages
1202-1220
ISSN
  • 1861-0684 (ISSN-L)
  • 1861-0692
DOI
10.1007/s00392-020-01774-y
PMC
PMC8318973
OpenAlex
W3120876513
Cited by
37
References
5
Citations by year
2026: 1 · 2025: 5 · 2024: 6 · 2023: 13 · 2022: 8 · 2021: 4
FWCI
5.20
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Research in Cardiology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
the Japan Society for the Promotion of Science (JP18K17677)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
heart failure, elderly patients, energy intake, malnutrition, nutritional status, all-cause mortality, mortality risk stratification, Mini Nutritional Assessment Short Form, cachexia, length of hospital stay, mortality prediction
MeSH terms
Aged, Animals, Energy Intake, Cause of Death, Dogs, Female, Heart Failure, Hospitalization, Humans, Male, Nutritional Status, Patient Discharge, Retrospective Studies, Risk Factors

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