Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association

In the paper

“Specifically in HF, a low-flow or congestive state impairs nutrient delivery and absorption, with associated decreased appetite, gastrointestinal dysfunction, and malnutrition.94”

What the sources say

• Supported

  Section 2.1 (Hemodynamic Alterations; page unavailable) links heart failure to tissue hypoperfusion and intestinal congestion, which can cause satiety, nausea, reduced intake, and enteric albumin loss. Section 2 (Causes and Pathophysiological Mechanisms; page unavailable) also states that heart failure can cause malnutrition through altered appetite, food intake, and nutrient malabsorption. Together, these support the citing sentence as a broad paraphrase. (LLM, conf=0.88)

  cites [94] Esteban-Fernandez A, Villar-Taibo R, Alejo M, Arroyo D, Bonilla Palomas JL, Cachero M, Joaquin C, Mendez Bailon M, Perez-Rivera JA, Romero-Vigara JC, Diagnosis and management of malnutrition in patients with heart failure. J Clin Med. 2023; 12: 3320. doi: 10.3390/jcm12093320 37176761 PMC10179706 source

In the paper

“There are, however, safety concerns about augmenting dietary protein above the 0.8 g·kg−1·d−1 range, especially from animal sources, because of concerns of accelerating coronary artery disease and HF incidence, as well as the potential for accelerating CKD progression.123–125”

What the sources say

• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [123] Virtanen HEK, Voutilainen S, Koskinen TT, Mursu J, Tuomainen T-P, Virtanen JK. Intake of different dietary proteins and risk of heart failure in men. Circ Heart Fail. 2018; 11: 1– 12. doi: 10.1161/circheartfailure.117.004531 PMC6023591 29844244 sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion (page not supplied) describes an association between red-meat consumption and cardiovascular risk, supporting that part of the safety concern. It does not establish a risk threshold above 0.8 g/kg/day, address heart-failure incidence, or show that increased protein intake accelerates chronic kidney disease progression; its renal findings concern metabolite excretion in healthy participants. (LLM, conf=0.88)

  cites [124] Wang Z, Bergeron N, Levison BS, Li XS, Chiu S, Jia X, Koeth RA, Li L, Wu Y, Tang WHW, Impact of chronic dietary red meat, white meat, or non-meat protein on trimethylamine N-oxide metabolism and renal excretion in healthy men and women. Eur Heart J. 2019; 40: 583– 594. doi: 10.1093/eurheartj/ehy799 30535398 PMC6374688 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [125] Levey AS, Greene T, Sarnak MJ, Wang X, Beck GJ, Kusek JW, Collins AJ, Kopple JD. Effect of dietary protein restriction on the progression of kidney disease: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) study. Am J Kidney Dis. 2006; 48: 879– 888. doi: 10.1053/j.ajkd.2006.08.023 17162142 source

In the paper

“In fact, sarcopenic obesity, when lean mass wasting and fat mass expansion occur concurrently, is increasingly recognized and may incur a distinct phenotype of low physical functioning and higher mortality rates, especially in older adults with HF.87,88”

What the sources say

• Supported

  The Background defines sarcopenic obesity as reduced lean body mass alongside excess adiposity. The Abstract Results report lower physical-performance scores, shorter walking distance, and higher one-year mortality in the sarcopenia/obesity group of older patients hospitalized with heart failure; the Conclusion identifies it as a risk factor for low physical function and all-cause death. (LLM, conf=0.91)

  cites [87] Saito H, Matsue Y, Kamiya K, Kagiyama N, Maeda D, Endo Y, Ueno H, Yoshioka K, Mizukami A, Saito K, Sarcopenic obesity is associated with impaired physical function and mortality in older patients with heart failure: insight from FRAGILE-HF. BMC Geriatr. 2022; 22: 556. doi: 10.1186/s12877-022-03168-3 35787667 PMC9254413 source
• Partly supported

  The Introduction (page unavailable) defines sarcopenic obesity as excess fat mass with reduced skeletal muscle mass and describes greater functional impairment. The Discussion (page unavailable) reports poorer cardiorespiratory fitness in patients with obesity and heart failure with reduced ejection fraction. The paper does not establish higher mortality rates from sarcopenic obesity in older adults with heart failure; its Introduction links low peak oxygen consumption to mortality risk in heart failure more generally. (LLM, conf=0.87)

  cites [88] Billingsley HE, Del Buono MG, Canada JM, Kim Y, Damonte JI, Trankle CR, Halasz G, Mihalick V, Vecchie A, Markley RR, Sarcopenic obesity is associated with reduced cardiorespiratory fitness compared with nonsarcopenic obesity in patients with heart failure with reduced ejection fraction. Circ Heart Fail. 2022; 15: e009518. doi: 10.1161/CIRCHEARTFAILURE.122.009518 36098058 PMC9588574 sourceExperimental — accuracy not yet measured

In the paper

“Malnutrition, cachexia, sarcopenia, and frailty are phenotypically distinct but interconnected conditions with interrelated pathophysiological processes that lead to different magnitudes of wasting and susceptibility to adverse outcomes.81–83”

What the sources say

• ?Not checked — no full text of the sourcecites [81] Jeejeebhoy KN. Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia: overlap of clinical features. Curr Opin Clin Nutr Metab Care. 2012; 15: 213– 219. doi: 10.1097/MCO.0b013e328352694f 22450775 source
• ?Not checked — no full text of the sourcecites [82] Severin R, Berner PM, Miller KL, Mey J. The crossroads of aging: an intersection of malnutrition, frailty, and sarcopenia. Topics Geriatr Rehabil. 2019; 35: 79– 87. doi: 10.1097/tgr.0000000000000218 source
• Partly supported

  The DOMAINS AND DEFINITIONS section links sarcopenia and unintentional weight loss to frailty and describes a nutritional domain of frailty. It does not establish that malnutrition, cachexia, sarcopenia, and frailty are four phenotypically distinct but interconnected conditions, or compare their magnitudes of wasting and susceptibility to adverse outcomes. Page numbers were not available in our copy. (LLM, conf=0.84)

  cites [83] Ijaz N, Buta B, Xue QL, Mohess DT, Bushan A, Tran H, Batchelor W, deFilippi CR, Walston JD, Bandeen-Roche K, Interventions for frailty among older adults with cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2022; 79: 482– 503. doi: 10.1016/j.jacc.2021.11.029 35115105 PMC8852369 sourceExperimental — accuracy not yet measured

In the paper

“In addition, BMI is now viewed as a flawed metric for representing normative weight ranges because of its insensitivity to differences in body type and lean versus fat mass and inconsistency across race and sex groups.76–80”

What the sources say

• Supported

  The Review says BMI can label people with greater muscle mass and less central adiposity as overweight, and describes racial differences in the relationship between BMI and adiposity. Its Sex Considerations discussion says the same BMI cutoffs do not adequately reflect differences between men and women. The Conclusions call for an alternative that accounts for sex, race, and abdominal adiposity. (LLM, conf=0.91)

  cites [76] Pray R, Riskin S. The history and faults of the body mass index and where to look next: a literature review. Cureus. 2023; 15: e48230. doi: 10.7759/cureus.48230 38050494 PMC10693914 source
• Supported

  The “BMI: Strengths and Limitations as a Diagnostic Tool” section says BMI does not directly measure adiposity, can overestimate it in people with high muscle mass and underestimate it in people with low lean mass. It also reports race and sex differences in BMI’s relationship to health outcomes and describes lower BMI thresholds for some populations. These passages support the cited characterization of BMI’s limitations for weight classification. (LLM, conf=0.93)

  cites [77] Sweatt K, Garvey WT, Martins C. Strengths and limitations of BMI in the diagnosis of obesity: what is the path forward? Curr Obes Rep. 2024; 13: 584– 595. doi: 10.1007/s13679-024-00580-1 38958869 PMC11306271 source
• Partly supported

  In Results, Question 1 (page not provided), the paper says BMI’s relationship to body fat varies by ethnicity and that BMI can underestimate body fat in South Asian children because they have lower lean body mass at a given weight. This supports limitations concerning ethnicity and lean versus fat mass, but the cited passages do not establish the broader claim about differences in body type or inconsistency across sex groups. (LLM, conf=0.86)

  cites [78] Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, Lee J, Nam TQ, Pathan F, Saboo B, Obesity in South and Southeast Asia: a new consensus on care and management. Obes Rev. 2023; 24: e13520. doi: 10.1111/obr.13520 36453081 PMC10078503 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [79] WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363: 157– 163. doi: 10.1016/S0140-6736(03)15268-3 14726171 source
• Supported

  In “The BMI issue,” the paper says BMI cannot distinguish fat from lean mass and can misclassify people with different body compositions, including athletes and people of certain ethnicities. In “Clinical assessment of obesity status,” it recommends BMI cutoffs appropriate to sex and ethnicity. These passages support the claim, although the paper discusses ethnicity rather than using the term race. (LLM, conf=0.90)

  cites [80] Rubino F, Cummings DE, Eckel RH, Cohen RV, Wilding JPH, Brown WA, Stanford FC, Batterham RL, Farooqi IS, Farpour-Lambert NJ, Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol. 2025: 13: 221– 262. doi: 10.1016/S2213-8587(24)00316-4 39824205 PMC11870235 source

In the paper

“The unintentional weight loss of cachexia is predominantly loss of muscle mass with or without loss of fat; however, not all individuals with sarcopenia are cachectic.86”

What the sources say

• Partly supported

  The Definitions section distinguishes sarcopenia from cachexia, supporting the point that not everyone with sarcopenia is cachectic. It also describes sarcopenic obesity, but our copy does not state that cachexia-related weight loss is predominantly muscle loss with or without fat loss (searched: cachexia and involuntary weight loss). (LLM, conf=0.85)

  cites [86] Damluji AA, Alfaraidhy M, AlHajri N, Rohant NN, Kumar M, Al Malouf C, Bahrainy S, Ji Kwak M, Batchelor WB, Forman DE, Sarcopenia and cardiovascular diseases. Circulation. 2023; 147: 1534– 1553. doi: 10.1161/CIRCULATIONAHA.123.064071 37186680 PMC10180053 sourceExperimental — accuracy not yet measured

In the paper

“For instance, GLIM criteria identified a higher malnutrition prevalence than International Classification of Disease,10th Revision codes in a large cohort of 2 multicenter observational studies with 2794 patients with cancer; malnutrition according to GLIM was nearly twice as prevalent (23% versus 12.6%).72”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [72] Poulter S, Steer B, Baguley B, Edbrooke L, Kiss N. Comparison of the GLIM, ESPEN and ICD-10 criteria to diagnose malnutrition and predict 30-day outcomes: an observational study in an oncology population. Nutrients. 2021; 13: 2602. doi: 10.3390/nu13082602 34444762 PMC8402162 source

In the paper

“Aging and chronic diseases such as CVD are 2 principal risk factors for the wasting continuum, and these conditions adversely influence outcomes for older adults with CVD at greater risk of disability and mortality.91,92”

What the sources say

• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [91] Damluji Abdulla A, Bernacki G, Afilalo J, Lyubarova R, Orkaby Ariela R, Kwak Min J, Hummel S, Kirkpatrick James N, Maurer Mathew S, Wenger N, TAVR in older adults. JACC Adv. 2024; 3: 100877. doi: 10.1016/j.jacadv.2024.100877 38694996 PMC11062620 sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [92] Damluji AA, Nanna MG, Rymer J, Kochar A, Lowenstern A, Baron SJ, Narins CR, Alkhouli M. Chronological vs biological age in interventional cardiology: a comprehensive approach to care for older adults: JACC family series. JACC Cardiovasc Interv. 2024; 17: 961– 978. doi: 10.1016/j.jcin.2024.01.284 38597844 PMC11097960 sourceExperimental — accuracy not yet measured

In the paper

“Dietary protein is generally considered a major determinant of muscle mass,118 but it is controversial whether enhanced dietary macronutrient intake can overcome the inflammatory catabolic metabolism of advanced cardiac conditions and achieve net gains in fat-free mass.119,120”

What the sources say

• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [118] Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, Phillips S, Sieber C, Stehle P, Teta D, Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013; 14: 542– 559. doi: 10.1016/j.jamda.2013.05.021 23867520 sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [119] Billingsley HE, Hummel SL, Carbone S. The role of diet and nutrition in heart failure: a state-of-the-art narrative review. Prog Cardiovasc Dis. 2020; 63: 538– 551. doi: 10.1016/j.pcad.2020.08.004 32798501 PMC7686142 sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [120] Katano S, Yano T, Kouzu H, Ohori K, Shimomura K, Honma S, Nagaoka R, Inoue T, Takamura Y, Ishigo T, Energy intake during hospital stay predicts all-cause mortality after discharge independently of nutritional status in elderly heart failure patients. Clin Res Cardiol. 2021; 110: 1202– 1220. doi: 10.1007/s00392-020-01774-y 33399954 PMC8318973 sourceExperimental — accuracy not yet measured

In the paper

“A post hoc analysis of participants with chronic HF demonstrated that the group receiving RDN-led deployment of tailored nutritional interventions experienced lower 30-day mortality (odds ratio, 0.44 [ 95% CI, 0.26–0.75]; P=0.002), with a particularly marked effect”

What the sources say

• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [105] Hersberger L, Dietz A, Burgler H, Bargetzi A, Bargetzi L, Kagi-Braun N, Tribolet P, Gomes F, Hoess C, Pavlicek V, Individualized nutritional support for hospitalized patients with chronic heart failure. J Am Coll Cardiol. 2021; 77: 2307– 2319. doi: 10.1016/j.jacc.2021.03.232 33958128 sourceExperimental — accuracy not yet measured

In the paper

“the most appropriate protein intake approaches for the CICU population are likely those in alignment with evidence-based guidance from ASPEN and the Society of Critical Care Medicine, which favor individualized protein intake targets within the 1.2– to 2.0–g·kg−1·d−1 range, with cautious consideration of higher intake in select patients with burns, trauma, or obesity.148–150”

What the sources say

• Supported

  Section C4 recommends 1.2–2.0 g/kg of actual body weight per day and says requirements may be higher in burn or multitrauma patients. The obesity recommendation gives higher targets based on ideal body weight, while the rationale calls for ongoing assessment of protein adequacy. The separate burns recommendation specifies 1.5–2.0 g/kg/day; the cited passages provide section labels but no page numbers. (LLM, conf=0.89)

  cites [148] McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA,; Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016; 40: 159– 211. doi: 10.1177/0148607115621863 26773077 source
• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [149] Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, McKeever L. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: the American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2022; 46: 12– 41. doi: 10.1002/jpen.2267 34784064 source
• ?Not checked — no full text of the sourcecites [150] Gramlich L, Guenter P. Enteral nutrition in hospitalized adults. N Engl J Med. 2025; 392: 1518– 1530. doi: 10.1056/NEJMra2406954 40239069 source

In the paper

“EN is more cost-effective; has lower rates of infection, overfeeding, and hyperglycemia compared with PN19,134,135”

What the sources say

• ?Not checked — no full text of the sourcecites [19] Frederiks P, Peetermans M, Wilmer A. Nutritional support in the cardiac intensive care unit. Eur Heart J Acute Cardiovasc Care. 2024; 13: 373– 379. doi: 10.1093/ehjacc/zuae018 38333990 source
• ?Not checked — no full text of the sourcecites [134] Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA,; Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Crit Care Med. 2016; 44: 390– 438. doi: 10.1097/CCM.0000000000001525 26771786 source
• Partly supported

  The Commentary reports a meta-analysis finding fewer ICU infections with EN than PN, but says the difference was absent when energy delivery was similar. It suggests caloric overfeeding may contribute to infections associated with PN; it does not report lower overfeeding rates with EN. Its discussion of hyperglycemia does not compare rates between EN and PN. The indexed passages provide section labels but no page numbers. (LLM, conf=0.88)

  cites [135] Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr. 2023; 42: 1671– 1689. doi: 10.1016/j.clnu.2023.07.011 37517372 sourceExperimental — accuracy not yet measured

In the paper

“The European Society for Clinical Nutrition and Metabolism135 recommends a more aggressive approach with early initiation of EN based on recent evidence139 compared with the more conservative approach of ASPEN.134”

What the sources say

• Partly supported

  Section 3.2.1 recommends starting enteral nutrition within 48 hours for critically ill adults who cannot eat orally. The Commentary discusses ASPEN/SCCM guidance but does not establish that ASPEN takes a more conservative approach to initiation, so the comparison is unsupported by this source. (LLM, conf=0.85)

  cites [135] Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr. 2023; 42: 1671– 1689. doi: 10.1016/j.clnu.2023.07.011 37517372 sourceExperimental — accuracy not yet measured
• Partly supported

  The Summary states that international guidelines recommend starting nutritional support within 48 hours, preferably by the enteral route when not contraindicated. But the Methods show that NUTRIREA-3 compared calorie and protein targets, not early versus delayed enteral nutrition; its text does not establish that ESPEN recommends earlier initiation than ASPEN. (LLM, conf=0.84)

  cites [139] Reignier J, Plantefeve G, Mira JP, Argaud L, Asfar P, Aissaoui N, Badie J, Botoc NV, Brisard L, Bui HN,; NUTRIREA-3 Trial Investigators. Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med. 2023; 11: 602– 612. doi: 10.1016/S2213-2600(23)00092-9 36958363 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [134] Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA,; Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Crit Care Med. 2016; 44: 390– 438. doi: 10.1097/CCM.0000000000001525 26771786 source

In the paper

“European recommendations have adopted evidence for clear liquids up to 2 hours before and a light meal up to 6 hours before surgery.180,188,193”

What the sources say

• ?Not checked — no full text of the sourcecites [180] Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017; 126: 376– 393. doi: 10.1097/ALN.0000000000001452 28045707 source
• ?Could not verify

  The 'Optimal time point for perioperative nutrition therapy' section discusses nutrition support before cardiac surgery, but does not address fasting allowances. Searches for clear liquids, light meals, and European preoperative fasting recommendations found no passage in our copy stating the two-hour and six-hour limits. (LLM, conf=0.73)

  cites [188] Stoppe C, Goetzenich A, Whitman G, Ohkuma R, Brown T, Hatzakorzian R, Kristof A, Meybohm P, Mechanick J, Evans A, Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Crit Care. 2017; 21: 131. doi: 10.1186/s13054-017-1690-5 28583157 PMC5460477 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [193] Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003: CD004423. doi: 10.1002/14651858.CD004423 14584013 source

In the paper

“Use of Global Leadership Initiative on Malnutrition criteria for malnutrition diagnosis for patients with cardiovascular disease has confirmed prognostic value, correlating with poorer physical function and higher mortality.”

• Also stated in: § PREVALENCE AND CONSEQUENCES OF MALNUTRITION IN ACUTE CARDIOVASCULAR CARE · boosted

  “Use of Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria for patients with CVD has confirmed prognostic value, demonstrating associations with poorer physical function and higher mortality.35”

What the sources say

• ?Not checked — no full text of the sourcecites [35] Kootaka Y, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Maekawa E, Reed JL, Yamaoka-Tojo M, The GLIM criteria for defining malnutrition can predict physical function and prognosis in patients with cardiovascular disease. Clin Nutr. 2021; 40: 146– 152. doi: 10.1016/j.clnu.2020.04.038 32571679 source

In the paper

“The predictive validity of the Academy of Nutrition and Dietetics/ASPEN indicators for diagnosing malnutrition tool was recently confirmed across 290 adult inpatients in whom both the original tool and a simplified version showed association with emergency department visits and hospital readmissions for patients with severe malnutrition and longer lengths of stay and greater”

What the sources say

• ?Not checked — no full text of the sourcecites [70] Jimenez EY, Lamers-Johnson E, Long JM, McCabe G, Ma X, Woodcock L, Bliss C, Abram JK, Steiber AL. Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study. Am J Clin Nutr. 2024; 119: 779– 787. doi: 10.1016/j.ajcnut.2023.12.012 38432715 source

In the paper

“Among older adults with HF, GLIM-defined malnutrition was linked to higher mortality independently of other prognostic factors and demonstrated better prognostic ability than the Geriatric Nutritional Risk Index (Table 2).7”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [7] Hirose S, Matsue Y, Kamiya K, Kagiyama N, Hiki M, Dotare T, Sunayama T, Konishi M, Saito H, Saito K, Prevalence and prognostic implications of malnutrition as defined by GLIM criteria in elderly patients with heart failure. Clin Nutr. 2021; 40: 4334– 4340. doi: 10.1016/j.clnu.2021.01.014 33551220 source

In the paper

“The pathophysiological basis of this catabolic state is thought to stem from complex interplay between the neurohormonal dysregulation of the advanced HF (particularly HF with reduced ejection fraction) syndrome, chronic inflammation, myocardial substrate demands of the failing heart, abnormalities of mesenteric perfusion,”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [90] Ilonze OJ, Parsly Read-Button L, Cogswell R, Hackman A, Breathett K, Saltzman E, Vest AR. Controversies and conundrums in cardiac cachexia: key questions about wasting in patients with HFrEF. JACC Heart Fail. 2024; 12: 1645– 1660. doi: 10.1016/j.jchf.2024.03.003 38727650 source

In the paper

“Conversely, cardiac cachexia is characterized by a catabolic metabolism and accelerated turnover of protein stores, degrading fat-free mass and leading to elevated urine nitrogen excretion.”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [90] Ilonze OJ, Parsly Read-Button L, Cogswell R, Hackman A, Breathett K, Saltzman E, Vest AR. Controversies and conundrums in cardiac cachexia: key questions about wasting in patients with HFrEF. JACC Heart Fail. 2024; 12: 1645– 1660. doi: 10.1016/j.jchf.2024.03.003 38727650 source

In the paper

“Coenzyme Q10 supplementation has limited clinical trial support in patients with HF but has not been routinely adopted.112”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [112] Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, Alehagen U, Steurer G, Littarru GP; Q-SYMBIO Study Investigators. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart failure. 2014; 2: 641– 649. doi: 10.1016/j.jchf.2014.06.008 25282031 source

In the paper

“Nutritional support plays a key role in the cardiac ICU (CICU), where malnutrition is frequently encountered.19”

What the sources say

• ?Not checked — no full text of the sourcecites [19] Frederiks P, Peetermans M, Wilmer A. Nutritional support in the cardiac intensive care unit. Eur Heart J Acute Cardiovasc Care. 2024; 13: 373– 379. doi: 10.1093/ehjacc/zuae018 38333990 source

In the paper

“Therefore, current practice favors that adults with mild CKD (stages 1 and 2) should avoid >1.30 g·kg−1·d−1 protein intake and patients with CKD stages 3 to 5 not on dialysis are recommended to limit to 0.60 to 0.80 g·kg−1·d−1.127”

What the sources say

• ?Not checked — no full text of the sourcecites [127] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024; 105: S117– S314. doi: 10.1016/j.kint.2023.10.018 38490803 source

In the paper

“Moreover, their higher metabolic demand increases cardiac cachexia and sarcopenia risks, often coexisting with malnutrition and frailty, which negatively affects outcomes.19,90”

What the sources say

• ?Not checked — no full text of the sourcecites [19] Frederiks P, Peetermans M, Wilmer A. Nutritional support in the cardiac intensive care unit. Eur Heart J Acute Cardiovasc Care. 2024; 13: 373– 379. doi: 10.1093/ehjacc/zuae018 38333990 source
• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [90] Ilonze OJ, Parsly Read-Button L, Cogswell R, Hackman A, Breathett K, Saltzman E, Vest AR. Controversies and conundrums in cardiac cachexia: key questions about wasting in patients with HFrEF. JACC Heart Fail. 2024; 12: 1645– 1660. doi: 10.1016/j.jchf.2024.03.003 38727650 source

In the paper

“Similarly, the implementation of effective nutritional interventions also remains suboptimal, related to gaps in awareness among clinicians and insufficient integration of nutritional care into clinical CVD workflows.34”

What the sources say

• ?Not checked — no full text of the sourcecites [34] Uhl S, Siddique SM, Bloschichak A, McKeever W, D’Anci K, Leas B, Mull NK, Compher C, Lewis JD, Wu GD, Interventions for malnutrition in hospitalized adults: a systematic review and meta-analysis. J Hosp Med. 2022; 17: 556– 564. doi: 10.1002/jhm.12891 35729866 source

In the paper

“The optimal protein intake for patients with cardiogenic shock is an area of ongoing research, with higher protein approaches not appearing beneficial in recent critical care trials.”

In the paper

“Patients admitted with HF to the CICU often have poor nutrient absorption from mucosal edema, low cardiac output, inflammation, and neurohormonal activation with mesenteric vasoconstriction and microvascular dysfunction.19”

What the sources say

• ?Not checked — no full text of the sourcecites [19] Frederiks P, Peetermans M, Wilmer A. Nutritional support in the cardiac intensive care unit. Eur Heart J Acute Cardiovasc Care. 2024; 13: 373– 379. doi: 10.1093/ehjacc/zuae018 38333990 source

In the paper

“Recognizing and differentiating between malnutrition, sarcopenia, and cachexia is clinically important because these conditions differ in their scope for reversibility and appropriate interventions.”

In the paper

“It also underscores the significant impact of malnutrition on patient outcomes, including morbidity, mortality, and length of stay, as well as higher readmission rates and health care costs.”

What the sources say

• ?Not checked — no full text of the sourcecites [35] Kootaka Y, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Maekawa E, Reed JL, Yamaoka-Tojo M, The GLIM criteria for defining malnutrition can predict physical function and prognosis in patients with cardiovascular disease. Clin Nutr. 2021; 40: 146– 152. doi: 10.1016/j.clnu.2020.04.038 32571679 source

In the paper

“Further diagnostic challenges are posed by the International Classification of Disease, 9th Revision and current International Classification of Disease,10th Revision, which do not fully align with the diagnostic recommendations from these clinical practice guidelines. This has led to misalignment between academic constructs and billing codes that hampers educational efforts to raise awareness of”

In the paper

“Refeeding syndrome can occur after prolonged starvation with aggressive oral feeding, EN, or parenteral nutrition (PN), and patients with mental health and substance use disorders, malabsorptive syndromes, surgeries, or vomiting are particularly at risk.133”

What the sources say

• ?Not checked — no full text of the sourcecites [133] da Silva JSV, Seres DS, Sabino K, Adams SC, Berdahl GJ, Citty SW, Cober MP, Evans DC, Greaves JR, Gura KM,; Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020; 35: 178– 195. doi: 10.1002/ncp.10474 32115791 source

In the paper

“It is also increasingly recognized that malnutrition and skeletal muscle wasting commonly coexist in patients with obesity and that basing an assessment of nutritional status on weight or BMI is frequently misleading, especially among patients with CVD, who may experience alterations in extracellular fluid compartment volume.”

In the paper

“In those cases, delayed EN (>48 hours) may be associated with better neurological outcomes,161 but this may simply reflect an immortal time bias.179”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [161] Gutierrez A, Carlson C, Kalra R, Elliott AM, Yannopoulos D, Bartos JA. Outcomes associated with delayed enteral feeding after cardiac arrest treated with veno-arterial extracorporeal membrane oxygenation and targeted temperature management. Resuscitation. 2021; 164: 20– 26. doi: 10.1016/j.resuscitation.2021.04.029 33965476 source
• Not checked yet

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  cites [179] Gutierrez A, Bartos JA. Reply to: immortal time bias in an observational study on enteral nutrition. Resuscitation. 2021; 166: 146– 147. doi: 10.1016/j.resuscitation.2021.07.032 34352332 source

In the paper

“The primary composite end point of hypotension, aspiration pneumonia, hyperglycemia, and hypoglycemia occurred in 19.1% of the fasting group and 2.0% of the no-fasting group, with the analyses confirming noninferiority of no fasting (based on a noninferiority margin of 3% and a likelihood of 99.1%).182”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [182] Ferreira D, Hardy J, Meere W, Butel-Simoes L, Sritharan S, Ray M, French M, McGee M, O’Connor S, Whitehead N, Fasting vs no fasting prior to catheterisation laboratory procedures: the SCOFF trial. Eur Heart J. 2024; 45: 4900– 4998. doi: 10.1093/eurheartj/ehae573 39217604 source

In the paper

“Evidence supporting prolonged preprocedural fasting for cardiac catheterization or implantation of electronic devices is weak, with no difference in gastric pH or volume between fasting 2 to 4 hours versus >4 hours.180,181”

What the sources say

• ?Not checked — no full text of the sourcecites [180] Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017; 126: 376– 393. doi: 10.1097/ALN.0000000000001452 28045707 source
• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [181] Bangalore S, Barsness GW, Dangas GD, Kern MJ, Rao SV, Shore-Lesserson L, Tamis-Holland JE. Evidence-based practices in the cardiac catheterization laboratory: a scientific statement from the American Heart Association. Circulation. 2021; 144: e107– e119. doi: 10.1161/CIR.0000000000000996 34187171 source

In the paper

“1 trial including 30% of patients with HF and 2% with CS demonstrated that EN continuation during MV liberation was associated with shorter extubation times, shorter MV duration, better achievement of caloric goals, lower mortality, and less hypoglycemia without differences in aspiration events compared with EN interruption.155”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [155] Landais M, Nay MA, Auchabie J, Hubert N, Frerou A, Yehia A, Mercat A, Jonas M, Martino F, Moriconi M,; REVA Network and CRICS-TriggerSEP F-CRIN Research Network. Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trial. Lancet Respir Med. 2023; 11: 319– 328. doi: 10.1016/S2213-2600(22)00413-1 36693402 source

In the paper

“Early EN has also been shown to be safe in a prospective observational study with >200 patients with mechanical circulatory support,160 although that study excluded patients with refractory CS.”

What the sources say

• ?Not checked — no full text of the sourcecites [160] Flordelis Lasierra JL, Montejo Gonzalez JC, Lopez Delgado JC, Zarate Chug P, Martinez Lozano-Aranaga F, Lorencio Cardenas C, Bordeje Laguna ML, Maichle S, Terceros Almanza LJ, Trasmonte Martinez MV,; the NUTRIVAD Study Group. Enteral nutrition in critically ill patients under vasoactive drug therapy: the NUTRIVAD study. JPEN J Parenter Enteral Nutr. 2022; 46: 1420– 1430. doi: 10.1002/jpen.2371 35274345 source

In the paper

“Although not good markers of nutritional status, albumin <3.0 g/dL and prealbumin ≤20 mg/dL have been used as acute-phase markers to trigger nutritional supplementation within 1 week of surgery.186,189–191”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [186] Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, Roselli EE, Khoynezhad A, Gerdisch M, Levy JH, Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery society recommendations. JAMA Surg. 2019; 154: 755– 766. doi: 10.1001/jamasurg.2019.1153 31054241 source
• ?Not checked — no full text of the sourcecites [189] Yu P-J, Cassiere HA, Dellis SL, Manetta F, Kohn N, Hartman AR. Impact of preoperative prealbumin on outcomes after cardiac surgery. JPEN J Parenter Enteral Nutr. 2015; 39: 870– 874. doi: 10.1177/0148607114536735 24898210 source
• ?Not checked — no full text of the sourcecites [190] Lauck SB, Wood DA, Achtem L, Baumbusch J, Boone RH, Cheung A, Dvir D, Stub D, Tan JS, Ye J, Risk stratification and clinical pathways to optimize length of stay after transcatheter aortic valve replacement. Can J Cardiol. 2014; 30: 1583– 1587. doi: 10.1016/j.cjca.2014.07.012 25475463 source
• ?Not checked — no full text of the sourcecites [191] Gillis C, Carli F. Promoting perioperative metabolic and nutritional care. Anesthesiology. 2015; 123: 1455– 1472. doi: 10.1097/ALN.0000000000000795 26248016 source

In the paper

“According to Enhanced Recovery After Surgery recommendations,186 perioperative nutritional optimization is key to expediting recovery.”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [186] Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, Roselli EE, Khoynezhad A, Gerdisch M, Levy JH, Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery society recommendations. JAMA Surg. 2019; 154: 755– 766. doi: 10.1001/jamasurg.2019.1153 31054241 source

In the paper

“the risk of intestinal ischemia is higher for lactate >2.0159 or Sequential Organ Failure Assessment score >11.154”

What the sources say

• ?Not checked — no full text of the sourcecites [159] Nuzzo A, Maggiori L, Ronot M, Becq A, Plessier A, Gault N, Joly F, Castier Y, Vilgrain V, Paugam C, Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol. 2017; 112: 597– 605. doi: 10.1038/ajg.2017.38 28266590 source
• ?Not checked — no full text of the sourcecites [154] Reignier J, Boisrame-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, Argaud L, Asehnoune K, Asfar P, Bellec F,; NUTRIREA-2 Trial Investigators. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018; 391: 133– 143. doi: 10.1016/S0140-6736(17)32146-3 29128300 source

In the paper

“Individualized RDN-led dietary counseling and support reduced the composite of hospital readmissions and mortality, as well as mortality as a secondary end point, and improved quality of life.132”

What the sources say

• ?Not checked — no full text of the sourcecites [132] Bonilla-Palomas JL, Gámez-López AL, Castillo-Domínguez JC, Moreno-Conde M, López Ibáñez MC, Alhambra Expósito R, Ramiro Ortega E, Anguita-Sánchez MP, Villar-Ráez A. Nutritional intervention in malnourished hospitalized patients with heart failure. Arch Med Res. 2016; 47: 535– 540. doi: 10.1016/j.arcmed.2016.11.005 28262195 source