Nutritional status is associated with inflammation and predicts a poor outcome in patients with chronic heart failure

Aim: malnutrition has been identified to be an independent predictor of morbidity and mortality in patients with chronic heart failure (chf). however,the pathophysiological mechanisms underlying this pathway remain unclear. methods: nutritional screening was performed using the controlling nutritional status (conut) score,which was calculated using the serum albumin and total cholesterol levels and lymphocyte number,in 114 chf patients with a mean left ventricular ejection fraction of 26.6%±6.4%. the carotid intima-media thickness (cimt) is correlated with carotid atherosclerosis and is a significant predictor of future cardiovascular events. peripheral blood mononuclear cells (pbmcs) were isolated,and the production of monocyte tumor necrosis factor (tnf)-α was measured and expressed as mean±sd (pg/ml/106 pbmcs). results: a multivariate linear regression analysis showed that the production of monocyte tnf-α (β coefficient =0.434,p<0.001) and mean cimt (β coefficient =0.204,p=0.006) were independent determinants of the conut score. during a median follow-up of 67.5 months,45 patients experienced cardiac events,including 16 cardiac deaths and 29 readmissions for worsening chf. a multivariate cox hazard analysis demonstrated that a monocyte tnf-α level of ≥4.1 pg/ml/106 pbmcs (hazard ratio (hr),14.10; 95% confidence interval (ci),2.55 –77.92; p=0.002) and conut score of ≥3 (hr,11.97; 95% ci,2.21– 64.67; p=0.004) were independently associated with the incidence of cardiac events. conclusions: these data indicate that a poor nutritional status as assessed using the conut score and atherosclerosis as indicated by cimt is significantly associated with inflammation and predicts poor outcomes in patients with chf. © 2016,japan atherosclerosis society. all rights reserved.