Abstract
Abstract Background: Anabolic/catabolic disorder in heart failure (HF) favors cardiac cachexia, implying a reduction in HF survival. Objectives: To assess the accuracy and concordance of the diagnosis of protein malnutrition and excess fat among the anthropometric and body composition methods in individuals with HF. Method: A study of accuracy that included 60 individuals with HF. Body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TST), adductor pollicis muscle thickness (APMT), arm muscle circumference (AMC) and corrected arm muscle area (cAMA). Fat free mass index (FFMI) and body fat percentage (BF%), obtained by electrical bioimpedance (EBI), were used to compare the diagnosis of protein malnutrition and excess fat. Accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive value. The concordance of the EBI diagnosis and other methods was performed by the chi-square test and kappa (k) statistic, where p<0.05 was considered significant. Results: Higher frequencies of protein malnutrition were identified by cAMA and AMC, and excess fat by BF%. BMI presented low sensitivity (43%) and accuracy (38.5%), with moderate concordance (0.50). AMC sensitivity was 86%, accuracy 66.4%, and acceptable concordance (0.36) compared to FFMI. Similar percentages of moderate sensitivity and low accuracy were observed for TST and BMI. Conclusion: AMC may be useful to identify protein malnutrition and TST has not been adequate to diagnose adiposity. BMI was not sensitive to assess muscle and adipose reserve. EBI was more accurate.
Highlights
Heart failure (HF) is a clinical syndrome characterized by the heart’s inability to supply the body’s metabolic demands or to do so at the expense of high filling pressures as a result of structural or functional abnormalities of the heart.[1]
The body mass index (BMI) does not clearly reflect body composition, low values for this index have been associated with worse prognosis in individuals with heart failure (HF), whereas increased values act as a protective factor.[5,6]
It was found that protein malnutrition, when evaluated by corrected arm muscle area (cAMA) (43.9%) and arm muscle circumference (AMC) (40%), was more frequent when compared to Fat free mass index (FFMI) (13.2%), Body mass index (BMI) (11.7%) and adductor pollicis muscle thickness (APMT) (5.1)
Summary
Heart failure (HF) is a clinical syndrome characterized by the heart’s inability to supply the body’s metabolic demands or to do so at the expense of high filling pressures as a result of structural or functional abnormalities of the heart.[1] It is the common final pathway of a number of cardiac diseases that determine activation of the neurohormonal and inflammatory axis and energetic metabolism, resulting in cardiac cachexia, worsening the prognosis and greater morbidity and mortality of individuals with HF.[2] On the other hand, overweight protects individuals with HF, which is called the “obesity paradox”.3 In this context, methods of anthropometric assessment and body composition are proposed, but without consensus.[4] the body mass index (BMI) does not clearly reflect body composition, low values for this index have been associated with worse prognosis in individuals with HF, whereas increased values act as a protective factor.[5,6] The evaluation of triceps skinfold thickness (TST) is a way of identifying adiposity in these. EBI was more accurate. (Int J Cardiovasc Sci. 2019;32(2)143-151) Keywords: Heart Failure; Nutrition Assessment, Anthropometry; Body Composition; Cachexia
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