Abstract
The clinical significance of polyunsaturated fatty acids (PUFAs) in acute decompensated heart failure (ADHF) in various nutritional statuses remains unclear. For this study, we enrolled 267 patients with ADHF admitted to the cardiac intensive care unit at Juntendo University hospital between April 2012 and March 2014. The association between long-term mortality, the geriatric nutritional risk index (GNRI), and levels of PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) was investigated. The median age was 73 (64–82) years, and mortality was 29% (62 patients). The event-free survival rates for all-cause death were higher in patients with high PUFA levels or GNRI than in those with low PUFA levels or GNRI (p < 0.05 for all). In particular, high DGLA in the low-GNRI group and high DHA or AA in the high-GNRI group were associated with high event-free survival (p < 0.05 for all). After accounting for confounding variables, DHA, DGLA, and AA, but not EPA, were associated with long-term mortality (p < 0.01 for all). This study concludes that in patients with ADHF, decreased levels of DHA, DGLA, and AA are independently associated with long-term mortality in the various nutritional statuses.
Highlights
Malnutrition is highly prevalent in patients with heart failure, in those with advanced heart failure and acute decompensated heart failure (ADHF) [1,2]
The present study demonstrated that low serum polyunsaturated fatty acids (PUFAs) levels in patients with ADHF were associated with poor long-term prognosis in the different grades of geriatric nutritional risk index (GNRI)
We could not assess the association of PUFA levels with dietary status and physical activity before admission. Both omega-3 and omega-6 PUFAs are associated with long-term mortality in patients with ADHF
Summary
Malnutrition is highly prevalent in patients with heart failure, in those with advanced heart failure and acute decompensated heart failure (ADHF) [1,2]. Undernutrition is associated with unfavorable prognosis and mortality in patients with heart failure [3,4,5]. The geriatric nutritional risk index (GNRI) is calculated from the serum albumin level and body mass index and is widely used for evaluating nutritional status [6,7,8,9]. Previous studies have reported that low GNRI levels. Nutrients 2017, 9, 956 are significantly associated with poor prognosis in patients with heart failure. In elderly patients, low GNRI levels are predictive of morbidity and mortality [3,6,10,11]. Frailty has been shown to be an independent predictor of early disability, long-term mortality, and readmission in patients with heart failure [12,13]. It remains difficult to improve the nutritional status and physical ability in these patients despite treatment [14,15]
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