Introduction:
Malnutrition is characterized by marasmus and kwashiorkor in children. However, the clinical significance of these aspects has been unclear in adult patients with heart failure (HF).
Methods and Results:
We divided a total of 1,888 patients with HF (median age 70.0, interquartile range 59.0-78.0) into four groups according to the presence/absence of marasmus type malnutrition (body mass index < 18.5 kg/m
2
) and kwashiorkor type malnutrition (serum albumin < 3.4 g/dL): Group C (patients without malnutrition, n = 1,302, 69.0%), Group M (those with only marasmus, n = 117, 6.2%), Group K (those with only kwashiorkor, n = 390, 20.7%) and Group MK (those with both marasmus and kwashiorkor, n = 79, 4.2%). Group M showed lowest systolic blood pressure (Groups C, M, K, and MK; 122.0, 111.0, 125.0 and 122.0 mmHg, respectively, P < 0.001). Groups K and MK showed higher levels of B-type natriuretic peptide (171.2, 375.4, 532.6 and 598.9 pg/mL, P < 0.001). Mean right atrial pressure was lowest in Group M and highest in Group K (6.0, 5.0, 8.0 and 6.0 mmHg, P < 0.001). Kaplan-Meir analysis demonstrated that Group MK had the lowest event-free rate of all-cause death compared to Group C, while Groups M and K had intermediate prognosis (
Figure
). In the multivariable Cox proportional hazard analysis, Groups M, K, MK were associated with all-cause death compared to Group C as a reference (adjusted hazard ratio 1.820, 1.623 and 2.248, respectively).
Conclusions:
Marasmus type malnutrition indicated wasting, kwashiorkor type malnutrition was characterized by congestion, and both types of malnutrition were independently associated with all-cause death in patients with HF.