Is there an association between the nutritional and functional parameters and congestive heart failure severity?

BACKGROUND & AIMS: The association between markers of nutritional status (handgrip strength [HGS] and adductor pollicis muscle thickness [APMT]) and clinical markers of congestive heart failure (CHF) severity is currently unclear. The objective of this study was to evaluate the association between HGS, APMT, as markers of nutritional status and CHF severity. METHODS: APMT and muscle strength was measured in 500 CHF patients bilaterally. Nutritional status was assessed by Subjective Global Assessment (SGA). Functional classification was performed according to guidelines provided by the New York Heart Association (NYHA) and ejection fraction (EF) was measured to classify CHF severity. Poisson regression, adjusted for sex and age, was performed to verify the association between nutritional factors and CHF severity markers. RESULTS: The majority of patients (75.8%) were ≥60 years old and 53.6% were either overweight or obese. SGA identified 42.2% of the patients as malnourished, 12.6% with low APMT, and 29.0% with low HGS. Most of the patients were classified as NYHA III/IV (56.8%) and almost one third of patients (31.1%) had EF ≤ 40%. HGS and APMT were significantly lower in malnourished male patients and in male patients with a lower EF or worse NYHA classification. Even after controlling for the EF, malnourished patients showed a 2.5-fold increased risk of CHF severity by NYHA classification and for each kilogram of increase in the HGS, there was a significant decrease of 2% in the risk (RR: 0.98 p < 0.001). Malnourished patients presented a 52% higher risk (RR: 1.52 p = 0.016) of having a low EF, whereas for each APMT increase, there was a 5% decrease in the risk (RR: 0.95 p < 0.001), even after controlling for NYHA classification. CONCLUSIONS: Malnutrition is highly prevalent among patients with CHF and it is associated with the functional class and the severity of the disease. Objective markers of strength (HGS) and muscle (APMT) are independently associated with the CHF severity, assessed by NYHA classification and EF, respectively, even after adjustment for other confounding variables. Thus, the implementation of these nutritional assessment methods in hospital routines, either by SGA or by objective methods, such as HGS and APMT, can configure effective measurements for early detection of malnutrition in patients at higher risk, and possibly a way to avoid their further functional decline.

Adductor pollicis muscle: reference values of its thickness in a healthy population.

BACKGROUND & AIMS: Adductor pollicis muscle is the only muscle which could be directly assessed, and its thickness could be useful in muscle mass assessment. Our objective is to determine values of adductor pollicis muscle thickness (APMT) in healthy subjects. METHODS: APMT was obtained using a skinfold caliper in 300 healthy subjects, grouped by age and gender, in dominant (DAPMT) and non-dominant (NDAPMT) sides. All patients were assessed by Subjective Global Assessment (SGA). General characteristics of the subjects were obtained by a questionnaire. RESULTS: One hundred and fifty men and one hundred and fifty women were evaluated. Their mean age was 44.9+/-18.5 years and they were all well nourished. DAPMT mean values found in men were 26.1+/-4.4mm and in women, 19.8+/-3.3mm, respectively. NDAPMT mean values found in men and women were 25.1+/-4.4mm and 18.7+/-3.1, respectively. Reference values for each gender and age group were created and values below the 5th percentile were considered as limit of normality. CONCLUSIONS: This study presents APMT reference values from a healthy population. New studies may demonstrate its role in the evaluation of muscle mass and its association with nutritional status.