RESUMO
Background and aims: Malnutrition is very common in patients with heart failure (HF) and is associated with a worse clinical outcome. The Controlling Nutritional Status (CONUT) score is an easily derived index for the evaluation of malnutrition. This study aimed to evaluate the association between the CONUT score and the prognosis in patients with HF. Methods and results: Electronic databases were searched for potential studies from inception up to February 15, 2022. Observational cohort studies included adult participants with HF, and reported the associations between the CONUT score and the adjusted relative risk (RR) of all-cause mortality, and patients with composite major adverse cardiac outcomes (MACEs) were included. We finally included 18 studies comprising 12,532 participants with HF for analysis. The median age of the patients was 70.5 years old, and 35.4% were women. After a median follow-up duration of 32.5 months, patients with HF with a higher CONUT score were associated with a higher risk of all-cause mortality (per 1 increment of the CONUT score: RR, 1.21, 95% CI, 1.13-1.29, I2 = 68%, P for heterogeneity = 0.002) and MACEs (per 1 increment of the CONUT score: RR, 1.14, 95% CI, 1.06-1.23, I2 = 81%, P for heterogeneity <0.0001) after adjusting for other prognostic factors. When the CONUT score was divided into the normal nutritional status and malnourished status, malnourished patients with HF were associated with increased risks of all-cause death (RR, 1.61, 95% CI, 1.40-1.85, I2 = 17%, P for heterogeneity = 0.29) and MACEs (RR, 2.12, 95% CI, 1.49-3.02, I2 = 87%, P for heterogeneity <0.0001), compared with those with normal nutritional status. Conclusions: The CONUT score is associated with the clinical outcomes in patients with HF, and can be used as a screening tool of nutritional status in HF to improve prognosis.
RESUMO
BACKGROUND: This long-term study investigates the influence of body mass index, blood pressure, smoking habits, impaired glucose metabolism and history of any disease on the mortality of Swiss males holding life insurance cover with high sums assured. METHODS: In a prospective study (1976-2001) including 22,927 Swiss insured males holding life insurance cover with high sums assured, the prevalence of overweight and obesity was compared with data from the general population. The relationship between BMI and all-cause mortality was assessed using a Cox proportional hazard model adjusted for age and calendar year, thereby controlling for mortality improvement over time. Multivariable models were used to investigate the impact of multiple cardiovascular risk factors on all-cause and cardiovascular mortality. The evolution of hazard ratios was assessed by dividing the observation period into two periods (1976-1985 vs 1986-2001). RESULTS: The prevalence of overweight was 35.7% and of obesity 6.2%. The prevalence of both increased over time. The association between BMI and all-cause mortality showed a 'U'-shaped curve with the nadir at 22.0-23.9 kg/m2. Compared with this optimal range, a relative risk of 1.76 (CI 95%: 1.17-2.67) was found for a BMI in the range of 30.0-31.9 kg/m2, representing the lowest category of obese subjects. In the multivariable model, obese subjects had a hazard ratio of 1.76 (CI 95%: 1.34-2.30) compared against those with normal BMI. The hazard ratios for all-cause mortality associated with prehypertension, stage 1 and stage 2 hypertension were 1.58, 2.28 and 3.14, respectively, all of them being statistically significant. The results for cardiovascular mortality were more pronounced, however, with wider confidence intervals. Comparing the two observational periods, the hazard ratios for obese vs non-obese subjects were 1.57 (CI 95%: 1.08 to 2.28) in period 1 and 2.41 (CI 95%: 1.71-3.39) in period 2. Similarly, the hazard ratio for combined stages 1 and 2 hypertension vs the other categories of JNC7 were 1.52 (CI 95%: 1.15-2.01) and 1.96 (CI 95%: 1.49-2.58) for periods 1 and 2, respectively. CONCLUSIONS: In this cohort of Swiss insured males holding life insurance cover with high sums assured, prevalence trends of elevated BMI are similar to those in the general population. The relative mortality risks associated with cardiovascular risk factors are higher than in the general population and, in the case of elevated BMI and high blood pressure, might exhibit an increase over time.