Association between isolated or combined malnutrition and sarcopenia and quality of life in heart failure outpatients: A cross-sectional study.

BACKGROUND: Heart failure (HF) is a chronic condition with symptoms linked to worse quality of life. Malnutrition and sarcopenia are conditions frequently found in patients with HF. This study aims to evaluate the association between isolated or combined malnutrition and sarcopenia and quality of life in outpatients with HF. METHODS: This is a cross-sectional study with a sample of outpatients with HF aged ≥18 years. Malnutrition was assessed according to the criteria of the Global Leadership Initiative on Malnutrition, and sarcopenia was evaluated by the European Working Group on Sarcopenia in Older People. Quality of life was assessed using the Minnesota Living with HF questionnaire (MLHFQ). Clinical and sociodemographic data were collected. RESULTS: One hundred and fifty-one patients were included in this study, with a median (interquartile range) age of 58 (48-65) years, 58.9% were adults, and 68.9% were male. A total of 29.5% of the patients were malnourished, and 28.5% and 2.6% were identified with probable sarcopenia and sarcopenia, respectively. Of the total, 15.9% of patients were identified with both conditions. Sarcopenia was associated with higher odds of increase in the MLHFQ total score, indicating worse quality of life (odds ratio [OR] = 3.61; 95% CI, 1.65-7.89). The same was found in the presence of two conditions (OR 3.97; 95% CI, 1.32-11.54), whereas isolated malnutrition was not related to life quality (OR = 1.62; 95% CI, 0.73-3.60). CONCLUSION: The presence of malnutrition and sarcopenia simultaneously were associated with worse quality of life scores when compared with these isolated conditions.

Sarcopenia: Inflammatory and Humoral Markers in Older Heart Failure Patients. / Sarcopenia: Marcadores Inflamatórios e Humorais em Pacientes Idosos com Insuficiência Cardíaca.

BACKGROUND: Sarcopenia is highly prevalent in heart failure (HF) patients, and the involvement of biomarkers in its pathophysiology is suggested, but little has been studied concerning HF sarcopenic patients. OBJECTIVES: To evaluate the association between inflammatory and humoral markers with sarcopenia, as well as the impact of sarcopenia on quality of life and functional capacity in older HF patients. METHODS: In this cross-sectional study, 90 outpatient HF patients, aged ≥ 60 years, were evaluated for sarcopenia (EWGSOP2 diagnostic criteria), inflammation (high-sensitive C-reactive protein [hs-CRP], Interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-α]) and humoral markers (total testosterone and insulin-like growth factor-1 [IGF-1]), physical activity (International Physical Activity Questionnaire), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walk test). The adopted level of significance was p<0.05. RESULTS: Patients had a mean age of 69.4 ± 7.2 years, 67.8% were male, with left ventricular ejection fraction (LVEF) of 35.9 ± 11.9% and 22 (24.4%) were sarcopenic. Age (73.1 ± 8.1 and 68.3 ± 6.5 years; p= 0.006), body mass index (BMI) (23.1 ± 2.8 and 28.2 ± 4.2 kg/m2; p <0.001), and LVEF (29.9 ± 8.8 and 37.9 ± 12.1%; p= 0.005) were different between groups with and without sarcopenia, respectively. After adjusting for age, ethnicity, BMI, LVEF, and the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, sarcopenia was associated with higher serum levels of IL-6 and worse functional capacity. CONCLUSION: In HF patients, sarcopenia was associated with IL-6 levels and functional capacity.

FUNDAMENTO: Sarcopenia é altamente prevalente em pacientes com insuficiência cardíaca (IC), e o envolvimento de biomarcadores em sua fisiopatologia é sugerido, mas poucos estudos foram realizados em relação a pacientes sarcopênicos com IC. OBJETIVOS: Avaliar a associação entre marcadores inflamatórios e humorais e sarcopenia, bem como o impacto da sarcopenia na qualidade de vida e na capacidade funcional em pacientes mais velhos com IC. MÉTODOS: Neste estudo transversal, 90 pacientes ambulatoriais com IC, com idade ≥60 anos, foram avaliados quanto a sarcopenia (critérios diagnósticos EWGSOP2), inflamação (Proteína C reativa de alta sensibilidade [PCR-as], Interleucina-6 [IL-6], fator de necrose tumoral alfa [TNF-α]) e marcadores humorais (testosterona total e fator de crescimento semelhante à insulina tipo 1 [IGF-1]), atividade física (Questionário internacional de atividade física), qualidade de vida ( Minnesota Living with Heart Failure Questionnaire ­ Questionário Minnesota sobre conviver com a insuficiência cardíaca), e capacidade funcional (teste de caminhada de 6 minutos). O nível de significância estatística adotado foi p <0,05. RESULTADOS: Os pacientes tinham uma média de idade de 69,4 ± 7,2 anos, 67,8% eram do sexo masculino, com fração de ejeção ventricular esquerda (FEVE) de 35,9 ± 11,9% e 22 (24,4%) eram sarcopênicos. Idade (73,1 ± 8,1 e 68,3 ± 6,5 anos; p= 0,006), índice de massa corporal (IMC) (23,1 ± 2,8 e 28,2 ± 4,2 kg/m2; p <0,001), e FEVE (29,9 ± 8,8 e 37,9 ± 12,1%; p= 0,005) eram diferentes nos grupos com e sem sarcopenia, respectivamente. Depois de normalizar em relação à idade, etnia, IMC, FEVE, e o uso de inibidores da enzima conversora de angiotensina/bloqueadores de receptor de angiotensina, a sarcopenia foi associada a níveis séricos de IL-6 mais altos e capacidade funcional pior. CONCLUSÃO: Em pacientes com IC, a sarcopenia foi associada aos níveis de IL-6 e à capacidade funcional.

Association of phase angle values and sarcopenia in older patients with heart failure.

BACKGROUND: Sarcopenia presents an accelerated and accentuated muscle loss in patients with heart failure (HF), leading to a worse prognosis for these patients. This study sought to assess the association of phase angle (PA) values with sarcopenia and its components, as well as to establish a PA cutoff point to predict outcomes such as hospitalization and mortality in older adult patients with HF. METHODS: Sarcopenia diagnosis followed the European Working Group on Sarcopenia in Older People criteria. Anthropometric, bioelectrical impedance (PA and body composition), functional capacity and inflammatory markers were assessed. RESULTS: Included patients were predominantly male (67%) and White, with a mean age of 69 ± 7 years, and a predominance of New York Heart Association I and II functional classes (82.1%) and reduced left ventricular ejection fraction (70.8%). Of the total sample, 23.6% were identified as sarcopenic. Mean PA values were lower in patients with sarcopenia (4.9 ± 0.9 and 6.0 ± 0.8°; P < 0.001). The cutoff point detected for sarcopenia in the receiver operating characteristic curve was 5.45°, which is an independent predictor for sarcopenia. PA values below this cutoff point were also associated with each of the sarcopenic components evaluated. PA proved to be an independent predictor for hospitalization (P = 0.042) in the entire sample studied. CONCLUSION: PA is associated with diagnostic components of sarcopenia and the cutoff point 5.45° proved to be an independent predictor of sarcopenia and hospitalization >3 years in older adult patients with HF.

Prognostic value of nutritional screening tools in hospitalized patients with decompensated heart failure: A systematic review and meta-analysis.

Nutritional risk screening is fundamental to prevent undesirable outcomes in heart failure (HF). Current reviews of nutritional screening tools encompass both hospitalized and outpatient settings, which may not be suitable because of different clinical manifestations. We hypothesize that multidimensional tools would better identify prognosis of decompensated patients because the tools assess more than isolated aspects. This systematic review aims to explore the association of multidimensional nutritional risk screening tools and prognosis in patients hospitalized with decompensated HF. Five databases were searched for studies that assessed nutritional risk through multidimensional screening tools and its association with prognosis in adults hospitalized with decompensated HF. The 95% confidence interval and relative risk were computed using a random-effects model. Inverse variance method was used. Thirty-eight studies were included. Most studies demonstrated higher nutritional risk was significantly associated with worse prognosis. Quantitative analysis identified higher nutritional risk by using the Mini Nutritional Assessment Short Form (MNA-SF), Controlling Nutritional Status, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to be associated with all-cause mortality. The MNA-SF demonstrated greater magnitude of association with all-cause mortality in older subjects (relative risk, 4.85; 95% confidence interval, 2.0-11.75). Higher nutritional risk was associated with poor prognosis and higher mortality in patients hospitalized with decompensated HF, especially when screened by MNA-SF. Tools were not directly compared. That might reinforce the importance of evaluating multiple aspects when screening hospitalized HF patients once symptoms associated with decompensation frequently mask the underlying nutritional status and risk. PROSPERO registration number (CRD42021256271).

C-Reactive Protein and Frailty in Heart Failure.

Frailty commonly coexists with heart failure and although both have been associated with neurohormonal dysregulation, inflammation, catabolism, and skeletal muscle dysfunction, there are still no defined biomarkers to assess frailty, especially from the perspective of populations with cardiovascular diseases. This is a cross-sectional study with 106 outpatients with heart failure, aged ≥60 years, which aimed to assess frailty through a physical (frailty phenotype) and multidimensional (Tilburg Frailty Indicator) approach and to analyze its association with inflammatory and humoral biomarkers (high sensitivity C-reactive protein [hs-CRP], interleukin 6, tumor necrosis factor-α, insulin-like growth factor-1, and total testosterone), clinical characteristics, and functional capacity. In univariate analysis, hs-CRP was associated with frailty in both phenotype and Tilburg Frailty Indicator assessment (PR = 1.005, 95% confidence interval [CI] 1.001 to 1.009, p = 0.027 and PR = 1.015, 95% CI 1.006 to 1.024, p = 0.001, respectively), which remained significant in the final multivariate model in the frailty assessment by the phenotype (PR = 1.004, 95% CI 1.001 to 1.008, p = 0.025). There was no statistically significant difference between the groups for other biomarkers analyzed. Frailty was also associated with worse functional capacity, nonoptimized pharmacological treatment and a greater number of drugs in use, age, female gender, and a greater number of comorbidities. In conclusion, frailty is associated with higher levels of hs-CRP, which can indicate it is a promising frailty biomarker.

Effect of testosterone supplementation on sarcopenic components in middle-aged and elderly men: A systematic review and meta-analysis.

The aim of this study was to conduct a systematic review of the literature of randomized controlled trials on the effect of testosterone (T) supplementation compared to the placebo group or lower dose on sarcopenic components (muscle mass, strength and physical performance) in middle-aged and elderly men. Major electronic databases were searched for articles published on or before December 2019. Studies including individuals with age ≥ 40 years and which described the effect of T supplementation on sarcopenic components were found eligible (11 studies). Outcomes were calculated as the difference in means between the experimental and control/placebo groups, and data were presented as effect size with 95% confidence limits (95%CI). The meta-analysis was performed using a random effects model. Regarding lean body mass (LBM), eight studies evaluated the effect of T supplementation on this outcome, of these, seven reported gains after the intervention period. Our meta-analysis showed a beneficial effect on LBM of 2.54 kg (95% CI, 1.27 to 3.80) (p < 0.001). In muscle strength (MS), seven included studies evaluated the handgrip strength (HGS) and just one reported gain after the intervention period, but the meta-analysis showed an increase for HGS of 1.58 kgf (95%CI, 0.17 to 3.0) (p = 0.03). The second outcome for MS was leg strength (LS), where nine studies were included and five demonstrated gains in this parameter after the intervention period. In the meta-analysis, two out of three tests showed an effect on LS: T supplementation increase the leg press strength in 91.23 N (95%CI, 0.23 to 182.22) (p = 0.05) and leg extension in 144.10 N (95%CI, 44.21 to 244.00) (p < 0.01). In physical performance, four studies evaluated this outcome, with three of them showing positive effects in this parameter. In the meta-analysis, only two studies that reported the same assessment test (Physical Performance Test) were included, but no effect of T supplementation on this parameter was found. It can be concluded that T supplementation influences sarcopenic components in middle-aged and older men, because is associated with increased in muscle mass and strength in addition to physical performance.

Sarcopenia: Marcadores Inflamatórios e Humorais em Pacientes Idosos com Insuficiência Cardíaca / Sarcopenia: Inflammatory and Humoral Markers in Older Heart Failure Patients

Resumo Fundamento Sarcopenia é altamente prevalente em pacientes com insuficiência cardíaca (IC), e o envolvimento de biomarcadores em sua fisiopatologia é sugerido, mas poucos estudos foram realizados em relação a pacientes sarcopênicos com IC. Objetivos Avaliar a associação entre marcadores inflamatórios e humorais e sarcopenia, bem como o impacto da sarcopenia na qualidade de vida e na capacidade funcional em pacientes mais velhos com IC. Métodos Neste estudo transversal, 90 pacientes ambulatoriais com IC, com idade ≥60 anos, foram avaliados quanto a sarcopenia (critérios diagnósticos EWGSOP2), inflamação (Proteína C reativa de alta sensibilidade [PCR-as], Interleucina-6 [IL-6], fator de necrose tumoral alfa [TNF-α]) e marcadores humorais (testosterona total e fator de crescimento semelhante à insulina tipo 1 [IGF-1]), atividade física (Questionário internacional de atividade física), qualidade de vida ( Minnesota Living with Heart Failure Questionnaire - Questionário Minnesota sobre conviver com a insuficiência cardíaca), e capacidade funcional (teste de caminhada de 6 minutos). O nível de significância estatística adotado foi p <0,05. Resultados Os pacientes tinham uma média de idade de 69,4 ± 7,2 anos, 67,8% eram do sexo masculino, com fração de ejeção ventricular esquerda (FEVE) de 35,9 ± 11,9% e 22 (24,4%) eram sarcopênicos. Idade (73,1 ± 8,1 e 68,3 ± 6,5 anos; p= 0,006), índice de massa corporal (IMC) (23,1 ± 2,8 e 28,2 ± 4,2 kg/m2; p <0,001), e FEVE (29,9 ± 8,8 e 37,9 ± 12,1%; p= 0,005) eram diferentes nos grupos com e sem sarcopenia, respectivamente. Depois de normalizar em relação à idade, etnia, IMC, FEVE, e o uso de inibidores da enzima conversora de angiotensina/bloqueadores de receptor de angiotensina, a sarcopenia foi associada a níveis séricos de IL-6 mais altos e capacidade funcional pior. Conclusão Em pacientes com IC, a sarcopenia foi associada aos níveis de IL-6 e à capacidade funcional.

Abstract Background Sarcopenia is highly prevalent in heart failure (HF) patients, and the involvement of biomarkers in its pathophysiology is suggested, but little has been studied concerning HF sarcopenic patients. Objectives To evaluate the association between inflammatory and humoral markers with sarcopenia, as well as the impact of sarcopenia on quality of life and functional capacity in older HF patients. Methods In this cross-sectional study, 90 outpatient HF patients, aged ≥ 60 years, were evaluated for sarcopenia (EWGSOP2 diagnostic criteria), inflammation (high-sensitive C-reactive protein [hs-CRP], Interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-α]) and humoral markers (total testosterone and insulin-like growth factor-1 [IGF-1]), physical activity (International Physical Activity Questionnaire), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walk test). The adopted level of significance was p<0.05. Results Patients had a mean age of 69.4 ± 7.2 years, 67.8% were male, with left ventricular ejection fraction (LVEF) of 35.9 ± 11.9% and 22 (24.4%) were sarcopenic. Age (73.1 ± 8.1 and 68.3 ± 6.5 years; p= 0.006), body mass index (BMI) (23.1 ± 2.8 and 28.2 ± 4.2 kg/m2; p <0.001), and LVEF (29.9 ± 8.8 and 37.9 ± 12.1%; p= 0.005) were different between groups with and without sarcopenia, respectively. After adjusting for age, ethnicity, BMI, LVEF, and the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, sarcopenia was associated with higher serum levels of IL-6 and worse functional capacity. Conclusion In HF patients, sarcopenia was associated with IL-6 levels and functional capacity.

Melhora do estilo de vida reduz o índice de Castelli 1 em indivíduos com síndrome metabólica / Lifestyle improvement reduces Castelli 1 index in people with metabolic syndrome

Avaliar o efeito de diferentes intervenções para modificação do estilo de vida sobre o Índice de Castelli 1 em indivíduos com síndrome metabólica. Tratou-se de uma subanálise de um ensaio clínico randomizado. Foram incluídos no estudo indivíduos com diagnóstico de síndrome metabólica e idade entre 30 e 59 anos, que foram posteriormente randomizados em três diferentes grupos de intervenção. Foram realizadas avaliações antropométricas e bioquímicas no início do estudo e ao final dos três meses de intervenção. Participaram do estudo 59 indivíduos. Os modelos de intervenção realizados nos grupos intervenção individual e intervenção em grupo foram eficazes na redução significativa do índice de Castelli 1, com variância absoluta de -0,70 e -0,23, respectivamente. O modelo de intervenção padrão não demonstrou redução favorável. As intervenções que contemplaram acompanhamento multiprofissional produziram efeito benéfico na redução do índice de Castelli 1 em pacientes com síndrome metabólica.

The effect of different interventions for lifestyle modification on Castelli I Index in people with metabolic syndrome is evaluated. It is a sub-analysis of a randomized clinical assay. People with metabolic syndrome, aged between 30 and 59 years old, were included and later divided, at random, into three different intervention groups. Anthropometric and biochemical evaluations of 59 people were performed at the start and at the end of the three months of intervention. Intervention models undertaken in individual intervention groups and intervention in groups were efficient to significantly reduce Castelli 1 Index, with absolute variance of -0.70 and -0.23, respectively. Standard intervention model did not reveal favorable reduction. Interventions that underscored multiprofessional following up produced beneficent effect on the reduction of Castelli 1 Index in patients with metabolic syndrome.