Prognostic Significance of Nutrition-Associated Markers in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. / Significado Prognóstico de Marcadores Associados à Nutrição na Insuficiência Cardíaca com Fração de Ejeção Preservada: Uma Revisão Sistemática e Metanálise.

BACKGROUND: The prognostic significance of nutrition indicators in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. OBJECTIVES: This systematic review and meta-analysis aimed to assess the prognostic value of serum albumin (SA), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) in patients with HFpEF. METHODS: Databases of PubMed, Embase, The Cochrane Library, and Web of Science were systematically searched for all studies published up to January 2022. The prognostic significance of SA, GNRI, and PNI for HFpEF was explored. Pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the STATA 15.0 software. The Quality of Prognosis Studies tool was used to assess the quality of studies. RESULTS: Nine studies met the inclusion criteria, and 5603 adults with HFpEF were included in the meta-analysis. The analyses showed that a decreased SA or GNRI was significantly related to high all-cause mortality (HR: 1.98; 95% CI: 1.282-3.057; p = 0.002; and HR: 1.812;95% CI: 1.064-3.086; p = 0.029, respectively). Furthermore, a lower SA indicates a bad composite outcome of all-cause mortality and HF rehospitalization (HR: 1.768; 95% CI: 1.483-2.108; p = 0.000), and a lower GNRI was significantly associated with high cardiovascular mortality (HR: 1.922; 95% CI: 1.504-2.457;p = 0.000). However, a lower PNI did not correlate with all-cause mortality (HR: 1.176; 95% CI: 0.858-1.612, p=0.314). CONCLUSIONS: Our meta-analysis indicates that SA and GNRI may be useful indicators to predict the prognosis of patients with HFpEF.

FUNDAMENTO: O significado prognóstico dos indicadores nutricionais em pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) não é claro. OBJETIVO: Esta revisão sistemática e metanálise teve como objetivo avaliar o valor prognóstico da albumina sérica (AS), o índice de risco nutricional geriátrico (IRNG) e o índice nutricional prognóstico (INP) em pacientes com ICFEP. MÉTODO: Os bancos de dados PubMed, Embase, The Cochrane Library e Web of Science foram sistematicamente pesquisados para todos os estudos publicados até janeiro de 2022. O significado prognóstico de IRNG, GNRI e INP para ICFEP foi explorado. A taxa de risco agrupada (HR) e o intervalo de confiança (IC) de 95% foram estimados usando o software STATA 15.0. A Ferramenta de Estudos de Qualidade de Prognóstico foi usada para avaliar a qualidade dos estudos. RESULTADOS: Nove estudos preencheram os critérios de inclusão e 5.603 adultos com ICFEP foram incluídos na metanálise. As análises mostraram que uma diminuição de AS ou IRNG estava significativamente relacionada à alta mortalidade por todas as causas (HR: 1,98; 95% IC: 1,282­3,057; p = 0,002; e HR: 1,812;95% IC: 1,064­3,086; p = 0,029, respectivamente). Além disso, uma AS mais baixa indica um resultado composto ruim de mortalidade por todas as causas e reinternação por IC (HR: 1,768; IC 95%: 1,483­2,108; p = 0,000), e um IRNG mais baixo foi significativamente associado a alta mortalidade cardiovascular (HR: 1,922; 95% IC: 1,504­2,457; p = 0,000). No entanto, um INP mais baixo não se correlacionou com mortalidade por todas as causas (HR: 1,176; IC 95%: 0,858­1,612, p=0,314). CONCLUSÕES: Nossa metanálise indica que AS e IRNG podem ser indicadores úteis para prever o prognóstico de pacientes com ICFEP.

Significado Prognóstico de Marcadores Associados à Nutrição na Insuficiência Cardíaca com Fração de Ejeção Preservada: Uma Revisão Sistemática e Metanálise / Prognostic Significance of Nutrition-Associated Markers in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Resumo Fundamento O significado prognóstico dos indicadores nutricionais em pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) não é claro. Objetivo Esta revisão sistemática e metanálise teve como objetivo avaliar o valor prognóstico da albumina sérica (AS), o índice de risco nutricional geriátrico (IRNG) e o índice nutricional prognóstico (INP) em pacientes com ICFEP. Método Os bancos de dados PubMed, Embase, The Cochrane Library e Web of Science foram sistematicamente pesquisados para todos os estudos publicados até janeiro de 2022. O significado prognóstico de IRNG, GNRI e INP para ICFEP foi explorado. A taxa de risco agrupada (HR) e o intervalo de confiança (IC) de 95% foram estimados usando o software STATA 15.0. A Ferramenta de Estudos de Qualidade de Prognóstico foi usada para avaliar a qualidade dos estudos. Resultados Nove estudos preencheram os critérios de inclusão e 5.603 adultos com ICFEP foram incluídos na metanálise. As análises mostraram que uma diminuição de AS ou IRNG estava significativamente relacionada à alta mortalidade por todas as causas (HR: 1,98; 95% IC: 1,282-3,057; p = 0,002; e HR: 1,812;95% IC: 1,064-3,086; p = 0,029, respectivamente). Além disso, uma AS mais baixa indica um resultado composto ruim de mortalidade por todas as causas e reinternação por IC (HR: 1,768; IC 95%: 1,483-2,108; p = 0,000), e um IRNG mais baixo foi significativamente associado a alta mortalidade cardiovascular (HR: 1,922; 95% IC: 1,504-2,457; p = 0,000). No entanto, um INP mais baixo não se correlacionou com mortalidade por todas as causas (HR: 1,176; IC 95%: 0,858-1,612, p=0,314). Conclusões Nossa metanálise indica que AS e IRNG podem ser indicadores úteis para prever o prognóstico de pacientes com ICFEP.

Abstract Background The prognostic significance of nutrition indicators in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. Objectives This systematic review and meta-analysis aimed to assess the prognostic value of serum albumin (SA), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) in patients with HFpEF. Methods Databases of PubMed, Embase, The Cochrane Library, and Web of Science were systematically searched for all studies published up to January 2022. The prognostic significance of SA, GNRI, and PNI for HFpEF was explored. Pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the STATA 15.0 software. The Quality of Prognosis Studies tool was used to assess the quality of studies. Results Nine studies met the inclusion criteria, and 5603 adults with HFpEF were included in the meta-analysis. The analyses showed that a decreased SA or GNRI was significantly related to high all-cause mortality (HR: 1.98; 95% CI: 1.282-3.057; p = 0.002; and HR: 1.812;95% CI: 1.064-3.086; p = 0.029, respectively). Furthermore, a lower SA indicates a bad composite outcome of all-cause mortality and HF rehospitalization (HR: 1.768; 95% CI: 1.483-2.108; p = 0.000), and a lower GNRI was significantly associated with high cardiovascular mortality (HR: 1.922; 95% CI: 1.504-2.457;p = 0.000). However, a lower PNI did not correlate with all-cause mortality (HR: 1.176; 95% CI: 0.858-1.612, p=0.314). Conclusions Our meta-analysis indicates that SA and GNRI may be useful indicators to predict the prognosis of patients with HFpEF.

Accuracy of a handheld 3D imaging system for child anthropometric measurements in population-based household surveys and surveillance platforms: an effectiveness validation study in Guatemala, Kenya, and China.

BACKGROUND: An efficacy evaluation of the AutoAnthro system to measure child (0-59 months) anthropometry in the United States found 3D imaging performed as well as gold-standard manual measurements for biological plausibility and precision. OBJECTIVES: We conducted an effectiveness evaluation of the accuracy of the AutoAnthro system to measure 0- to 59-month-old children's anthropometry in population-based surveys and surveillance systems in households in Guatemala and Kenya and in hospitals in China. METHODS: The evaluation was done using health or nutrition surveillance system platforms among 600 children aged 0-59 months (Guatemala and Kenya) and 300 children aged 0-23 months (China). Field team anthropometrists and their assistants collected manual and scan anthropometric measurements, including length or height, midupper arm circumference (MUAC), and head circumference (HC; China only), from each child. An anthropometry expert and assistant later collected both manual and scan anthropometric measurements on the same child. The expert manual measurements were considered the standard compared to field team scans. RESULTS: Overall, in Guatemala, Kenya, and China, for interrater accuracy, the average biases for length or height were -0.3 cm, -1.9 cm, and -6.2 cm, respectively; for MUAC were 0.9 cm, 1.2 cm, and -0.8 cm, respectively; and for HC was 2.4 cm in China. The inter-technical errors of measurement (inter-TEMs) for length or height were 2.8 cm, 3.4 cm, 5.5 cm, respectively; for MUAC were 1.1 cm, 1.5 cm, and 1.0 cm, respectively; and for HC was 2.8 cm in China. For intrarater precision, the absolute mean difference and intra-TEM (interrater, intramethod TEM) were 0.1 cm for all countries for all manual measurements. For scans, overall, absolute mean differences for length or height were 0.4-0.6 cm; for MUAC were 0.1-0.1 cm; and for HC was 0.4 cm. For the intra-TEM, length or height was 0.5 cm in Guatemala and China and 0.7 cm in Kenya, and other measurements were ≤0.3 cm. CONCLUSIONS: Understanding the factors that cause the many poor scan results and how to correct them will be needed prior to using this instrument in routine, population-based survey and surveillance systems.