The effect of nutritional support on nutritional status and quality of life as well as on inflammatory markers and cardiac functions in patients with cardiac cachexia due to chronic heart failure

Abstract

Objective: Cardiac cachexia (CC) is defined as a loss of at least 6% of total body weight in 6 months due to chronic heart failure (CHF). The prevalence of CC in patients with NYHA class II-IV is estimated to be approximately 12%-15%. There are only a few studies that demonstrate the effects of malnutrition treatment on nutrition, physical activity, quality of life (QoL), and clinical course of the disease. This study aimed to evaluate the effect of nutrition treatment on anthropometric measurements, fat free mass (FFM), muscle strength, physical performance, and QoL together with cardiac functions and immunity in patients with CC. Method: This was a prospective clinical intervention study. Patients with NYHA stage II-IV CHF (n=725) followed-up in Internal Medicine and Cardiology Departments were screened for CC. Eighteen patients with CC were enrolled in the study. The control group included 18 healthy adults. Nutritional status assessment, anthropometric measurements, gait speed, muscle strength, bioelectrical impedance analysis (BIA Tanita, Japan), biochemical analyses, and cytokine measurements were performed. Cardiac functions were assessed by echocardiography. Nutrition support treatment was given to patients with CC, and they were followed-up for next 3 months. QoL was measured with “Ferrans and Powers” Quality of Life Index (cardiac version). Similar studies were repeated after follow-up. Results: After excluding all other reasons for cachexia, the prevalence of CC was 2.5% in our patients with CHF. The patients with CC had higher serum C-Reactive Protein (CRP) and IL-6 levels than the healthy controls. After nutrition support treatment, the QoL scores and visceral fat level significantly increased in patients with CC. Although mid-upper arm circumference (MUAC), handgrip strength, FFM, fat mass, and serum albumin levels increased, they were not statistically significant. Conclusion: When compared to previous studies, our CC prevalence rate was lower. Nutrition support therapy can reverse weight loss in patients with CC, which can also improve QoL. An important limitation to the study is the low number of patients that is related with the exclusion criteria regarding every type of inflammatory disease, acute medical problems, and cancer. Therefore, further studies with more patients are needed.