急性心肌梗死后并发肥胖和营养不良患者的长期预后:一项队列研究。

IF 6.9 2区医学

Circulation. Cardiovascular Quality and Outcomes Pub Date : 2023-04-01 DOI:10.1161/CIRCOUTCOMES.122.009340

Gwyneth Kong, Audrey Zhang, Bryan Chong, Jieyu Lim, Shankar Kannan, Yip Han Chin, Cheng Han Ng, Chaoxing Lin, Chin Meng Khoo, Mark Muthiah, Mayank Dalakoti, William Kristanto, Yibin Wang, William Kong, Kian Keong Poh, Ping Chai, Roger Foo, Mark Yan-Yee Chan, Poay-Huan Loh, Nicholas W S Chew

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引用次数: 3

摘要

背景:营养不良的双重负担，即营养不良和肥胖的共存，是一个日益严重的全球健康问题。本研究探讨肥胖和营养不良对急性心肌梗死(AMI)患者的综合影响。方法:回顾性研究2014年1月至2021年3月在新加坡一家有经皮冠状动脉介入治疗能力的医院就诊的AMI患者。患者被分为以下几组:(1)营养非肥胖，(2)营养非肥胖，(3)营养肥胖，(4)营养不良肥胖。肥胖和营养不良分别根据世界卫生组织定义(体重指数≥27.5 kg/m2)和控制营养状况评分进行定义。主要结局为全因死亡率。结合年龄、性别、急性心肌梗死类型、既往急性心肌梗死、射血分数和慢性肾脏疾病等因素，采用Cox回归检验合并肥胖和营养状况与死亡率之间的关系。构建了全因死亡率的Kaplan-Meier曲线。结果:纳入AMI患者1829例，男性75.7%，平均年龄66岁。超过75%的患者营养不良。大多数是营养不良非肥胖(57.7%)，其次是营养不良肥胖(18.8%)、营养非肥胖(16.9%)和营养肥胖(6.6%)。营养不良非肥胖者的全因死亡率最高(38.6%)，其次是营养不良肥胖者(35.8%)、营养不良非肥胖者(21.4%)和营养肥胖者(9.9%，PP=0.010)，但营养不良肥胖者的死亡率没有显著增加(风险比为1.31 [95% CI, 0.94-1.83]， P=0.112)。结论:在急性心肌梗死患者中，即使是肥胖者也普遍存在营养不良。与营养不良的AMI患者相比，营养不良的AMI患者预后更不利，尤其是严重营养不良的AMI患者，与肥胖状况无关，但营养不良的AMI患者长期生存最有利。

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Long-Term Prognosis of Patients With Coexisting Obesity and Malnutrition After Acute Myocardial Infarction: A Cohort Study.

Background: The double burden of malnutrition, described as the coexistence of malnutrition and obesity, is a growing global health issue. This study examines the combined effects of obesity and malnutrition on patients with acute myocardial infarction (AMI).

Methods: Patients presenting with AMI to a percutaneous coronary intervention-capable hospital in Singapore between January 2014 and March 2021 were retrospectively studied. Patients were stratified into the following: (1) nourished nonobese, (2) malnourished nonobese, (3) nourished obese, and (4) malnourished obese. Obesity and malnutrition were defined according to the World Health Organization definition (body mass index ≥27.5 kg/m²) and Controlling Nutritional Status score, respectively. The primary outcome was all-cause mortality. The association between combined obesity and nutritional status with mortality was examined using Cox regression, adjusted for age, sex, AMI type, previous AMI, ejection fraction, and chronic kidney disease. Kaplan-Meier curves for all-cause mortality were constructed.

Results: The study included 1829 AMI patients, of which 75.7% were male and mean age was 66 years. Over 75% of patients were malnourished. Majority were malnourished nonobese (57.7%), followed by malnourished obese (18.8%), nourished nonobese (16.9%), and nourished obese (6.6%). Malnourished nonobese had highest all-cause mortality (38.6%), followed by the malnourished obese (35.8%), nourished nonobese (21.4%), and nourished obese (9.9%, P<0.001). Kaplan-Meier curves demonstrated least favorable survival in malnourished nonobese group, followed by malnourished obese, nourished nonobese, and nourished obese. With nourished nonobese group as the reference, malnourished nonobese had higher all-cause mortality (hazard ratio, 1.46 [95% CI, 1.10-1.96], P=0.010), but only a nonsignificant increase in mortality was observed in the malnourished obese (hazard ratio, 1.31 [95% CI, 0.94-1.83], P=0.112).

Conclusions: Among AMI patients, malnutrition is prevalent even in the obese. Compared to nourished patients, malnourished AMI patients have a more unfavorable prognosis especially in those with severe malnutrition regardless of obesity status, but long-term survival is the most favorable among nourished obese patients.

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来源期刊

Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine

CiteScore

9.80

自引率

2.90%

发文量

357

期刊介绍： Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.