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Effect of a double nutritional intervention on the nutritional status, functional capacity, and quality of life of patients with chronic heart failure: 12-month results from a randomized clinical trial. NUTR HOSP 2020; 34:422-431. [PMID: 32090585 DOI: 10.20960/nh.02820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: malnutrition is commonly associated with, and worsens the prognosis of heart failure. The management of chronic heart failure and its complications based only on the application of pharmacologic guidelines is incomplete. The benefits of interventions to improve nutritional status may be limited by the multifactorial nature of malnutrition. The objective of the present study was to determine whether nutritional advice and nutritional supplementation can improve the nutritional status of patients with chronic heart failure. Methods: we performed a randomized clinical trial on an intention-to-treat basis with blinded observers. We divided a sample of 76 patients into 2 groups: one that received structured advice combined with nutritional supplements for 12 weeks (test group), and one that received treatment as usual (control group). The outcome measure was nutritional status as evaluated using the Subjective Global Assessment and the Mini Nutritional Assessment tools. After 12 weeks of treatment the test group received a leaflet that served as a reminder. No further interventions were applied in either group. Patients were followed for 1 year. Results: at 3 months of follow-up nutritional status improved 4-fold in the test group, whereas no change was observed in the control group. At 9 months nutritional status in the intervention group had improved 2-fold with respect to the baseline visit, whereas no differences were recorded in the control group. Differences in mortality and length of stay at 1 year did not reach statistical significance.
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Szabó T, Scherbakov N, Sandek A, Kung T, von Haehling S, Lainscak M, Jankowska EA, Rudovich N, Anker SD, Frystyk J, Flyvbjerg A, Pfeiffer AFH, Doehner W. Plasma adiponectin in heart failure with and without cachexia: catabolic signal linking catabolism, symptomatic status, and prognosis. Nutr Metab Cardiovasc Dis 2014; 24:50-56. [PMID: 23791298 DOI: 10.1016/j.numecd.2013.04.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/05/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Adiponectin (ADPN) as an adipose tissue hormone contributes to regulation of energy metabolism and body composition and is associated with cardiovascular risk profile parameters. Cardiac cachexia may develop as a result of severe catabolic derangement in chronic heart failure (CHF). We aimed to determinate an abnormal ADPN regulation as a link between catabolic signalling, symptomatic deterioration and poor prognosis. METHODS AND RESULTS We measured plasma ADPN in 111 CHF patients (age 65 ± 11, 90% male, left ventricular ejection fraction (LVEF) 36 ± 11%, peak oxygen consumption (peakVO2) 18.1 ± 5.7 l/kg*min, body mass index (BMI) 27 ± 4 kg/m(2), all mean ± standard deviation) and 36 healthy controls of similar age and BMI. Body composition was assessed by dual energy X-ray absorptiometry, insulin sensitivity was evaluated by homoeostasis model assessment, exercise capacity by spiroergometry. Plasma ADPN did not differ between CHF vs. controls (13.5 ± 11.0 vs. 10.5 ± 5.3 mg/l, p > 0.4), but increased stepwise with NYHA functional class (I/II/III: 5.7 ± 1.4/10.7 ± 8.3/19.2 ± 14.0 mg/l, ANOVA p < 0.01). Furthermore, ADPN correlated with VO2 at anaerobic threshold (r = -0.34, p < 0.05). ADPN was highest in cachectic patients (cCHF, 16%) vs. non-cachectic (ncCHF) (18.7 ± 15.0 vs. 12.5 ± 9.9 mg/l; p < 0.05). ADPN indicated mortality risk independently of established prognosticators (HR: 1.04 95% CI: 1.02-1.07; p < 0.0001). ADPN above the mean (13.5 mg/l) was associated with a 3.4 times higher mortality risk in CHF vs. patients with ADPN levels below the mean. CONCLUSION Circulating ADPN is abnormally regulated in CHF. ADPN may be involved in impaired metabolic signalling linking disease progression, tissue wasting, and poor outcome in CHF.
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Affiliation(s)
- T Szabó
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - N Scherbakov
- Centre for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany
| | - A Sandek
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - T Kung
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - S von Haehling
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - M Lainscak
- Division of Cardiology, University Clinic, Golnik, Slovenia
| | - E A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - N Rudovich
- Department of Endocrinology, Diabetes, and Nutritional Medicine, Universitätsmedizin Berlin, Germany
| | - S D Anker
- Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
| | - J Frystyk
- Department of Endocrinology and Internal Medicine & the Medical Research Laboratories, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Flyvbjerg
- Department of Endocrinology and Internal Medicine & the Medical Research Laboratories, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A F H Pfeiffer
- Department of Endocrinology, Diabetes, and Nutritional Medicine, Universitätsmedizin Berlin, Germany
| | - W Doehner
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany; Centre for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany.
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Blozik E, Eisele M, Scherer M. [Improvements in survival in patients with heart failure]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:552-7. [PMID: 22441525 DOI: 10.1007/s00103-012-1456-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study is to describe improvements in survival of patients with heart failure. In addition, factors that may have contributed to these improvements are discussed. The extent of improvement in survival is substantial. This is presumably mainly due to a broad spectrum of new therapeutic options and the introduction of clinical guidelines, and the increasing level of awareness and adherence. For the near future, the increasing implementation of disease management programs and complex interventions has the potential to have a further positive influence on the survival of patients with heart failure.
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Affiliation(s)
- E Blozik
- Institut für Allgemeinmedizin, Universität Hamburg, Martinistr. 52, Haus West 34 (W34), 2. OG, 20246, Hamburg, Deutschland
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Ensor CR, Russell SD. Tonapofylline: a selective adenosine-1 receptor antagonist for the treatment of heart failure. Expert Opin Pharmacother 2010; 11:2405-15. [DOI: 10.1517/14656566.2010.514605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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