Malnutrition and associated factors among heart failure patients on follow up at Jimma university specialized hospital, Ethiopia

BMC Cardiovascular Disorders

Henok Asefa¹  Leja Hamza²  Hiwot Amare² 

[1]Department of Epidemiology and Biostatistics, Jimma University, Jimma, Ethiopia

[2]Department of Internal Medicine, Jimma University, Jimma, Ethiopia

关键词: Heart failure in Ethiopia;    Serum albumin;    Serum hemoglobin;    Angiotensin converting enzyme inhibitors;    Malnutrition;   

Others  :  1228357
DOI  :  10.1186/s12872-015-0111-4

 received in 2014-12-26, accepted in 2015-09-23,  发布年份 2015

【 摘 要 】

Background

Malnutrition and cachexia are serious consequences of numerous chronic diseases. Severe heart failure patients could be related with marked weight loss. Malnutrition is associated with poor prognosis among heart failure patients. Despite its implication, factors associated with malnutrition among heart failure patients in Africa and Ethiopia was not addressed. Hence, in this study we tried to determine factors associated with malnutrition among heart failure patients on follow up at Jimma University specialized hospital, Ethiopia.

Methods

A cross-sectional study was done on 284 randomly selected heart failure patients. The nutritional status of the patients was assessed based on their serum albumin level (normal value 4–5 mg/dl) and triceps skin fold thickness. The data was analyzed using SPSS version 20.0. Multivariable logistic regression was used to identify factors associated with malnutrition among heart failure patients using SPSS 20.0.

Results

Based on serum albumin and triceps skin fold thickness, 77.8 % of patients were malnourished. Mean age of the patients was 48.3 ± 15.9 years. The commonest cause of heart failure was ischemic heart disease (34.9 %). Hypertension (36 %) was the commonest co morbid disease. Forty four percent of patients had New York heart association functional class II heart failure. Serum hemoglobin (AOR = 0.77, 95 % CI: 0.67–0.92) was found to be significantly associated with nutritional status of heart failure patients. As serum hemoglobin increases by 1gm/dl, the risk of malnutrition decreased by 15 % (P value = 0.03).

Conclusions

The majority of patients were malnourished. A higher hemoglobin concentration was associated with reduced odds of being malnourished.

【 授权许可】

   
2015 Amare et al.

【 参考文献 】

• [1]Mendis S: Global status report on non communicable diseases. In Cardiovascular diseases. Fact sheet N°317 edition. World Health organization, Geneva; 2014.
• [2]Kengne AP, Dzudie A, Sobngwi E: Heart failure in sub-Saharan Africa: A literature review with emphasis on individuals with diabetes. Vasc Health Risk Manag 2008, 4(1):123-30.
• [3]Stenvinkel P, Andersson P: Do ACE-inhibitors supress tumor necrosis factor-alpha production in chronic renal failure. J Intern Med 1999, 246:503-7.
• [4]Anker S: Cardiac cachexia in early literature: a review of research prior to Medline. Int J Cardiol 2002, 85(1):7-14.
• [5]Anker SD, Negassa A: Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet 2003, 361:1077-83.
• [6]Barondess JA: The pathogenesis of cardiac cachexia. Arch Intern Med 1966, 117(6):841.
• [7]Freeman LM: The pathophysiology of cardiac cachexia : current opinion in supportive and palliative. Cahchexia Nutrition Hydration 2009, 3:276-81.
• [8]Morley J: Cachexia: a new definition. Clin Nutr 2008, 27(6):793-9.
• [9]Azhar GW, Wei JY: Nutrition and cardiac cachexia. Curr Opi Clin Nutr Metab Care 2006, 9:18-23.
• [10]Strassburg S, Anker SD: Cachexia in cardiovascular illness. Cachexia and wasting: a modern approach 2006, 349-61.
• [11]Jacobsson A, Pihl-Lindgren E: Malnutrition in patients suffering from chronic heart failure; the nurse’s care. Eur J Heart Fail 2001, 3(4):449-56.
• [12]Anker S: Imbalance of catabolic and anabolic pathways in chronic heart failure. Implication for treatment of cardiac cahexia. Scand J Nutr 2002, 46(1):3-10.
• [13]Sardesai V: Introduction to clinical nutrition. 2nd edition. Marcel Dekker, Switzerland; 2003.
• [14]Rao: Clinical examinations in cardiology. Elsevier, India Pvt. Limited; 2009.
• [15]Qureshi AR, Alvestrand A, Divino-Filho JC, Gutierrez A, Heimbürger O, Lindholm B, et al.: Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. J Am Soc Nephrol 2002, 13:28-36.
• [16]Gastelurrutia P, Lupón J, Domingo M: Usefulness of body mass index to characterize nutritional status of heart failure patients. Am J Cardiol 2011, 108(8):1166-70.
• [17]Stefan Anker WS: Cardiac cachexia. Ann Med 2004, 36(7):518-29.
• [18]Davos CH, Doehner W: Body mass and survival in patients with chronic heart failure without cachexia: the importance of obesity. J Card Fail 2003, 9(1):29-35.
• [19]Zamboni M, Rossi A: Sarcopenia, cachexia and congestive heart failure in the elderly. Endocr Metab Immune Disord Drug Targets 2013, 13(1):58-67.
• [20]Kalantar-Zadeh K: Albumin levels predict survival in patients with systolic heart failure. Am Heart J 2008, 155(5):883-9.
• [21]Hussein MF: Prognostic significance of serum albumin levels in patients with systolic heart failure. Iraqi Postgrad Med J 2012, 11(3):411-7.
• [22]Dunn SP, Bleske B, Dorsch M, Macaulay T: Nutrition and heart failure: impact of drug therapies and management strategies. Nutr Clin Pract 2009, 24(1):60-75.
• [23]Viorel G, Floreaa B, Moon J: Wasting of the left ventricle in patients with cardiac cachexia: a cardiovascular magnetic resonance study. Int J Cardiol 2004, 97(1):15-20.
• [24]Gaziano TGJ: A textbook of cardiovascular medicine. 9th edition. Elsevier Saunders, Philadelphia; 2009.
• [25]Harrison’s principles of internal medicine. 18th edition. The McGraw-Hill Companies, New York; 2012.
• [26]Lagua RT, Claudio VS: Nutrition and diet therapy reference dictionary. Chapman & Hall, New York; 1996.
• [27]Lainscak M, Keber I, Anker SD: Body composition changes in patients with systolic heart failure treated with beta blockers: a pilot study. Int J Cardiol 2006, 106(3):319-22.
• [28]Sliwa K, Mayosi BM: Recent advances in the epidemiology, pathogenesis and prognosis of acute heart failure and cardiomyopathy in Africa. Heart 2013, 99(18):1317-22.
• [29]Sliwa K, Davison BA, Mayosi BM, Damasceno A, Sani M, Ogah OS, et al.: Readmission and death after an acute heart failure event: predictors and outcomes in sub-Saharan Africa: results from the THESUS-HF registry. Eur Heart J 2013, 34(40):3151-9.
• [30]Mitchell J: Treatment of heart failure in African Americans--a call to action. J Natl Med Assoc 2011, 103(2):86-98.
• [31]Teklu B, Parry E, Pavlica D: Ethiopian cardiovascular studies. X. Normal variations of the electrocardiogram in Ethiopians. Ethiop Med J 1971, 9:133-9.
• [32]Mbewu AD: Can developing country systems cope with the epidemics of cardiovascular disease?. Heart Health Conference, New Delhi; 1998.
• [33]Megerssa YC, Gebre MW, Birru SK, Goshu AR, Tesfaye DY. Prevalence of undiagnosed diabetes mellitus and its risk factors in selected institutions at Bishoftu town, East Shoa, Ethiopia. J Diabetes Metab. 2013, 12; doi:. http://dx.doi.org/10.4172/2155-6156.S12-008
• [34]Nicol M: Identification of malnutrtion in heart failure patients. Eur J Cardiovasc Nurs 2002, 1:139-47.
• [35]Mancini DM, Walter G, Reichek N, Lenkinski R, McCully KK, Mullen JL, et al.: Contribution of skeletal muscle atrophy to exercise intolerance and altered muscle metabolism in heart failure. Circulation 1992, 85(4):1364-73.
• [36]Anker SD, Ponikowski P, Varney S: Wasting as independent risk factor of survival in chronic heart failure. Lancet 1997, 349:1050-3.
• [37]WHO: Nutrition Landscape Information System (NLiS), Ethiopia. World Health Organization, Geneva; 2005.
• [38]Central Statistical Agency: Mini Ethiopian demograhic health survey. Central Statistical Agency, Addis Ababa; 2014.
• [39]Carr J: Prevalence and hemodynamic correlates of malnutrition in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1989, 15(63(11)):709-13.
• [40]Elabbassi W: Prevalence and clinical implications of anemia in congestive heart failure patients followed at a specialized hospital. Congest Heart Fail 2007, 12(258–264):258.