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Cardiovascular risk increases with undernourishment
Adults aged at least 80 years who have already developed nonvalvular atrial fibrillation are at greater cardiovascular risk if they are also malnourished, according to findings published in Nutrition, Metabolism & Cardiovascular Diseases.
“Malnutrition among advanced-age patients with [atrial fibrillation] might be overlooked,” A.M. Dang, MD, PhD, of the department of special care center at Fuwai Hospital and the National Clinical Research Center for Cardiovascular Diseases and National Center for Cardiovascular Diseases at Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, and colleagues wrote. “Screening advanced-age patients with [atrial fibrillation] for malnutrition may be beneficial for early detection of patients with a high risk of adverse clinical outcomes, thereby providing them with more individual treatments to improve their prognosis.”
Dang and colleagues conducted a retrospective observational study with 461 participants (mean age, 82 years; 43% women) from Fuwai Hospital. All participants had nonvalvular atrial fibrillation and were hospitalized from 2010 to 2015 and followed for a median of 27 months. Using three separate malnutrition assessment models, the researchers identified individuals with malnutrition and then examined electronic medical records to confirm incidence of all-cause death, nonfatal ischemic stroke and systemic embolism, which were the primary endpoints of the study.
The first malnutrition assessment model (Controlling Nutritional Status) was based on serum albumin, total cholesterol and lymphocyte levels. Among the 130 participants who reached one of the primary endpoints, 16.9% met the criteria for malnutrition in this model, whereas 6.9% of those who did not reach one of the endpoints were malnourished (P = .03). The risk for all-cause death, nonfatal ischemic stroke or systemic embolism was more than doubled for those who were moderately to severely malnourished according to the Controlling Nutritional Status model (HR = 2.051; 95% CI, 1.143-3.679) vs. those who did not.
For those who met the cutoffs for moderate to severe malnutrition according to the Prognostic Nutritional Index, which was determined via a calculation of serum albumin in relation to lymphocytes, the risk was even higher for the combined endpoints (HR = 3.374; 95% CI, 1.898-5.998). In addition, moderate to severe malnutrition was observed in 13.1% of those who reached a primary endpoint vs. in 1.8% of those who did not reach an endpoint (P < .001).
The final nutrition assessment was the Geriatric Nutritional Risk Index, based on serum albumin and body weight as measurements of interest. Participants who were considered malnourished by this index were 2.254 times more likely to experience all-cause death, nonfatal ischemic stroke or systemic embolism vs. those who were not malnourished (HR = 2.254; 95% CI, 1.381-3.679). In addition, malnourished participants made up 19.2% of the 130 participants who reached the study endpoint and 7.6% of the 331 participants who did not (P < .001).
“The correlation of the malnutrition status with adverse clinical outcomes among older patients with nonvalvular [atrial fibrillation] may be partly explained by the vicious circle between malnutrition and chronic disease,” the researchers wrote. “Screening of the nutrition status using objective malnutrition scores can provide useful information regarding prognosis and risk stratification for advanced-age patients with nonvalvular [atrial fibrillation].” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.