Assessing the link of malnutrition with diabetes and mortality risk in heart failure patients

Abstract

Aims: Malnutrition is increasingly recognized as a significant factor influencing the clinical outcomes of patients with heart failure (HF). Diabetes exacerbates risks like hospitalizations and mortality due to cardiovascular complications. The aim of this study was to explore the association of malnutrition with diabetes and its prognostic impact on all-cause and cardiovascular mortality in patients with HF, using the nutritional assessment tools, controlling nutritional status (CONUT) score and geriatric nutritional risk index (GNRI).

Methods and results: Data were obtained from the National Health and Nutrition Examination Survey (1999-2018). Malnutrition was assessed using the CONUT score and GNRI. Multivariate logistic regression models were used to assess the association between malnutrition and diabetes. And Cox proportional hazards models were used to assess the risk of death from malnutrition combined with or without diabetes in HF separately. In addition, propensity score matching and inverse probability weighting were used to adjust for confounders for logistic regression model and Cox proportional hazards model analyses. Finally, subgroup analyses were performed. This study included 1501 HF participants (median age 70.0 years; 43.8% females), including 586 (39.0%) with diabetes. Continuous CONUT was significantly associated with diabetes in HF (OR 1.19, 95% CI: 1.08-1.32, P < 0.001) and remained significant after propensity score matching and inverse probability weighting. Similar relationships exist for categorized CONUT, but GNRI was not associated with diabetes in HF. Then, 1500 participants completed follow-up (5.6 [2.8-9.7] years). Elevated continuous CONUT was related to higher all-cause (HR = 1.18, 95% CI: 1.09-1.29, P < 0.001) and cardiovascular mortality (HR = 1.26, 95% CI: 1.12-1.42, P < 0.001) in HF patients with diabetes. And increased continuous CONUT was linked to higher all-cause (HR = 1.12, 95% CI: 1.03-1.22, P < 0.001) and cardiovascular mortality (HR = 1.20, 95% CI: 1.07-1.35, P < 0.001) in HF patients without diabetes. Similar relationships exist for categorized CONUT.

Conclusions: Malnutrition assessed by CONUT is linked to higher diabetes prevalence in HF, influenced by altered albumin, cholesterol and lymphocyte levels. CONUT also predicts all-cause and cardiovascular mortality in HF with and without diabetes. Future research should consider dietary assessments and body composition analysis to assess malnutrition in HF patients.

Keywords: Controlling nutritional status; Diabetes; Geriatric nutritional risk index; Heart failure; Malnutrition; Mortality.