Insufficient Calorie Intake Associated With Increased Readmission in Older Patients Hospitalized for Heart Failure

Insufficient calorie intake was found to be independently associated with a poorer quality of life and greater burden of hospital readmission at 12 weeks postdischarge among older patients hospitalized for heart failure, according to a study published in JACC: Heart Failure.

A total of 57 participants (70±8 years; 31% women; mean body mass index, 32±8 kg/m²) with heart failure were enrolled in the Geriatric Out-of-hospital Randomized MEal Trial in Heart Failure (ClinicalTrials.gov Identifier: NCT02148679) and asked to complete the Block Food Frequency Questionnaire (FFQ) to estimate baseline nutritional intake. In addition, the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs.

In this cohort, the median sodium and calorie intake were 2987 mg/day (interquartile range [IQR], 2160 to 3540) and 1602 kcal/day (IQR, 1201-2142), respectively. A total of 29 patients (53%) had insufficient caloric intake. Patients who had insufficient vs sufficient calorie intake had higher body mass index at hospital discharge and were younger.

A total of 11% of participants were considered to be malnourished according to the NRI. All patients who consumed <2000 mg/day sodium had insufficient calorie intake and more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients who had insufficient calorie intake had lower improvement in the Kansas City Cardiomyopathy Questionnaire Clinical Summary score (β = -14.6; 95% CI, -27.3 to -1.9), higher odds of readmission (odds ratio, 14.5; 95% CI: 2.2-94.4), and more days rehospitalized (incident rate ratio, 31.3; 95% CI, 4.3-229.3).

Study limitations include the small cohort and use of the FFQ, which may produce biased estimates of nutrient intakes.

“The present findings demonstrate the prognostic value of dietary assessment in hospitalized patients with heart failure and provide another possible method to select appropriate patients for dietary intervention,” concluded the investigators. “It is important to note that calorie restriction has been shown to improve exercise capacity in obese patients with stable heart failure with preserved ejection fraction. However, the sustainability of related loss of fat mass and physiological benefits is uncertain, as are the effects of calorie restriction in heart failure populations who are more ill.”

Reference

Bilgen F, Chen P, Poggi A, et al. Insufficient calorie intake worsens post-discharge quality of life and increases readmission burden in heart failure. [published online July 7, 2020]. JACC Heart Fail. doi:10.1016/j.jchf.2020.04.004