Hidden malnutrition and sarcopenic obesity in older heart failure outpatients
T Mannion, E Higgisson, V MaherAbstract
Background
Older patients with heart failure (HF) are particularly vulnerable to malnutrition, sarcopenia, and micronutrient deficiencies, which may adversely affect functional status, frailty, and response to guideline-directed medical therapy. However, nutritional status is not routinely assessed in outpatient HF management programmes.
Purpose
To describe the prevalence of nutritional deficiencies in older HF patients referred to an outpatient chronic disease management programme and to explore their associations with frailty, sarcopenia, and HF severity.
Methods
Data was collected on 80 consecutive patients (54 male, 26 female) aged ≥65 years (mean age 78 years) referred to an outpatient HF chronic disease management programme. Nutritional assessment comprised obesity status as assessed by Body Mass Index (BMI), malnutrition assessment (Mini-Nutritional Assessment Short-Form (MNA SF)) & biochemical markers including albumin, hemoglobin, iron studies, vitamin D, magnesium & potassium. Screening for frailty & sarcopenia was completed using Clinical Frailty Scale (CFS) & SARC-F questionnaire
Results
Malnutrition risk (43.8%, n=35) and overt malnutrition (8.8%, n=7) were highly prevalent in this older heart failure cohort (figure 1). Nutritional deficits frequently coexisted with anaemia (45.0%, n=36), iron deficiency (54.4%, n=43), and vitamin D deficit (30.8%, n=24), despite a high prevalence of obesity defined by BMI criteria (32.5%, n=26). Among patients classified as obese, 33.3% (n=13) demonstrated nutritional impairment while 57.7% (n=15) had a high probability of sarcopenia. Patients with nutritional impairment demonstrated significantly higher frailty scores (p=0.001) and greater sarcopenia burden (p=0.002) (figure 2). Additionally, nutritional impairment was associated with more advanced NYHA functional class (p=0.007), higher NTproBNP levels (p=0.001) and worse renal function (p=0.04).
Conclusion
Among patients aged ≥65 years referred to an outpatient HF chronic disease management programme, nutritional deficiencies and malnutrition are highly prevalent and closely linked to frailty, sarcopenia, and HF severity. Despite obesity by BMI criteria, one-third of obese patients exhibited nutritional deficits, and over half had a high probability of sarcopenia, highlighting the presence of sarcopenic obesity in this cohort. Routine, multidimensional nutritional screening should be embedded within outpatient HF programmes to enable early identification and targeted intervention.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.