Skip to main content

Advertisement

Log in

Prognostic impact of malnutrition in elderly patients with acute myocardial infarction

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

We aimed to investigate the prevalence and the prognostic impact of malnutrition using the geriatric nutritional risk index (GNRI) in elderly patients with acute myocardial infarction (AMI). We investigated 130 consecutive patients aged ≥ 75 years who were discharged following successful primary coronary intervention between March 2009 and December 2016. The mean age of the patients was 81.5 ± 5.0 years, and 55.4% of them were male. At discharge, the patients’ nutritional statuses were evaluated using the GNRI, which were calculated as follows: 14.89 × serum albumin (g/dL) + 41.7 × body mass index/22. The patients were divided into two groups, a low GNRI group (GNRI < 92) with nutrition-related risk and a high GNRI group (GNRI ≥ 92) without nutrition-related risk. The mean GNRI score of all patients was 95.2 ± 11.0, and 46 patients (35.4%) had a low GNRI score. During the mean follow-up of 1030 ± 850 days, the all-cause mortality was significantly higher in the low GNRI group than in the high GNRI group (32.6% vs. 13.1%, p < 0.001), while the event rates of AMI recurrence and hospitalization due to heart failure did not differ significantly between the two groups. Multivariate Cox proportional analysis revealed that low GNRI was a modest but independent predictor of mortality (hazard ratio, 0.94; 95% confidence interval 0.90–0.98; p = 0.01). Among elderly patients with AMI, malnutrition assessed using the GNRI was often encountered and was an independent predictor of long-term mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cederholm T, Hellström K (1992) Nutritional status in recently hospitalized and free-living elderly subjects. Gerontology 38:105–110

    Article  CAS  Google Scholar 

  2. Grant JP (1994) Nutrition care of patients with acute and chronic respiratory failure. Nutr Clin Pract 9:11–17

    Article  CAS  Google Scholar 

  3. Anker SD, Ponikowski P, Varney S, Chua TP, Clark AL, Webb-Peploe KM, Harrington D, Kox WJ, Poole-Wilson PA, Coats AJ (1997) Wasting as independent risk factor for mortality in chronic heart failure. Lancet 349:1050–1053

    Article  CAS  Google Scholar 

  4. Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, Payette H, Bernier P, Davidson B, Teterina A, Lou W (2016) Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: a prospective cohort study. Clin Nutr 35:144–152

    Article  Google Scholar 

  5. Kalantar-Zadeh K, Anker SD, Horwich TB, Fonarow GC (2008) Nutritional and anti-inflammatory interventions in chronic heart failure. Am J Cardiol 101:89e–103e

    Article  CAS  Google Scholar 

  6. Springer J, Springer JI, Anker SD (2017) Muscle wasting and sarcopenia in heart failure and beyond: update 2017. ESC Heart Fail 4:492–498

    Article  Google Scholar 

  7. Yoo SH, Kook HY, Hong YJ, Kim JH, Ahn Y, Jeong MH (2017) Influence of undernutrition at admission on clinical outcomes in patients with acute myocardial infarction. J Cardiol 69:555–560

    Article  Google Scholar 

  8. Komici K, Vitale DF, Mancini A, Bencivenga L, Conte M, Provenzano S, Grieco FV, Visaggi L, Ronga I, Cittadini A, Corbi G, Trimarco B, Morisco C, Leosco D, Ferrara N, Rengo G (2019) Impact of malnutrition on long-term mortality in elderly patients with acute myocardial infarction. Nutrients 11:224

    Article  CAS  Google Scholar 

  9. Lu YW, Lu SF, Chou RH, Wu PS, Ku YC, Kuo CS, Chang CC, Tsai YL, Wu CH, Huang PH (2019) Lipid paradox in patients with acute myocardial infarction: potential impact of malnutrition. Clin Nutr 38:2311–2318

    Article  CAS  Google Scholar 

  10. Takahashi T, Watanabe T, Otaki Y, Kato S, Tamura H, Nishiyama S, Arimoto T, Takahashi H, Shishido T, Watanabe M (2021) Prognostic significance of the controlling nutritional (CONUT) score in patients with acute coronary syndrome. Heart Vessels 36:1109–1116

    Article  Google Scholar 

  11. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C (2005) Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82:777–783

    Article  CAS  Google Scholar 

  12. Cereda E, Pedrolli C (2009) The geriatric nutritional risk index. Curr Opin Clin Nutr Metab Care 12:1–7

    Article  Google Scholar 

  13. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction (2018) Fourth universal definition of myocardial infarction. J Am Coll Cardiol 72:2231–2264

    Article  Google Scholar 

  14. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  Google Scholar 

  15. World Medical Association (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310:2191–2194

    Article  Google Scholar 

  16. Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, Kumagai H (2008) Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 87:106–113

    Article  CAS  Google Scholar 

  17. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl 48:452–458

    Article  CAS  Google Scholar 

  18. Aziz EF, Javed F, Pratap B, Musat D, Nader A, Pulimi S, Alivar CL, Herzog E, Kukin ML (2011) Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure: an ACAP-HF data analysis. Heart Int 6:e2

    Article  Google Scholar 

  19. Kinugasa Y, Kato M, Sugihara S, Hirai M, Yamada K, Yanagihara K, Yamamoto K (2013) Geriatric nutritional risk index predicts functional dependency and mortality in patients with heart failure with preserved ejection fraction. Circ J 77:705–711

    Article  CAS  Google Scholar 

  20. Nakamura T, Matsumoto M, Haraguchi Y, Ishida T, Momomura S (2020) Prognostic impact of malnutrition assessed using geriatric nutritional risk index in patients aged ≥ 80 years with heart failure. Eur J Cardiovasc Nurs 19:172–177

    Article  CAS  Google Scholar 

  21. Lavie CJ, Milani RV, Ventura HO (2009) Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 53:1925–1932

    Article  Google Scholar 

  22. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P, ESC Scientific Document Group (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39:119–177

    Article  Google Scholar 

  23. Kim DW, Her SH, Park HW, Park MW, Chang K, Chung WS, Seung KB, Ahn TH, Jeong MH, Rha SW, Kim HS, Gwon HC, Seong IW, Hwang KK, Chae SC, Kim KB, Kim YJ, Cha KS, Oh SK, Chae JK, KAMIR-NIH Registry Investigators (2019) Association between body mass index and 1-year outcome after acute myocardial infarction. PLoS ONE 14:e0217525

    Article  CAS  Google Scholar 

  24. Bucholz EM, Beckman AL, Krumholz HA, Krumholz HM (2016) Excess weight and life expectancy after acute myocardial infarction: the obesity paradox reexamined. Am Heart J 172:173–181

    Article  Google Scholar 

  25. Fukuoka S, Kurita T, Dohi K, Masuda J, Seko T, Tanigawa T, Saito Y, Kakimoto H, Makino K, Ito M (2019) Untangling the obesity paradox in patients with acute myocardial infarction after primary percutaneous coronary intervention (detail analysis by age). Int J Cardiol 289:12–18

    Article  Google Scholar 

  26. Bucholz EM, Krumholz HA, Krumholz HM (2016) Underweight, markers of cachexia, and mortality in acute myocardial infarction: a prospective cohort study of elderly medicare beneficiaries. PLoS Med 13:e1001998

    Article  Google Scholar 

  27. Niedziela J, Hudzik B, Niedziela N, Gąsior M, Gierlotka M, Wasilewski J, Myrda K, Lekston A, Poloński L, Rozentryt P (2014) The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol 29:801–812

    Article  CAS  Google Scholar 

  28. Sujino Y, Tanno J, Nakano S, Funada S, Hosoi Y, Senbonmatsu T, Nishimura S (2015) Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥ 85 years) with ST-elevation myocardial infarction. J Cardiol 66:263–268

    Article  Google Scholar 

  29. Akdag I, Yilmaz Y, Kahvecioglu S, Bolca N, Ercan I, Ersoy A, Gullulu M (2008) Clinical value of the malnutrition-inflammation-atherosclerosis syndrome for long-term prediction of cardiovascular mortality in patients with end-stage renal disease: a 5-year prospective study. Nephron Clin Pract 108:c99–c105

    Article  CAS  Google Scholar 

  30. de la Cruz KI, Bakaeen FG, Wang XL, Huh J, LeMaire SA, Coselli JS, Chu D (2011) Hypoalbuminemia and long-term survival after coronary artery bypass: a propensity score analysis. Ann Thorac Surg 91:671–675

    Article  Google Scholar 

  31. Maruyama S, Ebisawa S, Miura T, Yui H, Kashiwagi D, Nagae A, Sakai T, Kato T, Saigusa T, Okada A, Motoki H, Kuwahara K (2021) Impact of nutritional index on long-term outcomes of elderly patients with coronary artery disease: sub-analysis of the SHINANO 5 year registry. Heart Vessels 36:7–13

    Article  Google Scholar 

  32. Snider JT, Linthicum MT, Wu Y, LaVallee C, Lakdawalla DN, Hegazi R, Matarese L (2014) Economic burden of community-based disease-associated malnutrition in the United States. JPEN J Parenter Enter Nutr 38:77S-85S

    Article  Google Scholar 

  33. Bartali B, Frongillo EA, Bandinelli S, Lauretani F, Semba RD, Fried LP, Ferrucci L (2006) Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci 61:589–593

    Article  Google Scholar 

  34. Wei K, Nyunt MS, Gao Q, Wee SL, Yap KB, Ng TP (2018) Association of frailty and malnutrition with long-term functional and mortality outcomes among community-dwelling older adults: results from the Singapore longitudinal aging study 1. JAMA Netw Open 1:e180650

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomohiro Nakamura.

Ethics declarations

Conflicts of interest

The authors have no financial conflicts of interest to disclose concerning this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakamura, T., Haraguchi, Y., Matsumoto, M. et al. Prognostic impact of malnutrition in elderly patients with acute myocardial infarction. Heart Vessels 37, 385–391 (2022). https://doi.org/10.1007/s00380-021-01922-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-021-01922-y

Keywords

Navigation