Associations of Obesity and Prognostic Nutritional Index on 1-Year Mortality in Patients with Acute Heart Failure.

ABSTRACT:

Background

Increased BMI is paradoxically associated with improved survival among patients with acute heart failure (AHF). However, the impact of different nutritional status on this obesity paradox on 1-year mortality is underreported. The prognostic nutritional index is a simple tool to assess nutrition status.

Methods

From 10,027 emergency department admissions at the Amager and Hvidovre Hospital, Copenhagen University Hospital in Denmark, all patients with AHF were identified. Patients were categorised by BMI (normal: 18.5-24.9 kg/m², overweight: 25-29.9 kg/m², obese: ≥30 kg/m²) and nutritional status using the prognostic nutritional index (malnourished: <38, well-nourished: ≥38). Kaplan- Meier curves analysed cumulative survival, and Cox regression examined associations between BMI, nutritional status and outcomes, expressed as HR and 95% CI.

Results

Among 383 AHF patients (median age 76 years), 41.3% were malnourished and 58.7% well nourished. In the well-nourished group, obesity was inversely associated with 1-year mortality (adjusted HR 0.48; 95% CI [0.24-0.95]; p=0.035). However, this correlation disappeared in the malnourished group (adjusted HR 1.08; 95% CI [0.59-2.00]; p=0.798). Mortality rates were significantly lower in the well-nourished group among patients with overweight and obesity.

Conclusion

Obesity was associated with reduced 1-year mortality only in AHF patients with good nutritional status, while in malnourished patients, obesity was not associated with 1-year mortality. The prognosis in patients with AHF depends on both the presence of obesity and their nutritional status, highlighting the need for nutritional assessment for risk stratification.

SUBMITTER: El-Sheikh M 

PROVIDER: S-EPMC11904423 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature