Malnutrition is independently associated with an increased risk of major cardiovascular events in adult patients with congenital heart disease

Abstract

The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II UniversityBackground and aims: Malnutrition is found frequently during chronic diseases, and its prevalence and relation to disease outcome in adult patients with congenital heart disease (CHD) remains unknown. Methods and results: A cohort of 393 consecutive stable congenital heart disease (CHD) patients was followed up in a single dedicated clinical unit. Demographic, clinical and laboratory parameters, along with a nutritional risk index (NRI), were studied, as well as major acute cardiovascular events (MACE), defined as arterial thrombotic events, heart failure requiring hospitalization or cardiovascular and non-cardiovascular mortality. The median age of the patients was 23 years (17–35) and 225 (57%) were males. Median plasma albumin concentration was 4.5 (4.2–4.7) g/dL, the body mass index was 23 (21–27) kg/m2, the NRI was 112 (106–118), and 33 (8%) patients showed malnutrition (NIR<100). A worse NYHA functional class (II and III), total cholesterol and serum glucose levels were significant risk factors associated with malnutrition (NRI<100) in CHD patients. During a median follow-up of 8 (5–10) years, 39 (10%) CHD patients suffered a MACE. Multivariable Cox regression analysis showed that older patients (years) [HR 1.06 (1.04–1.09), p < 0.001], CHD patients with great anatomical complexity [HR 4.24 (2.17–8.27), p < 0.001] and those with a lower NRI [HR 0.95 (0.93–0.98), p = 0.001] had a significant worse MACE-free survival, being the NRI a better predictor of MACE than albumin concentration. Conclusions: A low NRI is independently associated with a significant increased risk of MACE in CHD patients.