BMI, Nutrition, Inflammation and Heart Failure Outcomes

心脏恶病质是心力衰竭（HF）患者发病率和死亡率的独立危险因素。相反，最近有报道称肥胖与发病率和死亡率风险降低有关。 超重和肥胖的HF患者有令人惊讶的更好的结果，这一发现与我们目前对肥胖和HF之间关系的理解相反，并与这些人应该减肥的建议相冲突。 这些患者组之间结果差异的生物行为机制尚不清楚。 营养摄入是体重的主要影响因素，也可能在影响HF结局方面发挥关键作用。 作为对肥胖和HF的全身炎症反应的一部分释放的促炎细胞因子影响食欲、食物摄入、身体组成、心肌功能、血管上皮，并且是患者结局的预测因子。 这项研究的目的是检查300例缺血性心力衰竭患者的体脂含量、营养摄入、炎症和患者结局之间的关系，这些患者平均分布在四组中：体重不足、正常体重、超重和肥胖。 这项前瞻性研究的主要目的是确定体脂量与12个月患者结局（再住院或死亡的复合终点）之间的关系。次要目的是检查体脂量和分布的差异如何改变营养缺乏（4天食物日记）和促炎细胞因子活性（肿瘤坏死因子-α [TNF α]，可溶性TNF-α受体，白细胞介素-6，白细胞介素-1受体拮抗剂和白细胞介素-10）对患者结局的影响。 检查体脂含量、营养摄入和促炎细胞因子活性之间的相互作用，将有助于了解在超重和肥胖HF患者中观察到的改善患者结局的生物行为机制。 这将有助于为超重和肥胖的HF患者制定新的营养和体重指南。 对潜在机制的理解也可能允许将这些发现应用于体重不足的患者，从而改善这些患者的结局。

Cardiac cachexia is an independent risk factor for morbidity and mortality in patients with heart failure (HF). In contrast, obesity was recently reported to be associated with decreased risk of morbidity and mortality. The finding that overweight and obese patients with HF have surprisingly better outcomes is in contrast to our current understanding of the relationships between obesity and HF and conflicts with the recommendation that these individuals should lose weight. The biobehavioral mechanisms underlying the differences in outcomes between these groups of patients are not well understood. Nutritional intake is a major contributor to body weight and may also play a crucial role in influencing HF outcomes. Proinflammatory cytokines released as part of the systemic inflammatory response to both obesity and HF affect appetite, food intake, body composition, myocardial function, vascular epithelium, and are predictors of patient outcomes. The purpose of the proposed research is to examine the relationships among body fat content, nutritional intake, inflammation, and patient outcomes in 300 patients with HF of ischemic origin that are equally distributed among four groups: underweight, normal weight, overweight and obese. The primary aim of this prospective study is to determine the relationship between body fat mass and twelve-month patient outcomes (composite end-point of rehospitalization of death). Secondary aims are to examine how differences in body fat mass and distribution alter the effect nutritional deficiencies (four-day food diaries) and proinflammatory cytokine activity (tumor necrosis factor-alpha [TNFalpha], soluble TNF-alpha receptors, interleukin-6, interleukin-1 receptor antagonist, and interleukin-10) on patient outcomes. Examination of the interactions among body fat content, nutritional intake, and proinflammatory cytokine activity will provide an understanding of the biobehavioral mechanisms underlying the improved patient outcomes observed in overweight and obese patients with HF. This will assist with developing new nutrition and body weight guidelines for patients with HF who are overweight and obese. An understanding of the underlying mechanisms may also allow application of these findings to underweight patients resulting in improved outcomes for these patients.