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。相比之下，最近有报道称，肥胖与发病率和死亡率的降低有关。超重和肥胖的心力衰竭患者的预后出人意料地好，这一发现与我们目前对肥胖和心力衰竭之间的关系的理解相反，也与这些人应该减肥的建议相冲突。这些患者之间预后差异背后的生物行为机制还没有被很好地理解。营养摄入量是体重的主要贡献者，也可能在影响心衰预后方面发挥关键作用。作为肥胖和心衰全身炎症反应的一部分而释放的促炎细胞因子影响食欲、食物摄入量、身体成分、心肌功能、血管上皮，并且是患者预后的预测因子。这项拟议的研究的目的是检查300名缺血性心力衰竭患者的体脂含量、营养摄入量、炎症和患者预后之间的关系，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质量和12个月患者结局(死亡再住院的综合终点)之间的关系。第二个目标是研究身体脂肪质量和分布的差异如何改变营养缺乏(四天食物日记)和促炎细胞因子活性(肿瘤坏死因子-α[TNFpha]、可溶性肿瘤坏死因子-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)对患者预后的影响。检查体内脂肪含量、营养摄入量和促炎细胞因子活性之间的相互作用将有助于理解超重和肥胖心力衰竭患者改善预后的生物行为机制。这将有助于为超重和肥胖的心衰患者制定新的营养和体重指南。对潜在机制的了解也可能使这些发现应用于体重过轻的患者，从而改善这些患者的预后。

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.