Insufficient Calorie Intake Worsens Post-Discharge Quality of Life and Increases Readmission Burden in Heart Failure

Abstract

Objectives: The purpose of this study was to evaluate the relationship between calorie intake and post-discharge outcomes in hospitalized patients with heart failure (HF).

Background: Malnutrition increases adverse outcomes in HF, and dietary sodium restriction may inadvertently worsen nutritional intake.

Methods: In a dietary intervention trial, baseline nutritional intake in HF inpatients was estimated using the Block Food Frequency Questionnaire (FFQ), and the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs, and a 15-point micronutrient deficiency score was created. Adjusted linear, logistic, and negative binomial regression were used to evaluate associations between insufficient calorie intake and quality of life (using the Kansas City Cardiomyopathy Questionnaire Clinical Summary [KCCQ-CS]), readmission risk, and days rehospitalized over 12 weeks.

Results: Among 57 participants (70 ± 8 years of age; 31% female; mean body mass index 32 ± 8 kg/m²); median sodium and calorie intake amounts were 2,987 mg/day (interquartile range [IQR]: 2,160 to 3,540 mg/day) and 1,602 kcal/day (IQR: 1,201 to 2,142 kcal/day), respectively; 11% of these patients were screened as malnourished by the NRI. All patients consuming <2,000 mg/day sodium had insufficient calorie intake; this group also more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient calorie intake had less improvement in the KCCQ-CS score (β = -14.6; 95% confidence interval [CI]: -27.3 to -1.9), higher odds of readmission (odds ratio: 14.5; 95% CI: 2.2 to 94.4), and more days rehospitalized (incident rate ratio: 31.3; 95% CI: 4.3 to 229.3).

Conclusions: Despite a high prevalence for obesity and rare overt malnutrition, insufficient calorie intake was associated with poorer post-discharge quality of life and increased burden of readmission in patients with HF. Inpatient dietary assessment could improve readmission risk stratification and identify patients for nutritional intervention. (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure [GOURMET-HF] NCT02148679).

Keywords: diet; hospitalization; nutrition; sodium.

Figure 1.. Relationship between sodium intake and energy available above minimal needs

Scatter-plot relationship between sodium intake and the energy available for physical activity. Values below zero on the y-axis represent insufficient calorie intake.

Figure 2.. Relationship between calorie intake and dietary micronutrient deficiencies

Histogram of dietary micronutrient deficiency scores, with groups defined by insufficient or adequate calorie intake. Higher scores represent a larger number of micronutrient deficiencies.

Central Illustration:. Calorie intake and (A) change in KCCQ-CS, (B) readmission burden over 12 weeks

Panel A of the Central Illustration represents a column scatter plot of KCCQ-CS scores at baseline and Week 12. Panel B represents a bar graph of total days rehospitalized over 12 weeks, overlaid with the number of patients who were rehospitalized. White bars denote insufficient and grey bars adequate calorie intake. Abbreviation: KCCQ-CS, Kansas City Cardiomyopathy Questionnaire