Associações entre a ingestão de nutrientes e fatores clínicos com a sobrevida de indivíduos com insuficiência cardíaca em seguimento ambulatorial

Abstract

Inadequate nutrient intake, in addition to unfavorable clinical and anthropometric factors, can lead to worse outcomes in patients with heart failure (HF). This prospective cohort study aims to assess the prevalence of inadequacies of micronutrients, clinical and anthropometric parameters, and associations with survival in 121 adults and elderly patients with HF treated in an outpatient clinic. An average of 3.4 24-hour recalls was used to assess the usual consumption of micronutrients. Participants were divided into moderate and high deficiency groups, and consumption clusters, according to individual assessment of the intake of each micronutrient. Sociobiodemographic, clinical and anthropometric data were collected, and clinical outcomes (hospitalization and mortality) occurred within 24 months. Overall and event-free survival were calculated by Kaplan-Meier and curves compared by Log-Rank. Cox regression models were built to identify outcome predictor variables. There was a 100% prevalence of inadequate intake of vitamins B1 and D, and more than 80% for vitamins B2, B9, E, and for calcium, magnesium and copper. There were no differences in overall survival and event-free survival between the groups of individuals with moderate and high micronutrient deficiency (HR = 0.94; p = 0.91 and HR = 1.63; p = 0.26, respectively), and between the Cluster with the highest and lowest consumption of calcium, potassium, phosphorus, magnesium and vitamin D (HR = 0.94; p = 0.91 and HR = 1.08; p = 0.84) as well as when the inadequacy of micronutrients was evaluated in isolation (all p>0.05). Overweight and glomerular filtration rate >60 mL/min/1.73m2 showed significant associations with better overall survival (both p<0.05). Cox regression models indicated that the New York Heart Association (NYHA) functional class III/IV is an independent predictor of overall and event-free survival, increasing the risk of mortality (HR = 6.70 (2.21 – 20 .29), p = 0.01) and hospitalizations (HR = 5.64, p < 0.01). Adequate weight according to BMI was associated with better overall survival (HR = 4.53, p = 0.02). In conclusion, individuals with HF treated in an outpatient clinic have a high prevalence of inadequacy of micronutrients. NYHA functional class and BMI are independent predictors of the occurrence of unfavorable clinical outcomes in individuals with HF.