Original article Influence of Obesity and Malnutrition on Acute Heart Failure Antonio Zapatero, a Raquel Barba, b, * Noemi Gonzalez, c Juan E. Losa, d Susana Plaza, e Jesu ´s Canora, a and Javier Marco f a Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain b Servicio de Medicina Interna, Hospital Infanta Cristina, Parla, Madrid, Spain c Seccio ´n de Endocrinologı´a y Nutricio ´n, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain d Servicio de Medicina Interna, Hospital Universitario Fundacio ´n Alcorco ´n, Alcorco ´n, Madrid, Spain e Servicio de Medicina Interna, Hospital Severo Ochoa, Legane ´s, Madrid, Spain f Servicio de Medicina Interna, Hospital Clı´nico San Carlos, Madrid, Spain Rev Esp Cardiol. 2012;65(5):421–426 Article history: Received 28 July 2011 Accepted 12 September 2011 Available online 30 November 2011 Keywords: Heart failure Malnutrition Obesity A B S T R A C T Introduction and objectives: Obesity is an independent risk factor for the development of heart failure. Several recent studies have found better outcomes of heart failure for obese patients, an observation termed as the ‘‘obesity paradox.’’ On the other hand, the negative effect of malnutrition on the evolution of heart failure has also been clearly established. Methods: Data from the Minimum Basic Data Set were analyzed for all patients discharged from all the departments of internal medicine in hospitals of the Spanish National Health System between the years 2006 and 2008. The information was limited to those patients with a primary or secondary diagnosis of heart failure. Patients with a diagnosis of obesity or malnutrition were identified. The mortality and readmission indexes of obese and malnourished patients were compared against the subpopulation without these diagnoses. Results: A total of 370 983 heart failure admittances were analyzed, with 41 127 (11.1%) diagnosed with obesity and 4105 (1.1%) with malnutrition. In-hospital global mortality reached 12.9% and the risk of readmission was 16.4%. Obese patients had a lower in-hospital mortality risk (odds ratio [OR]: 0.65, 95% confidence interval [95%CI]: 0.62-0.68) and early readmission risk (OR: 0.81, 95%CI: 0.78-0.83) than nonobese patients. Malnourished patients had a much higher risk of dying while in hospital (OR: 1.83 95%CI: 1.69-1.97) or of being readmitted within 30 days after discharge (OR: 1.39, 95%CI: 1.29-1.51), even after adjusting for possible confounding factors. Conclusions: Obesity in patients admitted for HF substantially reduces in-hospital mortality risk and the possibility of early readmission, whereas malnutrition is associated with important increases in in-hospital mortality and risk of readmission in the 30 days following discharge. ß 2011 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. Influencia de la obesidad y la desnutricio ´n en la insuficiencia cardiaca aguda Palabras clave: Insuficiencia cardiaca Desnutricio ´n Obesidad R E S U M E N Introduccio ´n y objetivos: La obesidad es un factor independiente de riesgo de insuficiencia cardiaca; sin embargo, se ha demostrado que los pacientes obesos con insuficiencia cardiaca tienen mejor evolucio ´ n, lo que se ha llamado «paradoja de la obesidad». Por otro lado, la desnutricio ´n tiene un papel prono ´ stico negativo en la insuficiencia cardiaca. Me ´todos: Se analizaron los datos del Conjunto Mı ´nimo Ba ´ sico de Datos de los pacientes con diagno ´ stico de insuficiencia cardiaca dados de alta por todos los servicios de medicina interna del paı ´s en los an ˜os 2006-2008. Se identifico ´a los pacientes con diagnostico de obesidad y/o desnutricio ´n y se comparo ´ la tasa de mortalidad y reingresos de los pacientes con desnutricio ´n u obesidad con los que no las tenı ´an. Resultados: Se analizaron 370.983 ingresos por insuficiencia cardiaca; 41.127 (11,1%) tenı ´an registrado un diagno ´ stico de obesidad y 4.105 (1,1%), de desnutricio ´ n. La mortalidad total fue del 12,9% y el riesgo de reingreso, del 16,4%. Los pacientes obesos presentaron menos riesgo de muerte durante el ingreso (odds ratio [OR] = 0,65; intervalo de confianza del 95% [IC95%], 0,62-0,68) y de reingreso a los 30 dı ´as (OR = 0,81; IC95%, 0,78-0,83) que los no obesos. Los pacientes con desnutricio ´n tenı ´an ma ´s riesgo de fallecer (OR = 1,83; IC95%, 1,69-1,97) o reingresar (OR = 1,39; IC95%, 1,29-1,51), incluso cuando se ajusta por posibles factores de confusio ´ n. SEE RELATED ARTICLE: DOI: 10.1016/j.rec.2011.12.012, Rev Esp Cardiol. 2012;65:403–4. * Corresponding author: Servicio de Medicina Interna, Hospital Infanta Cristina, Avda. 9 de Junio 2, 28981 Parla, Madrid, Spain. E-mail address: raquel.barba@hospitalreyjuancarlos.es (R. Barba). 1885-5857/$ – see front matter ß 2011 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. doi:10.1016/j.rec.2011.09.014 Document downloaded from https://www.revespcardiol.org/?ref=1435908024, day 11/10/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/?ref=1435908024, day 11/10/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.