Russian Heart Failure Journal 2010year Influence of nutritional support on trophological status, level of proinflammatory cytokines and adipokines in patients with chronic heart failure


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Influence of nutritional support on trophological status, level of proinflammatory cytokines and adipokines in patients with chronic heart failure

Arutyunov G. P., Bylova N. A., Hadyshyan G. G., Shavgulidze C. B.

Keywords: nutritional support, trophological status, CHF

DOI: 10.18087/rhfj.2010.6.1427

Urgency. High blood levels of inflammatory markers is common for patients with cardiac cachexia. Decrease of pro-inflammatory cytokines activity can be achieved through increase of body weight by means of nutritional support. Aim. To study the dynamics of fat and lean body mass in patients with CHF III–IV FC receiving Peptamen and Modulen (mixtures for enteral nutrition), to define the relationship of these changes with blood level of inflammatory cytokines and adipokines. Materials and methods. The study included 180 patients with CHF III–IV FC NYHA, divided into three groups: group 1 received the nutrient mixture Modulen, group 2 received the nutrient mixture Peptamen, group 3 received only standard therapy. Patients were examined on 1, 21, 56, 112 and 224‑day (physical examination, bioimpedance analysis of fat and lean body mass, caliperometry, 6 min walking test, C-reactive protein (CRP), TNF-α, adiponectin, leptin levels). Results. In all groups in 3 weeks from the start of treatment decrease of BMI, lean body mass (LBM), body fat (BF), total fluid, as well as CRP, TNF-α, adiponectin levels was revealed. In 8 months BMI in group 1 was 23.6±1.5 kg / m2 (baseline 24.1±1.2 kg / m2), LBM – 44.4±5.9 kg (47.2±5.8 kg at baseline, p=0.005), BF – 18.5±3.3 kg (16.6±3.1 kg at baseline, p=0.029), total amount of fluid – 38.3±5.3 kg (46.8±5.7 kg at baseline, p=0.01), CRP level – 4.7±1.1 mg / l (8.9±1.7 mg / l at baseline, p<0.001), TNF-α – 3.4±1.4 U / L (6.8±1.3 U / L at baseline, p<0.001), adiponectin – 15.8±2.1 mg / ml (24.4±1.9 mg / ml at baseline, p=0.002). In group 2 in 8 weeks BMI was 23.8±1.0 kg / m2 (24.2±1.4 kg / m2 at baseline), TMT – 47.4±5.1 kg (47.4±5.6 kg at baseline), LMC – 16.8±3.6 kg (16.5±3.9 kg at baseline), total amount of fluid – 47.2±6.2 kg (47.3±5.8 kg at baseline) CRP – 8.4±2.3 mg / l (8.8±2.2 mg / l at baseline), TNF-α – 6.2±1.3 U / L (6.7±1.2 mg / ml at baseline), adiponectin – 23.3±2.2 mg / ml (23.6±2.4 mg / ml at baseline). In Group 3 BMI was 24.4±1.1 kg / m2 (24.4±1.1 kg / m2 at baseline), TMT – 48.1±5.8 kg (46.9±6.1 kg at baseline), LMC – 14.9±3.1 kg (16.4±3.3 kg at baseline), total amount of fluid – 48.3±5.9 kg (47.1±5.8 kg at baseline), CRP – 8.9±1.9 mg / l (8.7±1,8 mg / l at baseline), TNF-alpha – 6.8±1.5 U / L (6.4±1.2 U / L at baseline), adiponectin – 24.3±2.2 mg / ml (24.2±2.1 mg / ml at baseline). Leptin level in all groups was not significantly changed. Thus, patients receiving nutritional mixture Modulen showed significant increase in LBM and BF, decrease of the total amount of fluid, CRP, TNF-α, and adiponectin levels. This led to an improvement of 6 min test and clinical status of patients (evaluated with SHOKS scale), lower hospital admission and death rates.
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Arutyunov G. P., Bylova N. A., Hadyshyan G. G. et al. Influence of nutritional support on trophological status, level of proinflammatory cytokines and adipokines in patients with chronic heart failure. Russian Heart Failure Journal. 2010;11(6):338-346.

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