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

To access this material please log in or register

Register Authorize

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.
  1. Kenchaiah S, Sesso HD, Gaziano JM. Body mass index and vigorous physical activity and the risk of heart failure among men. Circulation. 2009;119 (1):44–52.
  2. Wu AH, Eagle KA, Montgomery DG et al. Relation of body mass index to mortality after development of heart failure due to acute coronary syndrome. Am J Cardiol. 2009;103 (12):1736–1740.
  3. Anker SD, Ponikowski P, Varney S et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet. 1997;349 (9058):1050–1053.
  4. Насонов Е. Л., Самсонов М. Ю., Беленков Ю. Н., Фукс Д. Н. Иммуно­пато­логия застойной СН, роль цитокинов. Кардиология. 1999;39 (3):66–73.
  5. Levine B, Kalman J, Mayer L et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med. 1990;323 (4):236–241.
  6. McMurray J, Abdullah I, Dargie HJ, Shapiro D. Increased concentrations of tumour necrosis factor in «cachectic» patients with severe chronic heart failure. Br Heart J. 1991;66 (5):356–358.
  7. Juge-Aubry CE, Henrichot E, Meier CA. Adipose tissue: a regulator of inflammation. Best Pract Res Clin Endocrinol Metab. 2005;19 (4):547–566.
  8. Qasim A, Mehta NN, Tadesse MG et al. Adipokines, insulin resistance, and coronary artery calcification. J Am Coll Cardiol. 2008;52 (3):231–236.
  9. Shah A, Mehta N, Reilly MP. Adipose inflammation, insulin resistance, and cardiovascular disease. JPEN J Parenter Enteral Nutr. 2008;32 (6):638–644.
  10. el-Bindary EM, Darwish AZ. New biochemical markers in chronic heart failure. East Mediterr Health J. 2001;7 (4-5):697–706.
  11. Filippatos G, Tsilias K, Baltopoulos G, Anthopoulos L. Serum leptin concentration in heart failure patients: does the literature reflect reality? Eur Heart J. 2000;21 (4):334–335.
  12. Doehner W, Pflaum CD, Rauchhaus M et al. Leptin, Insulin sensitivity and growth hormone binding protein in chronic heart failure with and without cardiac cachexia. Eur J Endocrinol. 2001;145 (6):727–735.
  13. Guzik TJ, Mangalat D, Korbut R et al. Adipocytokines – novel link between inflammation and vascular function? J Physiol Pharmacol. 2006;57 (4):505–528.
  14. Fasshauer M, Paschke R. Regulation of adipocytokines and insulin resistance. Diabetologia. 2003;46 (12):1594–1603.
  15. Alberti L, Gilardini L, Girola A et al. Adiponectin receptors gene expression in lymphocytes of obese and anorexic patients. Diabetes Obes Metab. 2007;9 (3):344–349.
  16. Dekker JM, Funahashi T, Nijpels G et al. Prognostic value of adiponectin for cardiovascular disease and mortality. J Clin Endocrinol Metab. 2008;93 (4):1489–1496.
  17. Perseghin G, Lattuada G, De Cobelli F et al. Serum retinol-binding protein-4, leptin, and adiponectin concentrations are related to ectopic fat accumulation. J Clin Endocrinol Metab. 2007;92 (12):4883–4888.
  18. Marso SP, Mehta SK, Frutkin A et al. Low adiponectin levels are associated with atherogenic dyslipidemia and lipid-rich plaque in nondiabetic coronary arteries. Diabetes Care. 2008;31 (5):989–94
  19. McEntegart MB, Awede B, Petrie MC et al. Increase in serum adiponectin concentration in patients with heart failure and cachexia: relationship with leptin, other cytokines, and B-type natriuretic peptide. Eur Heart J. 2007;28 (7):829–835.
  20. Taenaka N, Yagi M. Nutritional support in cardiac failure. Nippon Rinsho. 2001;59 (Suppl 5):434–437.
  21. Цветков Д. С. Нутритивная поддержка у онкологических больных. Доступно на: / 2008‑01‑02.html
  22. Malone A. Enteral formula selection: a review of selected product categories. Available at: https: // / internet / digestive-health / nutritionarticles / MaloneArticle. pdf
  23. Арутюнов Г. П., Костюкевич О. И., Звонова Е. В., Топильская Н. В. Клиническая эффективноСть питАтельной смеси ПепТамен У пациентов с хронической сеРдечной недостаточностью III–IV ФК NYHA и призНаками гипотрофии (САТУРН II). Журнал Сердечная Недоста­точность. 2007;8 (5):239–243.
  24. Endres S, Ghorbani R, Kelley VE et al. The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med. 1989;320 (5):265–271.
  25. Donnet A, Di Guglielmo R, Serrant P et al. The use of TGFb containg polymeric diet in the treatment of inflammatory bowel disease. Research note No. BS-RN96007 1996.
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.

To access this material please log in or register

Register Authorize
Ru En