Effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in heart failure with reduced ejection fraction

Arslan, Kadem; Yılmaz, Emre; Aydın, Ercan

doi:10.1590/1806-9282.20220737

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 68 (11) • 2022 • https://doi.org/10.1590/1806-9282.20220737 copy

Effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in heart failure with reduced ejection fraction

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to evaluate the effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in patients with heart failure with reduced ejection fraction.

METHODS:

The sodium-glucose cotransporter-2 inhibitor treatment was initiated in 153 patients with heart failure with reduced ejection fraction who were symptomatic despite optimal medical treatment and were followed up for 6 months. The Minnesota Living With Heart Failure Questionnaire scores, New York Heart Association functional class, NT-pro-BNP levels, and nutritional index scores of the patients were evaluated before sodium-glucose cotransporter-2 inhibitor treatment and at the 6-month follow-up. The nutritional status of the patients was evaluated with the COntrolling NUTritional Status score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index.

RESULTS:

After sodium-glucose cotransporter-2 inhibitor treatment, significant changes were observed in the mean scores of the three different nutritional indexes: COntrolling NUTritional Status (before: 2.76±2.43 vs. after: 1.12±1.23, p<0.001), Geriatric Nutritional Risk Index (before: 98.2±9.63 vs. after: 104.4±5.83, p<0.001), and Prognostic Nutritional Index (before: 37.9±4.63 vs. after: 42.9±3.83, p<0.001) scores. A significant decrease in the number of patients with malnutrition was observed according to the COntrolling NUTritional Status (before: 46.4% vs. after: 9.7%, p<0.001), Geriatric Nutritional Risk Index (before: 41.8% vs. after: 18.9%, p=0.006), and Prognostic Nutritional Index (before: 36.6% vs. after: 13.7%, p=0.007) scores. A significant functional improvement was observed in patients after sodium-glucose cotransporter-2 treatment: Minnesota Living With Heart Failure Questionnaire scores (before: 39.2±7.2 vs. after: 20.4±7.4, p<0.001), NT-pro-BNP levels (before: 2989±681 vs. after: 1236±760, p<0.001), and New York Heart Association class (before: class II-III: 95.5%; class IV: 4.5% vs. after: class II-III: 78%; class IV: 0%, p<0.001).

CONCLUSION:

In patients with heart failure with reduced ejection fraction who are symptomatic despite optimal medical treatment, the addition of an sodium-glucose cotransporter-2 inhibitor to treatment can significantly improve both the nutritional and functional statuses.

KEYWORDS:
Heart failure; Malnutrition; Nutrition assessment; Sodium-glucose transporter 2 inhibitors

Parameter		Baseline (n=153)
Age (years)		62.4±10.6
Gender: female, n (%)		35 (22.8)
Ischemic heart failure, n (%)		90 (58.8)
Hypertension, n (%)		98 (64.1)
Diabetes mellitus, n (%)		50 (32.6)
Coronary artery disease, n (%)		104 (67.9)
Dyslipidemia (n/%)		77 (50.3)
COPD (n/%)		35 (22.8)
Atrial fibrillation		34 (22.2)
LVEF, n (%)		27.5±4.7
β-Blocker use, n (%)		143 (93.4)
ACE inhibitor use, n (%)		80 (52.2)
Sacubitril use, n (%)		71 (46.4)
Spironolactone use, n (%)		98 (64.1)
Statin use, n (%)		30 (19.6)
Ivabradine use, n (%)		56 (36.6)
Diuretic use, n (%)		142 (92.8)
Digoxin use, n (%)		26 (16.9)
		Baseline	After treatment	p-value
SBP (mmHg)		126.3±24	124.9±22	0.456
DBP (mmHg)		68.4±13	66.3±12	0.518
Sodium (mmol/L)		137.8±4.6	138.6±4.4	0.356
Potassium (mmol/L)		4.4 (3.2–5.8)	4.5 (3.3–5.8)	0.408
Hematocrit (%)		38.5±4.6	39.2±4.8	0.486
Lymphocyte (10⁹/L)		1.82±0.39	1.88±0.32	0.398
eGFR, mL/min/1.73 m²		66.8±15.4	68.2±14.2	0.246
Total cholesterol (mg/dL)		172.46±12.66	174.38±14.06	0.286
LDL (mg/dL)		108.82 (52.4–140.6)	109.64 (56.8–148.5)	0.308
CRP		4.9 (2.4–12.6)	4.5 (3.1–10.4)	0.382
Heart rate		74.1±4.8	73.8±4.4	0.412
HbA1c (%)		6.9±1.4	6.7±1.2	0.422
BMI (kg/m²)		27.9±5.2	27.7±4.7	0.620
Weight (kg)		75.6±13	76.1±14	0.668
Albumin (g/dL)		4.1±0.5	4.9±0.6	0.022
NT-pro-BNP, pg/mL		2989±681	1236±760	<0.001
NYHA class, n (%)				<0.001
	I	0	34 (22)
	II	64 (42)	88 (58)
	III	82 (53.5)	31 (20)
	IV	7 (4.5)	0
MLWHFQ score		39.2±7.2	20.4±7.4	<0.001
CONUT score		2.76±2.4	1.12±1.2	<0.001
CONUT ≥2, n (%)		71 (46.4)	14 (9.7)	<0.001
GNRI score		98.2±9.6	104.4±5.8	<0.001
GNRI <98, n (%)		64 (41.8)	29 (18.9)	0.006
PNI score		37.9±4.6	42.9±3.8	<0.001
PNI <38, n (%)		56 (36.6)	21 (13.7)	0.007

Variables	MLWHFQ score	NT-pro-BNP level	NYHA class	CONUT score	GNRI score	PNI score
MLWHFQ score		r: 0.230	r: 0.454	r: 0.302	r: −0.364	r: −0.392
MLWHFQ score		p: 0.028	p<0.001	p: 0.004	p<0.001	p<0.001
NT-pro-BNP level	r: 0.230		r: 0.278	r: 0.320	r: −0.339	r: −0.388
NT-pro-BNP level	p: 0.028		p: 0.006	p: 0.001	p<0.001	p<0.001
NYHA class	r: 0.454	r: 0.278		r: 0.288	r: −0.310	r: −0.354
NYHA class	p<0.001	p: 0.006		p: 0.007	p: 0.001	p<0.001
CONUT score	r: 0.302	r: 0.320	r: 0.288		r: −0.402	r: - 0.388
CONUT score	p: 0.004	p: 0.001	p: 0.007		p<0.001	p<0.001
GNRI score	r: −0.364	r: −0.339	r: −0.310	r: −0.402		r: 0.672
GNRI score	p<0.001	p<0.001	p: 0.001	p<0.001		p<0.001
PNI score	r: −0.392	r: −0.388	r: −0.354	r: - 0.388	r: 0.672
PNI score	p<0.001	p<0.001	p<0.001	p<0.001	p<0.001

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[1] *Corresponding author: kademarslan@hotmail.com