Anorexia may be one of the components of frailty state in patients with heart failure: a cross-sectional study

Background: Anorexia is a major symptom of cachexia, an underlying condition of frailty due to secondary sarcopenia in heart failure (HF). Yet, the role of anorexia in progress of HF frailty has not been well investigated. This study, therefore, aimed to examine the relationship between anorexia and frailty in HF patients. Methods: We analyzed 1,129 HF patients enrolled into the multicenter cohort study. Anorexia was defined as Simplified Nutritional Appetite Questionnaire (SNAQ) < 14 points. Frailty was defined as three or more of the followings: body mass index < 20 kg/m2; usual walking speed < 0.8 m/sec; grip strength < 26 kg in male, 17kg in female; Performance Measure of Activity in Daily Living-8 > 20. First, correlations between SNAQ and Controlling Nutritional status, Geriatric Nutritional Risk Index (GNRI), their components and brain natriuretic peptide (BNP) were assessed using Spearman's rank correlation. Then, logistic regression was performed to assess the relationship between anorexia and frailty. Results: SNAQ was significantly but weakly correlated with GNRI (r=0.10), serum albumin (r=0.09) and BNP (r=-0.10). As the result of logistic regression, anorexia was significantly associated with frailty after adjustment for age, gender and BNP. Conclusions: The findings of this study suggest that anorexia measured by SNAQ may be a marker of progressing frailty. Adequate medication and nutritional intervention should be considered before starting exercise program to improve frailty in HF.