The Relationship between Nutritional Status and Exercise Tolerance in Patients with Chronic Heart Failure

Background and Purpose: Malnutrition is known as a predictor of adverse events in patients with chronic heart failure (CHF). Geriatric Nutritional Risk Index (GNRI) is recently used as objective and simple nutritional assessment tool. However, little is known about the relationship between nutritional status and exercise tolerance. The purpose of this study was to investigate the relationship between GNRI and exercise tolerance in patients with CHF. Methods: We enrolled 241 consecutive CHF patients (65.7 ± 12.8 years, 186 males) who underwent echocardiography, laboratory measurements and cardiopulmonary exercise testing. GNRI was calculated by serum albumin, actual and ideal body weight. Patients were divided into two groups according to GNRI: low GNRI group: GNRI <98 (n = 117) and normal GNRI group: GNRI 98 >(n = 124). Peak oxygen consumption (peakVO2) and other factors were compared between two groups. Results: PeakVO2 was significantly lower in low GNRI group compared with normal GNRI group (15.8 ± 4.5 [ml/kg/min] vs 18.3 ± 5.1, P < .001). Multiple logistic regression analysis revealed that GNRI was an independent determinant of low peakVO2: peakVO2 < 18 (95% confidence interval: 0.87–0.98, P = .005). Age, hemoglobin, body mass index, left ventricular ejection fraction and brain natriuretic peptide were also elected as determinants. Conclusions: Malnutrition may contribute to reduced exercise tolerance in patients with CHF.