Clinical implications of low estimated protein intake in patients with heart failure

Koen W. Streng; Hans L. Hillege; Jozine M. ter Maaten; Dirk J. van Veldhuisen; Kenneth Dickstein; Leong L. Ng; Nilesh J. Samani; Marco Metra; Piotr Ponikowski; John G. Cleland; Stefan D. Anker; Simon P.R. Romaine; Kevin Damman; Peter van der Meer; Chim C. Lang; Adriaan A. Voors

doi:10.1002/jcsm.12973

Clinical implications of low estimated protein intake in patients with heart failure

Koen W. Streng, Hans L. Hillege, Jozine M. ter Maaten, Dirk J. van Veldhuisen, Kenneth Dickstein, Leong L. Ng, Nilesh J. Samani, Marco Metra, Piotr Ponikowski, John G. Cleland, Stefan D. Anker, Simon P.R. Romaine, Kevin Damman, Peter van der Meer, Chim C. Lang, Adriaan A. Voors^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: A higher protein intake has been associated with a higher muscle mass and lower mortality rates in the general population, but data about protein intake and survival in patients with heart failure (HF) are lacking.

Methods: We studied the prevalence, predictors, and clinical outcome of estimated protein intake in 2516 patients from the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) index cohort. Protein intake was calculated in spot urine samples using a validated formula [13.9 + 0.907 * body mass index (BMI) (kg/m²) + 0.0305 * urinary urea nitrogen level (mg/dL)]. Association with mortality was assessed using multivariable Cox regression models. All findings were validated in an independent cohort.

Results: We included 2282 HF patients (mean age 68 ± 12 years and 27% female). Lower estimated protein intake in HF patients was associated with a lower BMI, but with more signs of congestion. Mortality rate in the lowest quartile was 32%, compared with 18% in the highest quartile (P < 0.001). In a multivariable model, lower estimated protein intake was associated with a higher risk of death compared with the highest quartile [hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.03–2.18, P = 0.036 for the lowest quartile and HR 1.46; 95% CI 1.00–2.18, P = 0.049 for the second quartile].

Conclusions: An estimated lower protein intake was associated with a lower BMI, but signs of congestion were more prevalent. A lower estimated protein intake was independently associated with a higher mortality risk.

Original language	English
Pages (from-to)	1762-1770
Number of pages	9
Journal	Journal of Cachexia, Sarcopenia and Muscle
Volume	13
Issue number	3
Early online date	14-Apr-2022
DOIs	https://doi.org/10.1002/jcsm.12973
Publication status	Published - Jun-2022

Keywords

Body mass index
Heart failure
Mortality
Obesity
Protein

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Streng, K. W., Hillege, H. L., ter Maaten, J. M., van Veldhuisen, D. J., Dickstein, K., Ng, L. L., Samani, N. J., Metra, M., Ponikowski, P., Cleland, J. G., Anker, S. D., Romaine, S. P. R., Damman, K., van der Meer, P., Lang, C. C., & Voors, A. A. (2022). Clinical implications of low estimated protein intake in patients with heart failure. Journal of Cachexia, Sarcopenia and Muscle, 13(3), 1762-1770. https://doi.org/10.1002/jcsm.12973

@article{6846e1cd461f425c8130bbad5cdebaee,

title = "Clinical implications of low estimated protein intake in patients with heart failure",

abstract = "Background: A higher protein intake has been associated with a higher muscle mass and lower mortality rates in the general population, but data about protein intake and survival in patients with heart failure (HF) are lacking.Methods: We studied the prevalence, predictors, and clinical outcome of estimated protein intake in 2516 patients from the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) index cohort. Protein intake was calculated in spot urine samples using a validated formula [13.9 + 0.907 * body mass index (BMI) (kg/m2) + 0.0305 * urinary urea nitrogen level (mg/dL)]. Association with mortality was assessed using multivariable Cox regression models. All findings were validated in an independent cohort.Results: We included 2282 HF patients (mean age 68 ± 12 years and 27% female). Lower estimated protein intake in HF patients was associated with a lower BMI, but with more signs of congestion. Mortality rate in the lowest quartile was 32%, compared with 18% in the highest quartile (P < 0.001). In a multivariable model, lower estimated protein intake was associated with a higher risk of death compared with the highest quartile [hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.03–2.18, P = 0.036 for the lowest quartile and HR 1.46; 95% CI 1.00–2.18, P = 0.049 for the second quartile].Conclusions: An estimated lower protein intake was associated with a lower BMI, but signs of congestion were more prevalent. A lower estimated protein intake was independently associated with a higher mortality risk.",

keywords = "Body mass index, Heart failure, Mortality, Obesity, Protein",

author = "Streng, {Koen W.} and Hillege, {Hans L.} and {ter Maaten}, {Jozine M.} and {van Veldhuisen}, {Dirk J.} and Kenneth Dickstein and Ng, {Leong L.} and Samani, {Nilesh J.} and Marco Metra and Piotr Ponikowski and Cleland, {John G.} and Anker, {Stefan D.} and Romaine, {Simon P.R.} and Kevin Damman and {van der Meer}, Peter and Lang, {Chim C.} and Voors, {Adriaan A.}",

note = "Funding Information: This work was supported by the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation (CVON2014‐11 RECONNECT) and a grant from the European Commission (FP7‐242209‐BIOSTAT‐CHF). Funding Information: M.M. has received consulting honoraria from Amgen, Astra Zeneca, Novartis, Relypsa, and Servier and speaker's fees from Abbott Vascular and Servier. S.D.A. reports receiving fees from Abbott, Actimed, Bayer, Boehringer Ingelheim, Cardiac Dimension, Cordio, Impulse Dynamics, Novartis, Occlutech, Servier, and Vifor Pharma, and grant support from Abbott and Vifor Pharma. C.C.L. received consultancy fees and/or research grants from Amgen, Astra Zeneca, MSD, Novartis, Boehringher Ingelhiem, Vifor Pharma and Servier. A.A.V. reports consultancy fees and/or research grants from Amgen, Bayer, Boehringer Ingelheim, Merck/MSD, Novartis, Roche Diagnostics, Servier, Trevena, and Vifor. All other authors declare no conflict of interest. Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.",

year = "2022",

month = jun,

doi = "10.1002/jcsm.12973",

language = "English",

volume = "13",

pages = "1762--1770",

journal = "Journal of Cachexia, Sarcopenia and Muscle",

issn = "2190-5991",

publisher = "Wiley",

number = "3",

}

Streng, KW, Hillege, HL , ter Maaten, JM , van Veldhuisen, DJ, Dickstein, K, Ng, LL, Samani, NJ, Metra, M, Ponikowski, P, Cleland, JG, Anker, SD, Romaine, SPR, Damman, K , van der Meer, P, Lang, CC & Voors, AA 2022, 'Clinical implications of low estimated protein intake in patients with heart failure', Journal of Cachexia, Sarcopenia and Muscle, vol. 13, no. 3, pp. 1762-1770. https://doi.org/10.1002/jcsm.12973

TY - JOUR

T1 - Clinical implications of low estimated protein intake in patients with heart failure

AU - Streng, Koen W.

AU - Hillege, Hans L.

AU - ter Maaten, Jozine M.

AU - van Veldhuisen, Dirk J.

AU - Dickstein, Kenneth

AU - Ng, Leong L.

AU - Samani, Nilesh J.

AU - Metra, Marco

AU - Ponikowski, Piotr

AU - Cleland, John G.

AU - Anker, Stefan D.

AU - Romaine, Simon P.R.

AU - Damman, Kevin

AU - van der Meer, Peter

AU - Lang, Chim C.

AU - Voors, Adriaan A.

N1 - Funding Information: This work was supported by the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation (CVON2014‐11 RECONNECT) and a grant from the European Commission (FP7‐242209‐BIOSTAT‐CHF). Funding Information: M.M. has received consulting honoraria from Amgen, Astra Zeneca, Novartis, Relypsa, and Servier and speaker's fees from Abbott Vascular and Servier. S.D.A. reports receiving fees from Abbott, Actimed, Bayer, Boehringer Ingelheim, Cardiac Dimension, Cordio, Impulse Dynamics, Novartis, Occlutech, Servier, and Vifor Pharma, and grant support from Abbott and Vifor Pharma. C.C.L. received consultancy fees and/or research grants from Amgen, Astra Zeneca, MSD, Novartis, Boehringher Ingelhiem, Vifor Pharma and Servier. A.A.V. reports consultancy fees and/or research grants from Amgen, Bayer, Boehringer Ingelheim, Merck/MSD, Novartis, Roche Diagnostics, Servier, Trevena, and Vifor. All other authors declare no conflict of interest. Publisher Copyright: © 2022 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

PY - 2022/6

Y1 - 2022/6

N2 - Background: A higher protein intake has been associated with a higher muscle mass and lower mortality rates in the general population, but data about protein intake and survival in patients with heart failure (HF) are lacking.Methods: We studied the prevalence, predictors, and clinical outcome of estimated protein intake in 2516 patients from the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) index cohort. Protein intake was calculated in spot urine samples using a validated formula [13.9 + 0.907 * body mass index (BMI) (kg/m2) + 0.0305 * urinary urea nitrogen level (mg/dL)]. Association with mortality was assessed using multivariable Cox regression models. All findings were validated in an independent cohort.Results: We included 2282 HF patients (mean age 68 ± 12 years and 27% female). Lower estimated protein intake in HF patients was associated with a lower BMI, but with more signs of congestion. Mortality rate in the lowest quartile was 32%, compared with 18% in the highest quartile (P < 0.001). In a multivariable model, lower estimated protein intake was associated with a higher risk of death compared with the highest quartile [hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.03–2.18, P = 0.036 for the lowest quartile and HR 1.46; 95% CI 1.00–2.18, P = 0.049 for the second quartile].Conclusions: An estimated lower protein intake was associated with a lower BMI, but signs of congestion were more prevalent. A lower estimated protein intake was independently associated with a higher mortality risk.

AB - Background: A higher protein intake has been associated with a higher muscle mass and lower mortality rates in the general population, but data about protein intake and survival in patients with heart failure (HF) are lacking.Methods: We studied the prevalence, predictors, and clinical outcome of estimated protein intake in 2516 patients from the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) index cohort. Protein intake was calculated in spot urine samples using a validated formula [13.9 + 0.907 * body mass index (BMI) (kg/m2) + 0.0305 * urinary urea nitrogen level (mg/dL)]. Association with mortality was assessed using multivariable Cox regression models. All findings were validated in an independent cohort.Results: We included 2282 HF patients (mean age 68 ± 12 years and 27% female). Lower estimated protein intake in HF patients was associated with a lower BMI, but with more signs of congestion. Mortality rate in the lowest quartile was 32%, compared with 18% in the highest quartile (P < 0.001). In a multivariable model, lower estimated protein intake was associated with a higher risk of death compared with the highest quartile [hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.03–2.18, P = 0.036 for the lowest quartile and HR 1.46; 95% CI 1.00–2.18, P = 0.049 for the second quartile].Conclusions: An estimated lower protein intake was associated with a lower BMI, but signs of congestion were more prevalent. A lower estimated protein intake was independently associated with a higher mortality risk.

KW - Body mass index

KW - Heart failure

KW - Mortality

KW - Obesity

KW - Protein

U2 - 10.1002/jcsm.12973

DO - 10.1002/jcsm.12973

M3 - Article

AN - SCOPUS:85128037943

SN - 2190-5991

VL - 13

SP - 1762

EP - 1770

JO - Journal of Cachexia, Sarcopenia and Muscle

JF - Journal of Cachexia, Sarcopenia and Muscle

IS - 3

ER -

Clinical implications of low estimated protein intake in patients with heart failure

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