Cardiac cachexia is an independent risk factor for morbidity and mortality in patients with heart failure (HF). In contrast, obesity was recently reported to be associated with decreased risk of morbidity and mortality. The finding that overweight and obese patients with HF have surprisingly better outcomes is in contrast to our current understanding of the relationships between obesity and HF and conflicts with the recommendation that these individuals should lose weight. The biobehavioral mechanisms underlying the differences in outcomes between these groups of patients are not well understood. Nutritional intake is a major contributor to body weight and may also play a crucial role in influencing HF outcomes. Proinflammatory cytokines released as part of the systemic inflammatory response to both obesity and HF affect appetite, food intake, body composition, myocardial function, vascular epithelium, and are predictors of patient outcomes. The purpose of the proposed research is to examine the relationships among body fat content, nutritional intake, inflammation, and patient outcomes in 300 patients with HF of ischemic origin that are equally distributed among four groups: underweight, normal weight, overweight and obese. The primary aim of this prospective study is to determine the relationship between body fat mass and twelve-month patient outcomes (composite end-point of rehospitalization of death). Secondary aims are to examine how differences in body fat mass and distribution alter the effect nutritional deficiencies (four-day food diaries) and proinflammatory cytokine activity (tumor necrosis factor-alpha [TNFalpha], soluble TNF-alpha receptors, interleukin-6, interleukin-1 receptor antagonist, and interleukin-10) on patient outcomes. Examination of the interactions among body fat content, nutritional intake, and proinflammatory cytokine activity will provide an understanding of the biobehavioral mechanisms underlying the improved patient outcomes observed in overweight and obese patients with HF. This will assist with developing new nutrition and body weight guidelines for patients with HF who are overweight and obese. An understanding of the underlying mechanisms may also allow application of these findings to underweight patients resulting in improved outcomes for these patients.
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