IJCS | Volume 31, Nº3, May/ June 2018

227 Faria et al. Bod composition and heart failure International Journal of Cardiovascular Sciences. 2018;31(3)226-234 Original Article individual’s body composition, and has a relatively low sensitivity in predicting excessive body fat. 5 In this context, other nutritional assessment methods may be used, such as densitometry by dual-energy X-ray absorptiometry (DXA) and computed tomography (CT). These methods, however, although more accurate, are also more costly and complex. 6 When these recommendedmethods are not available, some anthropometric measures and indexes seem to be good alternatives for estimating body composition. In addition toWC, the conicity index (C-index), proposed by the World Health Organization (WHO) to evaluate obesity and body fat distribution is of equal importance. 7 Also, waist-to-height ratio (WHtR), which is based on the assumption that for each height, there is an acceptable level of fat stored in the upper body, has also a good relationship with central body fat. 8 Bioelectrical impedance analysis (BIA) has also been widely used, especially due to the high data processing speed, its non-invasiveness, easiness of use and relatively low cost. BIA provides estimates of fat mass and fat-free mass components using predictive equations, and of phase angle (PA). 9,10 Left ventricular ejection fraction (LVEF) is another parameter to be evaluated in these patients due to its prognostic importance. Its reduction is associated with lower survival, and distinction of HF patients with (HFREF) and without reduced ejection fraction is increasingly required because of different clinical manifestations and forms of treatment for each case. 11 Therefore, due to the association between obesity and cardiovascular changes, assessment of HFREF by methods that estimate not only total fat, but also central fat, is extremely relevant. Besides, the applicability of PA in HF has not been well established in the literature. Thus, the aim of the present study was to evaluate the relationship between anthropometric indicators, cardiac function and cell integrity in HFREF. Methods This was a cross-sectional study of patients treated at the Heart Failure Outpatient Center of Pedro Ernesto University Hospital. A convenience sample was used, and HFREF of both sexes, aged from 18 to 74 years were considered eligible. Exclusion criteria were patients with clinical evidence of edema and ascites, amputee patients and patients using pacemakers. Patients with a BMI lower than 16 kg/m 2 or greater than 34 kg/m 2 were also excluded, because estimation of body composition by most of BIA predictive equations using these BMI values is not considered reliable. 12 We also excluded patients who did not meet the standardized BIA protocol, and those with a higher percentage of extracellular water compared with intracellular water, indicating a water imbalance that had not been identified at the physical exam, 9 and patients with an electrocardiography performed longer than one year before the date of the anthropometric assessment. Out come measur e s we r e : sex , age , LVEF (electrocardiography), etiology of the disease, functional class (NewYorkHeartAssociation,NYHA), 13 comorbidities, previous myocardial revascularization surgery (MRS), valve replacement, stent implantation, acute myocardial infarction (AMI), and anthropometric parameters (body mass, kg; height, m; WC, cm; BMI, kg/m 2 ; WHtR and C index), measured by one trained examiner. Body mass was measured using a digital medical scale (Welmy®) with maximum capacity of 200 kg at the nearest 0.1kg. Height was measured to the nearest 0.1 cm using a wall mounted stadiometer (Sanny®, 220 cm). Measurements were performed as proposed by Lohman et al. 14 WC was measured using an inelastic tape at the nearest 0.1 mm, according to the IDF criteria. 15 Patients were divided into the following groups –WC ≥ 80 cmand < 80 cm for women; WC ≥ 90 cm and < 90 cm for men. WHtR was calculated by dividing WC (cm) by height (cm), and the cutoff points adopted were 0.52 for men and 0.53 for women. C-index was obtained according to the equation proposed by Valdez, 16 with the cutoff points of 1.25 and 1.18 for men and women, respectively. The WHtR and the C-index cutoff points indicating an increased coronary risk were defined based on the study by Pitanga and Lessa. 17 Nutritional diagnosis was determined by BMI, which was calculated by dividing body mass by height squared and classified according to the WHO criteria. 18 Body composition and cell integrity were evaluated by tetrapolar BIA (Biodynamics 450®), according the BrazilianMedical Association criteria. 12 BIA results of PA and body fat percentage (BF%) were used for analyses. For BF% classification, we used the cutoff points of 25% for men and 32% for women. 19