IJCS | Volume 32, Nº2, March/April 2019

147 Table 2 - Frequency of muscle depletion and excess adiposity/body fat in patients with HF Variables/categories N % 95%CI* Indicators of protein malnutrition FFMI Presence of malnutrition 7 13.2 5.5 - 26.3 Eutrophy 46 86.5 74.7 - 94.5 BMI Presence of leanness 7 11.7 4.8 - 22.6 Eutrophy 53 88.3 77.4 - 95.2 AMC Muscle deficit 24 40 27.6 - 53.5 Eutrophy 36 60 45.5 - 72.4 cAMA Reduced musculature 25 43.9 30.7 - 57.6 Eutrophy 32 56.1 42.4 - 69.3 APMT Reduced musculature 3 5.1 1.1 - 14.2 Eutrophy 56 94.9 85.8 - 98.9 Indicators of excess adiposity/body fat BF% Excess body fat 33 63.5 48.9 - 74.4 Eutrophy 19 36.5 23.6 - 51 BMI Excess weight 31 51.7 38.4 - 64.8 Eutrophy 29 48.3 35.2 - 61.6 TST Excess adiposity 28 46.7 33,7 - 60 Eutrophy 32 53.3 40 - 66.3 *CI: 95% confidence interval. FFMI: Fat free mass index; BMI: Body mass index; AMC: Arm muscle circumference; cAMA: Corrected arm muscle circumference; AMPT: Adductor pollicis muscle thickness; BF%: Body fat percentage; TST: Triceps skinfold thickness. Rocha et al. Nutritional assessment in heart failure Int J Cardiovasc Sci. 2019;32(2)143-151 Original Article were classified as functional class I. This is opposed to the findings reported by Garlet. et al., 24 whose data revealed that individuals with HF evaluated in functional class I presented higher LVEF than those in functional class II, III or IV. At this point, it can be said that the inconsistent data can be due to the fact that the individuals with HF in our study are followed up, in an outpatient setting, by a well-structured interprofessional andmultidisciplinary team, reinforcing that high-qualitymultidisciplinary care can benefit individuals withHF in the prevention or early detection of acute decompensation. 25,26 It is important toknowthe stateof clinical compensation of individuals with HF upon anthropometric and body composition evaluation, as it may have repercussions on inaccuracies due to the inability to follow the evaluation protocols in the presence of symptoms. In our study, it was found that the participants had body water volume within the acceptable ranges. It has been found that the total body water volume of individuals with compensatedHF is reported to be equal to that of normal individuals. 23 Studies evaluating total, intercellular and extracellular body water volumes in individuals with HF, either followed up in an outpatient setting or not, but who were compensated at the time of the evaluation, found results similar to those of this study. 27-29 Analyzing the diagnosis of indicators of protein malnutrition/muscle depletion, we found discrepancies between anthropometric and body compositionmethods. Although reduced sensitivity presents moderate concordance, it suggests that BMI assessment compared to other methods is not a good predictor of protein malnutrition. Authors reaffirm this finding, pointing out that BMI may not provide a good overview of the nutritional status of patients with HF, especially when used for the diagnosis of malnutrition, as this index does not distinguish between fat and lean body mass. 30 However, the literature is controversial when it recommends the use of BMI as a marker of prognosis in individuals with HF. A retrospective study comparing the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), which is a strong risk factor for mortality, for the increase in the BMI of individuals with decompensatedHF, suggests that overweight is not associated with mortality in this population, reporting that BMI is inversely proportional to the increase of NT-proBNP. 31 However, Cescau et al., 32 found that although BMI is not an independent predictor of mortality, it is significantly related to greater reverse myocardial remodeling, promoting a protective effect of overweight in the course of HF. In a meta-analysis that assessed the association between BMI and all causes of death in individuals with HF, it was found that both BMI corresponding to malnutrition and morbid obesity are associated with higher mortality in this population. 33