IJCS | Volume 32, Nº2, May/June 2019

DOI: 10.5935/2359-4802.20180094 253 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(3)253-260 Mailing Address: Denise Tavares Giannini Av. 28 de setembro, 77- Vila Isabel - Postal Code: 20551-030, Rio de Janeiro, RJ - Brazil. E-mail: denisegiannini@uol.com.br Adductor Pollicis Muscle Thickness as a Marker of Nutritional Status in Heart Failure Fabiane da Silva Rosári o, D enise Tavares Giannin i, Viviane de Oliveira Lea l, R icardo Mourilhe-Roch a Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil Manuscript received May 23, 2017, revised manuscript February 03, 2018, accepted June 07, 2018. Abstract Background: Malnutrition is associated with morbidity and mortality in patients with heart failure (HF). Thus, it is essential to apply reliable indicators to assess the nutritional status of these individuals. Objective: To evaluate the thickness of the adductor pollicis muscle (APM) in patients with HF as an indicator of somatic protein status and correlate the obtained values with conventionally used parameters and electrical bioimpedance (EBI) markers. Methods: Cross-sectional study with patients with HF undergoing regular outpatient treatment. APM thickness was measured in the dominant arm, and the values obtained were classified according to gender and age. The anthropometric parameters assessed included the body mass index (BMI) and specific parameters to assess the muscle (arm muscle circumference [AMC] and arm muscle area [AMA]). Values of phase angle (PA), standard PA (SPA), and lean mass were obtained by EBI. Statistical analyses were performed with the software Statistical Package for the Social Sciences, version 19, using unpaired Student’s t, Mann-Whitney, or one-way analysis of variance (ANOVA) tests for comparisons between groups, as appropriate. The correlation between variables of interest was performed using Pearson’s or Spearman’s correlation coefficient, as adequate. The level of significance was set at 5%. Results: About 70% of the 74 patients evaluated were classified as malnourished according to the APM thickness. Values of AMC, AMA, and lean mass correlated positively with APM thickness (p < 0.005). The APM thickness also correlated positively with PA and SPA (r = 0.49, p < 0.001 and r = 0.31, p = 0.008, respectively). Conclusion: Patients with HF presented a high frequency of protein malnutrition when APM thickness was used as an indicator of nutritional status. APM thickness values correlated with conventional measures of somatic protein evaluation and may be related to the prognosis of these patients, since they correlated positively with PA and SPA. (Int J Cardiovasc Sci. 2019;32(3)253-260) Keywords: Heart Failure; Thumb; Malnutrition / mortality; Nutrition Assessment; Anthropometry. Introduction A series of neurohormonal modifications, such as chronic inflammation, anorexia, and resistance to anabolic hormones, are common in heart failure (HF) and are closely related to the emergence of malnutrition in this population. 1,2 Malnutrition, in turn, is associated with a higher prevalence of comorbidities and constitutes an important predictive factor for decreased survival regardless of variables like age, functional class, and ejection fraction (EF). 2 Although the classification of nutritional status according to body mass index (BMI) indicates a higher prevalence of eutrophy, overweight, and obesity, when evaluating anthropometric measures specifically used to estimate the muscle compartment, patients with HF commonly present different stages of protein malnutrition, independent of total body mass, 1,3,4 which can be explained by the fact that BMI does not clearly reflect the body composition. 5,6 Dual-energy X-ray absorptiometry is one of the techniques considered the gold standard for assessment