Acuracy and Concordance of Anthropometric Indicators and Body Composition in Heart Failure

Abstract Background: Anabolic/catabolic disorder in heart failure (HF) favors cardiac cachexia, implying a reduction in HF survival. Objectives: To assess the accuracy and concordance of the diagnosis of protein malnutrition and excess fat among the anthropometric and body composition methods in individuals with HF. Method: A study of accuracy that included 60 individuals with HF. Body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TST), adductor pollicis muscle thickness (APMT), arm muscle circumference (AMC) and corrected arm muscle area (cAMA). Fat free mass index (FFMI) and body fat percentage (BF%), obtained by electrical bioimpedance (EBI), were used to compare the diagnosis of protein malnutrition and excess fat. Accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive value. The concordance of the EBI diagnosis and other methods was performed by the chi-square test and kappa (k) statistic, where p<0.05 was considered significant. Results: Higher frequencies of protein malnutrition were identified by cAMA and AMC, and excess fat by BF%. BMI presented low sensitivity (43%) and accuracy (38.5%), with moderate concordance (0.50). AMC sensitivity was 86%, accuracy 66.4%, and acceptable concordance (0.36) compared to FFMI. Similar percentages of moderate sensitivity and low accuracy were observed for TST and BMI. Conclusion: AMC may be useful to identify protein malnutrition and TST has not been adequate to diagnose adiposity. BMI was not sensitive to assess muscle and adipose reserve. EBI was more accurate.

摘要 背景：心力衰竭（Heart Failure, HF）患者体内的合成代谢与分解代谢紊乱易诱发心脏恶病质，提示心力衰竭患者的生存预后不佳。目的：评估人体测量学与身体成分检测方法在心力衰竭患者中诊断蛋白质营养不良与脂肪过剩的准确性及诊断一致性。方法：本研究为准确性研究，共纳入60名心力衰竭患者。检测指标包括体重指数（Body Mass Index, BMI）、上臂围（Arm Circumference, AC）、三头肌皮褶厚度（Triceps Skinfold Thickness, TST）、拇内收肌肌厚度（Adductor Pollicis Muscle Thickness, APMT）、上臂肌围（Arm Muscle Circumference, AMC）及校正上臂肌面积（Corrected Arm Muscle Area, cAMA）；通过生物电阻抗法（Electrical Bioimpedance, EBI）获取无脂质量指数（Fat Free Mass Index, FFMI）与体脂百分比（Body Fat Percentage, BF%），用于对比蛋白质营养不良与脂肪过剩的诊断结果。通过计算灵敏度、特异度、阳性预测值与阴性预测值评估各方法的诊断准确性；采用卡方检验与kappa（k）统计量分析生物电阻抗法与其余检测方法的诊断一致性，以p<0.05为差异具有统计学意义。结果：经cAMA与AMC检出的蛋白质营养不良发生率更高，经BF%检出的脂肪过剩发生率更高。BMI的诊断灵敏度较低（43%），准确率为38.5%，诊断一致性中等（kappa值0.50）。AMC的灵敏度为86%，准确率为66.4%，与FFMI相比一致性尚可（kappa值0.36）。TST与BMI同样表现出中等灵敏度与较低的诊断准确率。结论：AMC可用于识别心力衰竭患者的蛋白质营养不良，而TST不足以诊断脂肪过剩。BMI无法有效评估肌肉与脂肪储备。生物电阻抗法的诊断准确性更高。