Elucidation of Metabolic Dynamics and Establishment of Optimal Nutritional Therapy in Patients with Refractory Heart Failure

2020 Fiscal Year Final Research Report

• Project/Area Number: 17K17854
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Cardiovascular medicine; Metabolomics
• Research Institution: Osaka University
• Principal Investigator: Sakamoto Yoko 大阪大学, 医学系研究科, 特任助教(常勤) (30444053)
• Project Period (FY): 2017-04-01 – 2021-03-31
• Keywords: 重症心不全 / 栄養管理 / 安静時消費エネルギー / 尿中必須アミノ酸

Outline of Final Research Achievements

In patients with refractory heart failure, the resting energy expenditure (REE) measured by indirect calorimetry increased by an average of 4% compared to the predicted REE by the Harris-Benedict equation.In addition, when we analyzed the correlation with heart failure severity, we found no correlation with BNP levels, right heart catheterization parameters, or heart failure stage classification, and only an inverse correlation with body mass index (BMI).
As a result of analysis of blood and urine amino acid analysis, blood Albumin and essential amino acid levels were within the normal range even in the group that did not meet the energy requirement based on the measured REE, but urinary essential amino acid levels were significantly lower than normal in the group that did not meet the requirement compared to the group that did meet the requirement.
These results suggest that urinary amino acids may be a useful indicator that can sharply reflect energy insufficiency.

Free Research Field

心不全栄養管理

Academic Significance and Societal Importance of the Research Achievements

心不全患者はカヘキシーに陥りやすく、またカヘキシーは独立した予後不良因子であることが知られている。カヘキシー進行の一因として安静時消費エネルギーを実測した研究は数少なく、また重症度との関連を調べた研究はほとんどない。今回心不全患者において体格指数が安静時消費エネルギー亢進に関与すること、またそのことは低体重の患者においてより必要なカロリー量が不足しないように留意することが重要であることが示唆された。さらに体重減少を治療目標とする心不全治療において、体重ではない生化学的指標として、新たに尿中アミノ酸分析がカロリー摂取不足を示唆する有用な指標になりうることを見出した。