Low calf circumference is associated with higher plasma N‐terminal pro‐B‐type natriuretic peptide in hospitalized heart failure patients: A retrospective study

BACKGROUND: Heart failure (HF) affects millions of persons worldwide, with malnutrition and sarcopenia as prevalent complications. Both are characterized by low muscle mass (MM), which can be estimated using Body mass index (BMI)-adjusted calf circumference (CC). Although CC is a simple and practical surrogate for MM, it is not routinely included in standard nutrition screening tools, despite recommendations from the Global Leadership Initiative on Malnutrition. In patients with HF, low MM has been linked to elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, a marker of cardiac stress. Including CC in nutrition screening may improve detection of malnourished patients. This study aimed to assess the association between BMI-adjusted CC and NT-proBNP levels in hospitalized patients with HF. METHODS: This retrospectively conducted cross-sectional study included 202 patients with HF across different ejection fraction categories. Data on demographics, anthropometry, and biochemical markers were collected. The association between BMI-adjusted CC and NT-proBNP were analyzed using Spearman correlation and multivariate linear regression. RESULTS: Low BMI-adjusted CC was prevalent in 74.8% of patients, with higher NT-proBNP levels compared with those with normal CC (11,970 vs 5621 pg/ml, P < 0.001). BMI-adjusted CC was inversely associated with NT-proBNP concentrations (β = -927, 95% CI: -1543 to -311) after adjusting for confounders. CONCLUSION: A high prevalence of low MM was detected in patients with HF. Low BMI-adjusted CC is associated with elevated NT-proBNP, highlighting the link between muscle depletion and cardiac stress. Incorporating BMI-adjusted CC into nutrition assessment may improve the identification of malnutrition in patients with HF and enable more targeted nutrition risk stratification and intervention strategies.