Sex Differences in the Association Between Nutritional Status and in-Hospital Mortality in HFpEF Patients

AIMS: The study aimed to assess whether the effect of nutritional risk score (NRS-2002) on the odds of in-hospital mortality would be modulated by sex and body mass index (BMI) in patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: A retrospective analysis was conducted on 234 patients admitted with acute heart failure, in whom HFpEF was identified as the underlying diagnosis, during the period 08.2018-08.2020. Nutritional status was assessed using BMI and NRS2002. NRS-2002 is a validated screening tool recommended by ESPEN that evaluates nutritional risk based on recent weight loss, reduced dietary intake, severity of illness and age. Logistic regression models were used to evaluate the associations between these nutritional indices and in-hospital mortality. The models were adjusted for sex, age and comorbidities. Interactions between NRS2002, BMI and sex were also explored to assess whether the effect of nutritional status on mortality was modulated by these factors. The analysis revealed that male patients with elevated NRS2002 scores had significantly higher odds of in-hospital mortality (odds = 47.512 at NRS2002 = 4 compared to odds = 0.031 at NRS2002 = 1; BMI = 28 in both cases). BMI negatively modulated the odds of death (OR = 0.843, P = 0.012) in the population sample. This effect was consistent across the sample regardless of NRS2002 score, as NRS2002 did not significantly influence the BMI-mortality relationship (P = 0.289). Importantly, this relationship was observed only in male patients, as no such association between NRS2002 and mortality was found in women. CONCLUSIONS: In male patients with HFpEF, elevated NRS2002 scores showed significantly higher odds of in-hospital mortality. Higher BMI was generally associated with lower odds of mortality, with this protective effect remaining consistent in the population sample, regardless of the NRS2002 score.