Increased Resting Metabolic Rate in Patients with Congestive Heart Failure

doi:10.1059/0003-4819-121-11-199412010-00006

Increased Resting Metabolic Rate in Patients with Congestive Heart Failure

From the University of Maryland, the Baltimore Veterans Affairs Medical Center, the Geriatric Research Education and Clinical Center, and University of Maryland Claude D. Pepper Older Americans Independence Center, Baltimore, Maryland. Requests for Reprints: Eric T. Poehlman, PhD, Baltimore Veterans Affairs Medical Center, Geriatrics (Ref. 18), 10 North Greene Street, Baltimore, MD 21201. Acknowledgments: The authors thank Philip A. Ades, MD, Andrew P. Goldberg, MD, and Michael J. Toth, BS, for critiques of this paper. Grant Support: In part by a grant from the National Institute of Aging (AG-07857), a Research Career and Development Award from the National Institute of Aging (AG-05564), the Office of the Dean at the University of Maryland, and the Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs.

Abstract

Objective: To examine resting metabolic rate in patients with congestive heart failure as a cause of cardiac cachexia and associated weight loss.

Design: Cross-sectional study.

Setting: Baltimore Veterans Affairs Medical Center.

Patients: 20 men with heart failure (mean age ±SD, 69 ±7 years) and reduced ejection fraction (mean, 0.24 ±0.10) and 40 healthy men (mean age, 69 ±7 years).

Results: Patients with heart failure had smaller fat-free mass than did controls (53 ±8 kg compared with 56 ±6 kg; P < 0.09), but no difference in fat mass existed (21 ±8 kg compared with 19 ±8 kg). Measured resting metabolic rate was 18% higher in patients with heart failure than in controls (1828 ±275 kcal/d compared with 1543 ±219 kcal/d; P < 0.01); no difference in caloric intake existed (2144 ±479 kcal/d compared with 2174 ±826 kcal/d). The difference in resting metabolic rate between the two groups was even more striking when indexed per kilogram of fat-free mass.

Conclusions: Higher resting metabolic rate in patients with heart failure at least partially accounts for otherwise unexplained weight loss. Present caloric guidelines, which were established in healthy elderly persons, substantially underestimate the resting caloric needs of elderly persons with heart failure.