Nutrition-related Diseases and Cardiovascular Mortality in American Society: National Health and Nutrition Examination Study, 1999-2006

Abstract Background: Despite many significant advances in treatment and management, cardiovascular disease (CVD) remains the main cause of the global disease burden. Nutrition-related disease is a modifiable cardiovascular risk factor. However, few studies have examined the relationship between nutrition-related diseases and cardiovascular mortality in community populations. Objective: We aimed to investigate the association of nutrition-related diseases with cardiovascular mortality based on a large nationally representative community population.Design: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 with mortality follow-up through December 31, 2015. Finally, 12,529 participants were analyzed. Each participant was assigned to one of four groups: normal nutrition without sarcopenia, sarcopenia with normal nutrition, malnutrition without sarcopenia, and malnutrition-sarcopenia syndrome. Survival curves and Cox regressions based on the NHANES recommended weights were used to assess the association between nutrition-related diseases and cardiovascular mortality.Results: Of the 12,529 patients included in the study and divided into four groups, malnutrition-sarcopenia syndrome had the highest 5- and 10-year cardiovascular mortality rates (17 of 318, 5.4%; 33 of 318, 10.4%). After adjustment for related factors, sarcopenia with normal nutrition (hazard ratio [HR]: 1.68, 95% confidence interval [CI]:1.35−2.09; P < 0.001), malnutrition without sarcopenia (HR: 1.48, 95% CI:1.18−1.84; P < 0.001), and malnutrition-sarcopenia syndrome (HR: 2.41, 95% CI:1.63−3.56; P < 0.001) were significantly associated with increased risk of all-cause mortality. Malnutrition-sarcopenia syndrome remained associated with an increased risk of cardiovascular mortality (HR: 3.69, 95% CI: 1.92−7.23; P < 0.001). Conclusions: Malnutrition-sarcopenia syndrome was highly prevalent among community-dwelling adults in the United States and was a strong prognostic factor for cardiovascular mortality in the community setting. Randomized clinical trials are needed to demonstrate whether prevention or treatment of malnutrition-sarcopenia syndrome in community populations can reduce global cardiovascular mortality.