Incidence of Cachexia and its Association with Functional Capacity in Chronic Heart Failure Patients


  • Anam Tariq Department of Nutrition and Dietetics, School of Health Sciences, University of Management and Technology, Lahore, 54000, Pakistan
  • Muhammad Muneeb Department of Cardiology, Shalamar Medical and Dental College, Lahore, 54000, Pakistan
  • Atta Ullah Khan Niazi Department of Cardiology, Shalamar Medical and Dental College, Lahore, 54000, Pakistan
  • Faheem Mustafa Department of Nutrition and Dietetics, School of Health Sciences, University of Management and Technology, Lahore, 54000, Pakistan
  • Naveed Munir Department of Biomedical Lab Sciences, School of Health Sciences, University of Management and Technology, Lahore, 54000, Pakistan
  • Zahra Khan Department of Nutrition and Health Science, Faculty of Engineering and Science, University of Greenwich Medway Campus ME4 4TB, UK
  • Tayyaba Arshad Department of Cardiology, Shalamar Medical and Dental College, Lahore, 54000, Pakistan
  • Muhammad Riaz Department of Allied Health Sciences, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan
  • Zanib Javed Chatha Department of Cardiology, Shalamar Medical and Dental College, Lahore, 54000, Pakistan



Cachexia, Cardiovascular diseases, Chronic heart failure, Malnutrition


Heart failure (HF) is a progressive clinical syndrome with a high morbidity and mortality rate. In such patients Cachexia also known as wasting syndrome or anorexia cachexia syndrome and is very complicated problem which is far dangerous than a loss of appetite. This study was planned to investigate the incidence of cachexia in chronic heart failure (CHF) patients and further elucidate its association with functional capacity and outcomes in affected patients. We assessed cachexia status among 55 patients with CHF (25 females, 30 males, over 35 years old) using a convenient sampling method. Patients were included in this study due to their diagnosis from the outpatient Heart Failure Department of Shalamar Hospital (Trust) in Lahore. Reduction of the body weight was noted upto 6 months. Functional capacity was assessed by the handgrip dynamometer and the short physical performance battery test (SPPB). Results explored 64% of females became cachectic with a mean age of (58.43± 7.25), and 52.7% of males became cachectic with a mean age of (64.15 ±11.02). In this study, the mean value of SPPB was reported lower in the cachectic group than the non-cachectic group (5.0± 2.1 vs. 7.4±0.94) with a mean age of 61.0 ± 9.4. These results reflect that the physical activity level of heart failure (CHF) patients was reduced due to cachexia development and anorexia. Patients with cachexia are more likely to show weakened functional capacity and may lead to higher mortality rate in CHF cachexia patients as compared to non-cachectic patients Additionally, patients who developed cachexia also showed reduced muscular strength and exercise ability. It could be concluded that CHF patients affected by cachexia with the passage of time which might affect adversely the health status of cardiac patients both in male and female.


Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D. Cachexia: a new definition. Clinical nutrition. 2008;27(6):793-9.

Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, De Simone G, Ford ES, Fox CS. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18-209.

Savarese G, Lund LH. Global public health burden of heart failure. Cardiac failure review. 2017;3(1):7.

Kleiner Shochat M, Fudim M, Shotan A, Blondheim DS, Kazatsker M, Dahan I, Asif A, Rozenman Y, Kleiner I, Weinstein JM, Panjrath G. Prediction of readmissions and mortality in patients with heart failure: lessons from the IMPEDANCE‐HF extended trial. ESC heart failure. 2018;5(5):788-99.

Crespo‐Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, Gustafsson F, Tsui S, Barge‐Caballero E, De Jonge N, Frigerio M. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. European journal of heart failure. 2018;20(11):1505-35.

Rodil Fraile R, Malafarina V, Tiberio López G. Sacubitril–valsartan in heart failure and multimorbidity patients. ESC heart failure. 2018 Oct;5(5):956-9.

Rosano G. Medical Treatment of Heart Failure with Reduced Ejection Fraction–Prognostic Indication. InInternational Cardiovascular Forum Journal 2017 Jun 3 (Vol. 10).

Cogswell RJ, Norby FL, Gottesman RF, Chen LY, Solomon SD, Shah AM, Alonso A. High Prevalence of Sub-clinical Cerebral Infarctions in Patients with Heart Failure with Preserved Ejection Fraction. Journal of Cardiac Failure. 2015 Aug 1;21(8):S104-5.

Streng KW, Nauta JF, Hillege HL, Anker SD, Cleland JG, Dickstein K, Filippatos G, Lang CC, Metra M, Ng LL, Ponikowski P. Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction. International Journal of Cardiology. 2018 Nov 15;271:132-9.

Lena A, Coats AJ, Anker MS. Metabolic disorders in heart failure and cancer. ESC heart failure. 2018 Dec;5(6):1092-8.

von Haehling S. Muscle wasting and sarcopenia in heart failure: a brief overview of the current literature. ESC heart failure. 2018 Dec;5(6):1074.

Scherbakov N, Doehner W. Cachexia as a common characteristic in multiple chronic disease. Journal of cachexia, sarcopenia and muscle. 2018 Dec;9(7):1189.

Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo GI, Boirie Y, Bosaeus I, Cederholm T, Costelli P, Fearon KC. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG)“cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clinical nutrition. 2010 Apr 1;29(2):154-9.

Pocock SJ, McMurray JJ, Dobson J, Yusuf S, Granger CB, Michelson EL, Östergren J, Pfeffer MA, Solomon SD, Anker SD, Swedberg KB. Weight loss and mortality risk in patients with chronic heart failure in the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. European heart journal. 2008 Nov 1;29(21):2641-50.

Anker SD, Negassa A, Coats AJ, Afzal R, Poole-Wilson PA, Cohn JN, Yusuf S. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. The Lancet. 2003 Mar 29;361(9363):1077-83.

Araújo JP, Lourenço P, Rocha-Gonçalves F, Ferreira A, Bettencourt P. Nutritional markers and prognosis in cardiac cachexia. International Journal of Cardiology. 2011 Feb 3;146(3):359-63.

Grossniklaus DA, O’Brien MC, Clark PC, Dunbar SB. Nutrient intake in heart failure patients. The Journal of cardiovascular nursing. 2008 Jul;23(4):357.

Blauwhoff-Buskermolen S, Ruijgrok C, Ostelo RW, de Vet HC, Verheul HM, de van der Schueren MA, Langius JA. The assessment of anorexia in patients with cancer: cut-off values for the FAACT–A/CS and the VAS for appetite. Supportive Care in Cancer. 2016 Feb;24:661-6.

Drexler H, Riede U, Münzel T, König H, Funke E, Just H. Alterations of skeletal muscle in chronic heart failure. Circulation. 1992 May;85(5):1751-9.

Castillo-Martínez L, Colín-Ramírez E, Orea-Tejeda A, Islas DG, García WD, Díaz CS, Rodríguez AE, Durán MV, Davies CK. Cachexia assessed by bioimpedance vector analysis as a prognostic indicator in chronic stable heart failure patients. Nutrition. 2012 Sep 1;28(9):886-91.

Thomas E, Gupta PP, Fonarow GC, Horwich TB. Bioelectrical impedance analysis of body composition and survival in patients with heart failure. Clinical cardiology. 2019 Jan;42(1):129-35.

Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midlife hand grip strength as a predictor of old age disability. Jama. 1999 Feb 10;281(6):558-60.

Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of gerontology. 1994 Mar 1;49(2):M85-94.

Saitoh M, Dos Santos MR, Emami A, Ishida J, Ebner N, Valentova M, Bekfani T, Sandek A, Lainscak M, Doehner W, Anker SD. Anorexia, functional capacity, and clinical outcome in patients with chronic heart failure: results from the Studies Investigating Co‐morbidities Aggravating Heart Failure (SICA‐HF). ESC Heart Failure. 2017 Nov;4(4):448-57.

Yasuda T, Nakajima T, Sawaguchi T, Nozawa N, Arakawa T, Takahashi R, Mizushima Y, Katayanagi S, Matsumoto K, Toyoda S, Inoue T. Short Physical Performance Battery for cardiovascular disease inpatients: implications for critical factors and sarcopenia. Scientific reports. 2017 Dec 12;7(1):17425.

Sandek A, Doehner W, Anker SD, Von Haehling S. Nutrition in heart failure: an update. Current Opinion in Clinical Nutrition & Metabolic Care. 2009 Jul 1;12(4):384-91.

Mustafa F, Munir F, Munir M, Riaz S, Bacha U, Tahir H, Baig AA. Association of Age and Gender with the BMI of Obese Subjects in Pakistan. BioScientific Review. 2022;4(3):29-39.

Hajhashemy Z, Foshati S, Saneei P. Relationship between abdominal obesity (based on waist circumference) and serum vitamin D levels: a systematic review and meta-analysis of epidemiologic studies. Nutrition reviews. 2022;80(5):1105-17.

Narumi T, Watanabe T, Kadowaki S, Takahashi T, Yokoyama M, Kinoshita D, Honda Y, Funayama A, Nishiyama S, Takahashi H, Arimoto T. Sarcopenia evaluated by fat-free mass index is an important prognostic factor in patients with chronic heart failure. European journal of internal medicine. 2015;26(2):118-22.

De Brandt J, Beijers RJ, Chiles J, Maddocks M, McDonald ML, Schols AM, Nyberg A. Update on the Etiology, Assessment, and Management of COPD Cachexia: Considerations for the Clinician. International journal of chronic obstructive pulmonary disease. 2022:2957-76.

McEntegart MB, Awede B, Petrie MC, Sattar N, Dunn FG, MacFarlane NG, McMurray JJ. Increase in serum adiponectin concentration in patients with heart failure and cachexia: relationship with leptin, other cytokines, and B-type natriuretic peptide. European heart journal. 2007;28(7):829-35.

Sato Y, Yoshihisa A, Kimishima Y, Yokokawa T, Abe S, Shimizu T, Misaka T, Yamada S, Sato T, Kaneshiro T, Oikawa M. Prognostic factors in heart failure patients with cardiac cachexia. Journal of Geriatric Cardiology: JGC. 2020;17(1):26.

Holder ER, Alibhai FJ, Caudle SL, McDermott JC, Tobin SW. The importance of biological sex in cardiac cachexia. American Journal of Physiology-Heart and Circulatory Physiology. 2022;323(4):H609-27.

Amare H, Hamza L, Asefa H. Malnutrition and associated factors among heart failure patients on follow up at Jimma University specialized hospital, Ethiopia. BMC cardiovascular disorders. 2015;15(1):1-6.






Research Article