What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=54). Intervention: Decreased BMI and body fat mass. Primary outcome: overall mortality (r = -0.343, p=0.032).

What question did this study set out to answer?

The study aimed to identify clinical parameters differentiating HFrEF and HFpEF patients and their impact on mortality.

June 12, 2026Open Access

Association of body composition with clinical variables and mortality in heart failure patients with preserved and reduced systolic function

Key Result

Decreases in BMI (r=-0.343; p=0.032) and total body fat mass (r=-0.324; p=0.039) were significantly correlated with increased overall mortality in patients with compensated heart failure.

Key Points

The study aimed to identify clinical parameters differentiating HFrEF and HFpEF patients and their impact on mortality.
Enrolled 54 compensated heart failure patients categorized into HFpEF and HFrEF based on ejection fraction.
Assessed nutritional status using BMI and bioimpedance analysis for body composition.
Conducted laboratory tests for routine biomarkers and analyzed data using Mann–Whitney U test and Pearson correlation.
BMI was significantly higher in HFpEF patients (26.548 ± 3.912 vs. 31.839 ± 8.992; p=0.026).
NT-proBNP levels were significantly higher in HFrEF patients (5295.930 ± 5890.349 vs. 1813.870 ± 3156.359; p=0.008).
Decreases in BMI (r = –0.343; p=0.032) and total body fat mass (r = –0.324; p=0.039) correlated significantly with increased mortality.

Study Design

Type

Observational (n=54)

Structured PICO

Is body composition associated with clinical variables and mortality in patients with compensated heart failure?

Population

54 compensated (NYHA I, II) heart failure patients with preserved or reduced ejection fraction.

Outcome

Clinical parameters (BMI, body composition, NT-proBNP) and overall mortalityhard clinical

In patients with heart failure, a decrease in BMI and total body fat mass is associated with increased mortality, supporting the obesity paradox.

Main Result

Effect estimate: r = -0.343

p-value: p=0.032

Abstract

Abstract Introduction Obesity and heart failure are among the major public health challenges of our time. Heart failure is characterized by impaired cardiac pump function, which affects blood flow and consequently the delivery of oxygen and nutrients to the tissues. In advanced stages, cardiac cachexia may develop. In this context, excess body weight may provide a survival benefit due to higher metabolic reserves - a phenomenon known as the obesity paradox. Purpose Our aim was to identify the clinical parameters that differ between HFrEF and HFpEF patients and to determine which parameters have the greatest impact on mortality. Methods We enrolled 54 compensated (NYHA I, II) heart failure patients in our study. Participants were divided into two groups: those with preserved ejection fraction (EF ≥45%; HFpEF) and those with reduced ejection fraction (EF 45%; HFrEF). EF was determined by echocardiography. Nutritional status was assessed using BMI and bioimpedance-based body composition analysis, which allows for the assessment of muscle and fat mass as well as intra- and extracellular fluid volumes. Routine laboratory tests and NT-proBNP were obtained from blood samples. Data were analysed using the Mann–Whitney U test and Pearson correlation. Results BMI values were significantly higher in HFpEF patients (26.548 ± 3.912 vs. 31.839 ± 8.992; p=0.026), and also higher total body fat mass and trunk fat. Conversely, NT-proBNP levels were significantly higher in HFrEF patients (5295.930 ± 5890.349 vs. 1813.870 ± 3156.359; p=0.008). Among the variables examined, decreases in BMI (r = –0.343; p=0.032) and total body fat mass (r = –0.324; p=0.039) showed a significant correlation with the overall mortality. Conclusion Obesity is a major risk factor for HFpEF; however, in HFpEF patients, NT-proBNP levels may often be lower, partly due to reduced production and partly due to enhanced metabolism. Among heart failure patients, a decrease in BMI—particularly a reduction in body fat mass, even without a marked decline in skeletal muscle mass—is associated with increased mortality. In addition to optimal guideline-directed medical therapy, it is essential to place greater emphasis on preserving physical activity and maintaining adequate nutritional status in patients with heart failure.