Does malnutrition worsen outcomes in obese patients with heart failure compared to well-nourished obese patients?
In patients with heart failure and obesity, malnutrition outweighs the protective effects of high BMI, suggesting that nutritional status should be prioritized over routine weight loss recommendations.
The obesity paradox seems to be an inherent characteristic of HF regardless of phenotype and nutritional status. Yet malnutrition significantly changes trajectory of outcome with regard to BMI alone: obese patients with malnutrition have a considerably worse outcome compared with their well-nourished counterparts, outweighing protective effects of high BMI alone. In this context, routine recommendation towards weight loss in patients with obesity and HF should generally be made with caution and focus should be shifted on nutritional status.
Prausmüller et al. (Tue,) studied this question.