Factors Associated with Malnutrition in Thai Patients with Heart Failure: A Cross-Sectional Study

Background: Malnutrition is a well-established independent predictor of adverse clinical outcomes and reduced quality of life among patients with heart failure (HF). In middle-income countries such as Thailand, nutritional assessment and management in outpatient HF care remain underprioritized. Objective: To examine the association and predictive contribution of fatigue, constipation, comorbidities, and family support to malnutrition among Thai patients with HF. Methods: A cross-sectional predictive study was conducted among 138 patients with HF attending a tertiary hospital in Thailand. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF). Fatigue, constipation, comorbidities, and family support were measured using the Piper Fatigue Scale-12, Rome IV criteria, Charlson Comorbidity Index, and Family APGAR, respectively. Binary logistic regression analysis was performed to identify independent predictors of malnutrition. Results: Participants had a mean age of 64.77 ± 15.15 years, and 63.0% were male. Overall, 39.9% of participants were malnourished or at risk of malnutrition (28.3% at risk; 11.6% malnourished). All participants reported some degree of fatigue, with 42.7% experiencing moderate-to-severe levels, and 31.2% meeting criteria for constipation. In multivariable analysis, moderate-to-severe fatigue (OR = 5.45, 95% CI 2.33– 12.72, p < 0.001) and constipation (OR = 4.91, 95% CI 1.88– 12.83, p =0.001) were significant independent predictors of malnutrition, collectively explaining 40.5% of the variance (Nagelkerke R2 =0.405). Conclusion: Fatigue and constipation are significant predictors of malnutrition among Thai patients with HF. These findings highlight the importance of routine symptom assessment and early intervention to prevent nutritional deterioration in outpatient HF care.