Nutritional Interventions on Quality of Life and Functional Outcomes in Heart Failure

Background: Malnutrition is common in heart failure (HF) and associated with poor quality of life (QoL) and functional decline. However, definitive evidence for nutritional interventions on patient-centered outcomes remains lacking. Objectives: To evaluate the effect of nutritional interventions on QoL and functional outcomes in adults with HF. Methods: We systematically searched PubMed, Web of Science, Cochrane, and Scopus from inception to March 30, 2026. Randomized controlled trials (RCTs) comparing any nutritional intervention to usual care or placebo in adults with HF were included. Outcomes included QoL (standardized mean difference [SMD]), six-minute walk test (6MWT), handgrip strength, and clinical events (odds ratio [OR]). Random-effects meta-analysis with REML estimation was performed. Results: Twenty-two RCTs (4,042 participants) were included. Nutritional interventions significantly improved QoL (SMD = 0.76, 95% CI 0.41 to 1.11; p < 0.0001; I 2 = 67%), particularly when measured by MLHFQ (SMD = 0.95, 95% CI 0.60 to 1.31). Significant improvements were also observed for 6MWT (SMD = 0.65, 95% CI 0.21 to 1.09; p = 0.004; I 2 = 42%) and handgrip strength (SMD = 0.82, 95% CI 0.39 to 1.26; p = 0.0002; I 2 = 0%). Clinical events were reduced (OR = 0.54, 95% CI 0.36 to 0.82; p = 0.004), with strongest evidence for hospital readmissions (OR = 0.25, 95% CI 0.12 to 0.50). Conclusion: Nutritional interventions significantly improve QoL, functional capacity, and reduce clinical events in HF, particularly hospital readmissions. Systematic nutritional assessment and support should be integrated into routine HF management.