Key result
Nutritional intervention cuts all-cause mortality ~57% in adult patients with heart failure.
Why the study?
Approximately 50% of HF patients are malnourished, which doubles mortality risk, yet interventional evidence remains limited. A prior meta-analysis of 5 studies (n = 275) evaluated only malnourished or cachectic patients, leaving the effects of nutritional interventions in a broader HF population unclear.
Does nutritional intervention to increase protein/energy intake reduce all-cause mortality and hospital readmissions or improve body mass index in adult patients with heart failure?
Meta-Analysis (n=2,240)
Does nutritional intervention to increase protein/energy intake reduce all-cause mortality and hospital readmissions or improve body mass index in adult patients with heart failure?
In adult patients with heart failure, nutritional interventions to increase protein and energy intake are associated with a significant reduction in all-cause mortality and improved 6-minute walk distance, though without significant effects on hospital readmissions or BMI.
Answers are grounded in this paper and cite their sources.
Supports nutritional intervention in heart failure; extends prior evidence from weight gain to mortality reduction.
Approximately 50% of heart failure (HF) patients are malnourished, doubling mortality risk; however, interventional evidence remains limited. A previously published meta-analysis found modest weight improvements only in malnourished/cachectic patients (5 studies, n = 275). This review updates the evidence in a broader HF population to evaluate the effect of nutritional interventions on all-cause mortality, hospital readmissions, and body mass index (BMI) in HF, determine whether intervention type moderates effect size, and identify sources of heterogeneity via meta-regression. This PRISMA-compliant, PROSPERO-registered (CRD420261445761) systematic review and meta-analysis searched PubMed, Scopus, Cochrane, and Embase for randomized controlled trials, quasi-randomized, and observational studies evaluating nutritional interventions (supplements, fortification, enteral/parenteral nutrition, counseling, with or without exercise) to increase protein/energy intake in HF, updating a 2021 search. Two reviewers independently screened, extracted data, and assessed risk of bias (RoB 2.0 for randomized controlled trials; ROBINS-I for observational studies). Random-effects models pooled risk ratios (RRs) and mean differences (MDs), with subgroup, meta-regression, and sensitivity analyses. Of 7190 records screened, 23 studies (n = 2240) were included; 18 contributed to meta-analysis. Risk of bias was predominantly low. Nutritional intervention significantly reduced all-cause mortality (RR 0.43, 95% confidence interval: 0.26-0.71, P = 0.001), with no significant effect on readmission or BMI. Exercise capacity improved significantly (6-minute walk distance mean difference 25.01, 95% confidence interval: 5.26-44.76, P = 0.013), while quality of life, creatinine, and B-type natriuretic peptide showed no significant change. Nutritional intervention was associated with reduced mortality and improved exercise capacity in HF, though effects on hospitalization, BMI, and biomarkers were nonsignificant, warranting cautious interpretation.
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Batool et al. (2026) conducted a meta-analysis in Heart failure (n=2,240). Nutritional intervention (supplements, fortification, enteral/parenteral nutrition, or counseling, with or without exercise) was evaluated on All-cause mortality (RR 0.43, 95% CI 0.26-0.71, p=0.001). Nutritional intervention significantly reduced all-cause mortality in adult patients with heart failure (RR 0.43; 95% CI 0.26-0.71; P=0.001) and improved 6-minute walk distance.
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