Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Sep;26(5):1103-1118.
doi: 10.1007/s10741-020-09937-9.

Nutritional interventions for heart failure patients who are malnourished or at risk of malnutrition or cachexia: a systematic review and meta-analysis

Dina Habaybeh  1 , Mariana Bordinhon de Moraes  2 , Adrian Slee  1 , Christina Avgerinou  3
Affiliations
Meta-Analysis

Nutritional interventions for heart failure patients who are malnourished or at risk of malnutrition or cachexia: a systematic review and meta-analysis

Dina Habaybeh et al. Heart Fail Rev. 2021 Sep.

Abstract

Malnutrition is common in heart failure (HF), and it is associated with higher hospital readmission and mortality rates. This review aims to answer the question whether nutritional interventions aiming to increase protein and energy intake are effective at improving outcomes for patients with HF who are malnourished or at risk of malnutrition or cachexia. Systematic searches of four databases (Medline, Embase, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL)) were conducted on 21 June 2019. Randomized controlled trials (RCTs) or other interventional studies using protein or energy supplementation for adult HF patients who are malnourished or at risk of malnutrition or cachexia were included. Two independent reviewers assessed study eligibility and risk of bias. Five studies (four RCTs and one pilot RCT) met the inclusion criteria. The majority of studies were small and of limited quality. The pooled weighted mean difference (WMD) for body weight showed a benefit from the nutritional intervention by 3.83 kg (95% confidence interval (CI) 0.17 to 7.50, P = 0.04) from three trials with no significant benefit for triceps skinfold thickness (WMD = - 2.14 mm, 95% CI - 9.07 to 4.79, P = 0.55) from two trials. The combination of personalized nutrition intervention with conventional treatment led to a decrease in all-cause mortality and hospital readmission in one study. Findings of this review suggest that nutritional interventions could potentially improve outcomes in HF patients who are malnourished or at risk of malnutrition. However, the strength of the evidence is poor, and more robust studies with a larger number of participants are needed.

Keywords: Heart failure; Malnutrition; Nutritional interventions; Oral nutritional supplements.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of selecting eligible studies
Fig. 2
Fig. 2
Risk of bias assessment using the Cochrane Risk of Bias Tool for RCTs. KEY: (+)/Green = Low risk (−)/Red = High risk (?)/Yellow = Unclear.
Fig. 3
Fig. 3
Forest plot for body weight (kg) (nutritional intervention vs. no nutritional intervention)
Fig. 4
Fig. 4
Forest plot for triceps skinfold thickness (mm) (nutritional intervention vs. no nutritional intervention)
See this image and copyright information in PMC

References

    1. Ambrosy A, Fonarow G, Butler J, Chioncel O, Greene S, Vaduganathan M, Nodari S, Lam C, Sato N, Shah A, Gheorghiade M. The global health and economic burden of hospitalizations for heart failure. J Am Coll Cardiol. 2014;63(12):1123–1133. doi: 10.1016/j.jacc.2013.11.053. - DOI - PubMed
    1. Braunschweig F, Cowie M, Auricchio A. What are the costs of heart failure? Europace. 2011;13(suppl 2):ii13–ii17. doi: 10.1093/europace/eur081. - DOI - PubMed
    1. Dharmarajan K, Rich M. Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart Fail Clin. 2017;13(3):417–426. doi: 10.1016/j.hfc.2017.02.001. - DOI - PubMed
    1. Health care cost and utilization project (HCUP) (2019) Statistical brief #66 [online]. Available from: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb66.jsp (Accessed 18 April 2019)
    1. NHFA (2016-2017) [online]. Available from: https://www.nicor.org.uk/wp-content/uploads/2018/11/Heart-Failure-Summar... (Accessed 18 April 2019)