Effects of Enhanced Nutritional Care in Heart Failure　- A Systematic Review and Meta-Analysis.

Background: Malnutrition worsens outcomes in heart failure (HF). Although nutritional therapy is important, evidence for enhanced nutritional care (ENC) combined with exercise therapy (ET) is limited. Methods and Results: This systematic review and meta-analysis evaluated ENC, alone or with ET, in HF. Randomized controlled trials (RCTs) published to March 31, 2023, were identified through comprehensive searches. Meta-analyses used a random-effects model with risk ratios (RRs) or mean differences (MDs) and 95% confidence intervals (CIs). Twenty-five RCTs were included: 20 assessed ENC alone and 5 assessed ENC+ET. ENC alone did not reduce all-cause mortality but was associated with fewer post hoc-defined cardiovascular events (RR 0.64; 95% CI 0.48-0.85), driven largely by 1 study and considered exploratory. ENC+ET improved 6-min walk distance (MD 39.85 m; 95% CI 13.05-66.65) and handgrip strength. Conclusions: ENC may reduce cardiovascular events and improve physical function in HF, particularly with ET, but evidence is preliminary and large-scale trials are warranted.