Effect of nutrition interventions on quality of life and functional outcomes in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials

Abstract

Malnutrition and impaired physical function are common in patients with heart failure and are associated with reduced quality of life and adverse clinical outcomes. However, randomized trials have evaluated clinically diverse nutritional strategies, and their overall effects remain uncertain. PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to March 30, 2026. Randomized controlled trials evaluating oral nutritional interventions in adults with heart failure and reporting quality of life, functional outcomes, or clinical events were included. Standardized mean differences (SMDs) and odds ratios (ORs) were pooled using random-effects models with restricted maximum-likelihood estimation. Risk of bias was assessed using the Cochrane RoB 2 tool. Exploratory analyses according to intervention category were conducted to examine clinical heterogeneity. Twenty-two randomized controlled trials involving 4,042 participants were included. The primary quality-of-life analysis included seven effect estimates and favored nutritional intervention (SMD = 0.76, 95% CI 0.41 to 1.11; p < 0.0001), although substantial heterogeneity was present (I² = 66.9%). Nutritional interventions also improved six-minute walk performance (five studies; SMD = 0.65, 95% CI 0.21 to 1.09; p = 0.0037; I² = 41.6%) and handgrip strength (four effect estimates; SMD = 0.82, 95% CI 0.39 to 1.26; p = 0.0002; I² = 0%). The pooled analysis of clinical events favored nutritional intervention (OR = 0.54, 95% CI 0.36 to 0.82; p = 0.0038; I² = 55.7%). In outcome-specific random-effects analyses, heart-failure readmission was reduced (OR = 0.25, 95% CI 0.12 to 0.50), whereas reductions in all-cause mortality (OR = 0.55, 95% CI 0.28 to 1.06) and cardiovascular events (OR = 0.78, 95% CI 0.43 to 1.41) were not statistically significant. Exploratory analyses by intervention category were descriptive because each category was represented by only one study and did not establish the superiority of any specific nutritional strategy. Nutritional interventions were associated with improvements in quality of life and functional outcomes and may reduce heart-failure readmission. However, substantial clinical heterogeneity, limited studies within intervention categories, and risk-of-bias concerns require cautious interpretation. The pooled findings represent average effects across diverse nutritional strategies and should not be interpreted as supporting every included intervention or identifying a preferred nutritional approach.