McIntosh Nathalie, Billingsley Hayley, Hummel Scott L, Mills Whitney L
Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island.
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
J Card Fail. 2025 Jun;31(6):939-950. doi: 10.1016/j.cardfail.2024.10.446. Epub 2024 Dec 12.
Dietary interventions have potential to improve symptoms and outcomes in patients with heart failure (HF), but there are barriers to eating nutrient-dense diets. One strategy to address challenges is to provide medically tailored meals (MTMs), fully prepared meals that align with an individual's nutritional needs. In this systematic review, we examined clinical outcomes of studies that provided MTMs to patients with HF.
We searched CINAH, EBSCO/MEDLINE, EMBASE, PUBMED and the Cochrane Central Register of Controlled Trials to identify MTM interventions published between 2013 and 2023. We included six studies. Five studies involved sodium restriction. Four of these were randomized control trials and one was a matched cohort study. Sample sizes ranged from 31 to 641. Patient populations included individuals who had heart failure, acute decompensated heart failure and heart failure with preserved ejection fraction. One study involved energy restriction in patients with heart failure with preserved ejection fraction and obesity. This was a randomized controlled study with a sample size of 100. Sodium-restriction interventions, when aligned with Dietary Approaches to Stop Hypertension goals, reduced 90-day HF readmissions in one study and trended towards improving 30-day and 12-week HF readmissions in another. The energy-restriction intervention reduced diastolic blood pressure, weight, and inflammatory biomarkers, and improved quality of life (QoL) and cardiorespiratory fitness. Neither intervention had an impact on mortality.
Provision of sodium-restricted MTMs to patients with HF may reduce the risk of rehospitalization. Provision of energy-restricted MTMs to patients with HF and obesity can improve symptoms, weight loss, QoL, and cardiorespiratory fitness. Adequately powered randomized controlled trials are needed to confirm these effects and investigate underlying mechanisms.
饮食干预有可能改善心力衰竭（HF）患者的症状和预后，但食用营养丰富的饮食存在障碍。应对这些挑战的一种策略是提供医学定制餐（MTMs），即根据个人营养需求完全准备好的膳食。在这项系统评价中，我们研究了为HF患者提供MTMs的研究的临床结局。
我们检索了CINAH、EBSCO/MEDLINE、EMBASE、PUBMED和Cochrane对照试验中央注册库，以确定2013年至2023年间发表的MTM干预措施。我们纳入了六项研究。五项研究涉及钠限制。其中四项是随机对照试验，一项是匹配队列研究。样本量从31到641不等。患者群体包括患有心力衰竭、急性失代偿性心力衰竭和射血分数保留的心力衰竭患者。一项研究涉及对射血分数保留且肥胖的心力衰竭患者进行能量限制。这是一项样本量为100的随机对照研究。钠限制干预措施若符合终止高血压饮食方法目标，在一项研究中可降低90天HF再入院率，在另一项研究中则有降低30天和12周HF再入院率的趋势。能量限制干预降低了舒张压、体重和炎症生物标志物，并改善了生活质量（QoL）和心肺适应性。两种干预措施均未对死亡率产生影响。
为HF患者提供钠限制MTMs可能会降低再住院风险。为HF和肥胖患者提供能量限制MTMs可改善症状、减轻体重、提高QoL和心肺适应性。需要进行足够样本量的随机对照试验来证实这些效果并研究潜在机制。
