Evangelista Lorraine S, Meraz Rebecca, Wierenga Kelly L, Nguyen Angelina P, Angosta Alona D, Kawi Jennifer
Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA 92697, USA.
Louise Herrington School of Nursing, Baylor University, Dallas, TX 75246, USA.
Nutrients. 2025 Jul 18;17(14):2361. doi: 10.3390/nu17142361.
Heart failure (HF) is frequently associated with skeletal muscle wasting, reduced functional capacity, and malnutrition. High-protein diets offer a promising nutritional intervention to improve these outcomes in individuals with HF. This systematic review evaluated randomized controlled trials of high-protein dietary interventions in HF populations, with emphasis on intervention characteristics, quantitative benefits, and risk of bias. We conducted a comprehensive search in PubMed, MEDLINE, Embase, and Cochrane CENTRAL from inception to June 2025. Eligible studies enrolled adults (≥18 years) with HF, implemented high-protein regimens (≥1.1 g/kg/day or ~25-30% of energy), and reported on functional capacity, body composition, muscle strength, clinical outcomes, or biochemical markers. Two reviewers independently screened, extracted data, and assessed bias (Cochrane RoB 2). Heterogeneity in dosing, duration, and outcomes precluded meta-analysis; we therefore provide a narrative synthesis. Ten trials (nine randomized controlled trials, one pilot) involving 1080 patients (median n = 38; range 21-652) were included. High-protein interventions yielded mean improvements in six-minute walk distance of +32 ± 14 m, lean body mass gain of +1.6 ± 0.9 kg, and 9 ± 4% enhancement in quality-of-life scores; muscle strength effects varied from -2% to +11%. Two studies reported an 18% reduction in HF readmissions ( < 0.05). The risk-of-bias assessment identified two low-risk, three moderate-risk, and one high-risk study. Key limitations include small sample sizes, varied protein dosing (1.1-1.5 g/kg/day), short follow-up (2-6 months), and outcome heterogeneity. High-protein dietary strategies appear to confer modest, clinically relevant gains in functional capacity, nutritional status, and HF readmission risk. Larger, well-powered trials with standardized dosing and longer follow-up are necessary to establish optimal protein targets, long-term efficacy, and safety.
心力衰竭（HF）常伴有骨骼肌萎缩、功能能力下降和营养不良。高蛋白饮食为改善HF患者的这些结局提供了一种有前景的营养干预措施。本系统评价评估了HF人群中高蛋白饮食干预的随机对照试验，重点关注干预特征、量化益处和偏倚风险。我们从创刊至2025年6月在PubMed、MEDLINE、Embase和Cochrane CENTRAL进行了全面检索。符合条件的研究纳入了≥18岁的HF成年患者，实施了高蛋白方案（≥1.1 g/kg/天或能量的~25 - 30%），并报告了功能能力、身体成分、肌肉力量、临床结局或生化标志物。两名研究者独立筛选、提取数据并评估偏倚（Cochrane RoB 2）。给药剂量、持续时间和结局的异质性排除了进行荟萃分析的可能性；因此，我们进行了叙述性综合分析。纳入了10项试验（9项随机对照试验，1项试点试验），涉及1080例患者（中位数n = 38；范围21 - 652）。高蛋白干预使六分钟步行距离平均改善了+32 ± 14 m，瘦体重增加了+1.6 ± 0.9 kg，生活质量评分提高了9 ± 4%；肌肉力量的影响从 - 2%到+11%不等。两项研究报告HF再入院率降低了18%（P < 0.05）。偏倚风险评估确定了2项低风险、3项中度风险和1项高风险研究。主要局限性包括样本量小、蛋白质给药剂量不同（1.1 - 1.5 g/kg/天）、随访时间短（2 - 6个月）以及结局异质性。高蛋白饮食策略似乎在功能能力、营养状况和HF再入院风险方面带来了适度的、具有临床意义的改善。需要开展更大规模、有充分统计学效力的试验，采用标准化给药剂量并进行更长时间的随访，以确定最佳蛋白质目标、长期疗效和安全性。
