Knobloch Ingrid da Silveira, Zucatti Kelly Pozzer, de Carvalho Bruna Zardo Oliveira, da Costa-Pereira Jarson P, Hartmann Alicia Sommer, Razzera Elisa Loch, Vale Marla Darlene Machado, Souza Gabriela Corrêa, Silva Flávia Moraes
Master's Student in the Health Sciences Graduate Program at the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
PhD Student in the Health Sciences Graduate Program at the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Nutrition. 2025 Jul 20;140:112913. doi: 10.1016/j.nut.2025.112913.
BACKGROUND & AIMS: Impairment in nutritional status (i.e. malnutrition) can significantly affect the progression and prognosis of patients with heart failure (HF). However, systematic evidence synthesizing its prevalence using new tools and associations with clinical outcomes remains insufficient. Therefore, this study aimed to systematically review the prevalence of malnutrition and its association with adverse clinical outcomes in patients with HF.
We conducted a systematic review of observational studies identified in four databases (Pubmed, Embase, Web of Science and Scopus), without date or language restrictions. Studies reporting data on malnutrition diagnosis from any integrative tool, and its association with predefined clinical outcomes in HF patients were included. Outcomes of interest were mortality, disease exacerbation, quality of life, physical function, and length of hospital stay. The screening process (Rayyan®) and the data extraction (Redcap®) were independently conducted by two reviewers. Disagreements were solved by a third reviewer. Risk of bias in primary studies was assessed by New-Castle Ottawa scale. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Publication bias was explored. A meta-analysis with a random-effects model was performed to combine data using R software. Heterogeneity was explored by subgroup analyses.
Ninety one studies were included [38.4% conducted in Japan, 79.1% involving inpatients, 59.3% of with Controlling Nutritional Status (CONUT) score]. Pooled data (n = 90 studies, 51,086 patients) estimated the prevalence of malnutrition at 44.6% (95% CI, 37.7-51.7%; I 99.1%). This prevalence was higher in studies evaluating inpatients compared to outpatients (49.3 vs 27.1%) and in studies using the CONUT score rather than the Mini Nutritional Assessment (MNA) (60.5 vs 15.7%). Malnutrition was associated with higher risk of mortality (n = 28 studies, 23,163 patients; RR = 2.02, 95% CI 1.53-2.67; I² = 88.3%), and prolonged hospitalization (n = 7 studies, 4803 patients; RR = 2.14, 95% CI 1.83-2.50; I² = 0.0%), without differences in the subgroup analyses. The heterogeneity and small number of studies precluded a meta-analysis of the other outcomes. 33.3% of studies had high risk of bias. For all outcomes, the certainty of evidence was very low.
Malnutrition is a prevalent concern among patients with HF, increasing the risk of worse outcomes. The high risk of bias in primary studies and the incomplete explained heterogeneity graded the certainty of evidence as very low. Taken together, caution is necessary in interpreting our findings.
Internal Prospective Register of Systematic Reviews (PROSPERO registration code: CRD42024506372).
营养状况受损（即营养不良）会显著影响心力衰竭（HF）患者的病情进展和预后。然而，使用新工具综合其患病率以及与临床结局相关性的系统证据仍然不足。因此，本研究旨在系统评价HF患者中营养不良的患病率及其与不良临床结局的相关性。
我们对在四个数据库（PubMed、Embase、Web of Science和Scopus）中检索到的观察性研究进行了系统评价，无日期或语言限制。纳入报告来自任何综合工具的营养不良诊断数据及其与HF患者预定义临床结局相关性的研究。感兴趣的结局包括死亡率、疾病加重、生活质量、身体功能和住院时间。筛选过程（Rayyan®）和数据提取（Redcap®）由两名审阅者独立进行。分歧由第三名审阅者解决。通过纽卡斯尔渥太华量表评估原始研究的偏倚风险。使用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。探索发表偏倚。使用R软件进行随机效应模型的荟萃分析以合并数据。通过亚组分析探索异质性。
纳入91项研究[38.4%在日本进行，79.1%涉及住院患者，59.3%使用控制营养状况（CONUT）评分]。汇总数据（n = 90项研究，51,086例患者）估计营养不良的患病率为44.6%（95%CI，37.7 - 51.7%；I² = 99.1%）。与门诊患者相比，评估住院患者的研究中该患病率更高（49.3%对27.1%），使用CONUT评分而非小型营养评估（MNA）的研究中患病率更高（60.5%对15.7%）。营养不良与更高的死亡风险相关（n = 28项研究，23,163例患者；RR = 2.02，95%CI 1.53 - 2.67；I² = 88.3%），以及住院时间延长（n = 7项研究，4803例患者；RR = 2.14，95%CI 1.83 - 2.50；I² = 0.0%），亚组分析中无差异。研究的异质性和数量较少使得无法对其他结局进行荟萃分析。33.3%的研究存在高偏倚风险。对于所有结局，证据的确定性非常低。
营养不良是HF患者中普遍存在的问题，增加了不良结局的风险。原始研究中的高偏倚风险和未完全解释的异质性将证据的确定性分级为非常低。综上所述，在解释我们的研究结果时需要谨慎。
系统评价内部前瞻性注册库（PROSPERO注册号：CRD42024506372）
