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J Card Fail. 2019 Mar 13. pii: S1071-9164(18)30917-5. doi: 10.1016/j.cardfail.2019.03.007. [Epub ahead of print]

Nutrition, Obesity, and Cachexia in Patients With Heart Failure: A Consensus Statement from the Heart Failure Society of America Scientific Statements Committee.

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Division of Cardiology, Tufts Medical Center, Boston, Massachusetts. Electronic address:
Division of Cardiology, University of Alberta, Alberta, Canada.
Winters Center for Heart Failure Research, Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine, Houston, Texas.
Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Division of Cardiology, Duke University, Durham, North Carolina.
College of Nursing, University of Kentucky, Lexington, Kentucky.
Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
Frances Stern Nutrition Center, Tufts Medical Center, Boston, Massachusetts.
Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina, Chapel Hill, North Carolina.
Cardiovascular Division, Washington University School of Medicine, Saint Louis, Missouri.
Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany.


Dietary guidance for patients with heart failure (HF) has traditionally focused on sodium and fluid intake restriction, but dietary quality is frequently poor in patients with HF and may contribute to morbidity and mortality. Restrictive diets can lead to inadequate intake of macronutrients and micronutrients by patients with HF, with the potential for deficiencies of calcium, magnesium, zinc, iron, thiamine, vitamins D, E, and K, and folate. Although inadequate intake and low plasma levels of micronutrients have been associated with adverse clinical outcomes, evidence supporting therapeutic repletion is limited. Intravenous iron, thiamine, and coenzyme Q10 have the most clinical trial data for supplementation. There is also limited evidence supporting protein intake goals. Obesity is a risk factor for incident HF, and weight loss is an established approach for preventing HF, with a role for bariatric surgery in patients with severe obesity. However weight loss for patients with existing HF and obesity is a more controversial topic owing to an obesity survival paradox. Dietary interventions and pharmacologic weight loss therapies are understudied in HF populations. There are also limited data for optimal strategies to identify and address cachexia and sarcopenia in patients with HF, with at least 10%-20% of patients with ambulatory systolic HF developing clinically significant wasting. Gaps in our knowledge about nutrition status in patients with HF are outlined in this Statement, and strategies to address the most clinically relevant questions are proposed.


Heart failure; cachexia; metabolism; nutrition; obesity

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