Use of a Structured Interview to Assess the Association of Inadequate Energy and Protein Intake with Subclinical...

Although previous studies have suggested a relationship between subclinical congestion and poor dietary intake, evidence on this topic remains limited. This study aimed to evaluate whether subclinical congestion is associated with inadequate dietary intake in patients with heart failure (HF). A cross-sectional study was conducted in 122 ambulatory patients at the Heart Failure Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán between April 2023 and January 2025. Subclinical congestion was assessed using the Venous Excess Ultrasound Score (VExUS) and bioelectrical impedance vector analysis (BIVA). Dietary intake was evaluated through three nonconsecutive 24 h dietary recalls. Inadequate dietary intake was defined as consumption below 60% of the standard energy requirement (25-30 kcal/kg) and a protein intake below 1.2 g/kg/day. Patients with subclinical congestion showed significantly lower total energy intake (1098.42 vs. 1478 kcal, p = 0.001) and protein intake (0.84 vs. 1.44 g/kg, p = 0.001), alongside a higher carbohydrate intake (64.3% vs. 49.1%, p < 0.001) and lower fiber intake (10.90 g vs. 16.83 g, p = 0.008), particularly soluble fiber (0.53 vs. 3.01 g, p < 0.001). Subclinical congestion was strongly associated with inadequate dietary intake (odds ratio [OR] = 10.04; 95% confidence interval [CI]: 1.03-97.75; p = 0.047). Additionally, lack of appetite emerged as an independent risk factor for insufficient intake (OR = 11.37; 95% CI: 2.14-60.30; p = 0.004). In conclusion, subclinical congestion in HF patients was associated with significantly lower energy and protein intake, higher carbohydrate consumption, and reduced fiber intake. These findings highlight the potential role of nutritional assessment in the early identification and management of subclinical congestion in HF.