心不全における強化栄養管理の効果 - システマティックレビューとメタアナリシス

Malnutrition worsens outcomes in heart failure (HF). Although nutritional therapy is important, evidence for enhanced nutritional care (ENC) combined with exercise therapy (ET) is limited.

This systematic review and meta-analysis evaluated ENC, alone or with ET, in HF. Randomized controlled trials (RCTs) published to March 31, 2023, were identified through comprehensive searches. Meta-analyses used a random-effects model with risk ratios (RRs) or mean differences (MDs) and 95% confidence intervals (CIs). Twenty-five RCTs were included: 20 assessed ENC alone and 5 assessed ENC+ET. ENC alone did not reduce all-cause mortality but was associated with fewer post hoc-defined cardiovascular events (RR 0.64; 95% CI 0.48-0.85), driven largely by 1 study and considered exploratory. ENC+ET improved 6-min walk distance (MD 39.85 m; 95% CI 13.05-66.65) and handgrip strength.

ENC may reduce cardiovascular events and improve physical function in HF, particularly with ET, but evidence is preliminary and large-scale trials are warranted.