Nutritional Care of the Frail Patient with Heart Failure: Evidence, Uncertainties and Research Priorities
12 affiliations
- 1Institute of Dietetics, The Academy of Business and Health Science, 90-361 Lodz, Poland
- 2Department Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland
- 3Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland
- 4Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh EH14 1DJ, UK
- 5Boston College William F. Connell School of Nursing, Chestnut Hill, MA 02467, USA
- 6Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
- 7Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, 26006 Logroño, Spain
- 8Institute of Neurosciences of Castile and León (INCYL), University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- 9Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, 40-055 Katowice, Poland
- 10Department of Biochemistry and Microbiology, Faculty of Biology and Biotechnology, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159, 02-776 Warsaw, Poland
- 11Division of Scientific Research and Innovation in Emergency Medical Service, Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland
- 12Nursing Care and Education Research Group (GRIECE), Department of Nursing, University of Valencia, 46010 Valencia, Spain
Abstract
Frailty is highly prevalent in patients with heart failure (HF) and frequently coexists with malnutrition, sarcopenia, cachexia, and obesity, creating substantial challenges for nutritional assessment and management. These conditions overlap clinically but represent distinct biological phenotypes and should not be treated as interchangeable constructs. This narrative review critically synthesizes current evidence on nutritional care in patients with HF and frailty, focusing on nutritional assessment, energy and protein requirements, areas of alignment and conflict between HF- and frailty-oriented recommendations, and the effects of nutritional interventions on frailty-related outcomes. Nutritional assessment should be multidimensional, as congestion, inflammation, altered body composition, and renal dysfunction may limit the interpretability of body weight, BMI, biochemical indices, and screening tools. Current recommendations for energy and protein intake remain largely extrapolated from geriatric, multimorbidity, renal, or general HF populations, and no universally validated targets exist for frail patients with HF. Dietary management therefore requires balancing potentially competing priorities, including congestion control, preservation of muscle mass and function, adequate nutrient intake, renal limitations, and, in obesity-related HF, intentional fat loss without excessive loss of lean tissue. Available interventional evidence suggests that individualized nutritional support may improve nutritional status and selected functional outcomes, but effects on frailty as an integrated syndrome remain uncertain. Overall, nutritional care in HF with frailty should move towards phenotype-directed, multidisciplinary strategies integrating nutrition, physical activity, rehabilitation, and longitudinal assessment. Future trials should standardize frailty definitions, clinically relevant outcomes, and nutrition-related targets.
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BibTeX
@article{kwasny2026nutritional,
title = {{Nutritional Care of the Frail Patient with Heart Failure: Evidence, Uncertainties and Research Priorities}},
author = {Adrian Kwaśny and Małgorzata Słoma-Krześlak and Izabella Uchmanowicz and Christopher S. Lee and Ercole Vellone and Raúl Juárez-Vela and Stanisław Surma and Mateusz Labudda and Michał Czapla},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18213527},
url = {https://www.mdpi.com/2072-6643/18/21/3527},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nutritional Care of the Frail Patient with Heart Failure: Evidence, Uncertainties and Research Priorities
AU - Adrian Kwaśny
AU - Małgorzata Słoma-Krześlak
AU - Izabella Uchmanowicz
AU - Christopher S. Lee
AU - Ercole Vellone
AU - Raúl Juárez-Vela
AU - Stanisław Surma
AU - Mateusz Labudda
AU - Michał Czapla
PY - 2026
DA - 2026/10/26
JO - Nutrients
DO - 10.3390/nu18213527
UR - https://www.mdpi.com/2072-6643/18/21/3527
AB - Frailty is highly prevalent in patients with heart failure (HF) and frequently coexists with malnutrition, sarcopenia, cachexia, and obesity, creating substantial challenges for nutritional assessment and management. These conditions overlap clinically but represent distinct biological phenotypes and should not be treated as interchangeable constructs. This narrative review critically synthesizes current evidence on nutritional care in patients with HF and frailty, focusing on nutritional assessment, energy and protein requirements, areas of alignment and conflict between HF- and frailty-oriented recommendations, and the effects of nutritional interventions on frailty-related outcomes. Nutritional assessment should be multidimensional, as congestion, inflammation, altered body composition, and renal dysfunction may limit the interpretability of body weight, BMI, biochemical indices, and screening tools. Current recommendations for energy and protein intake remain largely extrapolated from geriatric, multimorbidity, renal, or general HF populations, and no universally validated targets exist for frail patients with HF. Dietary management therefore requires balancing potentially competing priorities, including congestion control, preservation of muscle mass and function, adequate nutrient intake, renal limitations, and, in obesity-related HF, intentional fat loss without excessive loss of lean tissue. Available interventional evidence suggests that individualized nutritional support may improve nutritional status and selected functional outcomes, but effects on frailty as an integrated syndrome remain uncertain. Overall, nutritional care in HF with frailty should move towards phenotype-directed, multidisciplinary strategies integrating nutrition, physical activity, rehabilitation, and longitudinal assessment. Future trials should standardize frailty definitions, clinically relevant outcomes, and nutrition-related targets.
SN - 2072-6643
ER -