Use of a Structured Interview to Assess the Association of Inadequate Energy and Protein Intake with Subclinical Congestion in Heart Failure Patients

Summary

This study evaluates the association between subclinical congestion and dietary intake in patients with heart failure using combined diagnostic tools, including bioelectrical impedance and Doppler ultrasound, as well as 24 h dietary recalls, showing that subclinical congestion is linked to reduced energy, protein, and micronutrient intake.

Abstract

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.

Introduction

Congestion is a leading cause of hospitalization in patients with heart failure (HF), and its recurrence is strongly associated with worse prognosis¹. While pulmonary and peripheral oedema are classical clinical signs, subclinical congestion, characterized by elevated cardiac filling pressures without overt symptoms, can develop weeks before decompensation and often remains undetected with conventional assessment methods². This early-stage congestion may promote gastrointestinal dysfunction through mechanisms such as intestinal wall oedema, increased mucosal permeability, bacterial translocation, and systemic inflammatio....

Protocol

This study was conducted according to the guidelines of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) and approved by the Biomedical Research Ethics Committee (reference number 4504). Written and verbal informed consent was obtained from all participants prior to enrolment.

Study design and population

This was a cross-sectional study. Patients aged ≥ 18 years with a confirmed diagnosis of heart failure for at least six months, clinically stable, with no medication adjustments in the preceding three months, and no hospital admissions or acute decompensation wi....

Results

Study population

A total of 117 patients met the inclusion criteria and were enrolled in the study. Among them, 54% were women, and the median age was 66.5 years. The patient selection process is detailed in the flowchart presented in Figure 1. The baseline characteristics of the study population, stratified by the presence or absence of subclinical congestion, are summarized in Table 1. No significant differences were observed be.......

Discussion

This study proposes that subclinical congestion, even in the absence of overt clinical signs, is significantly associated with inadequate dietary intake in patients with heart failure. Our results revealed that individuals with subclinical congestion consumed fewer calories and less protein, along with higher carbohydrate intake and reduced fiber intake, than those without congestion. These findings raise the possibility that nutritional status is intertwined with the mechanisms driving subclinical congestion; however, t.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
White paper	NA	NA	Any brand can be used
Pen	NA	NA	Any brand can be used
ESHA food processor software	Trustwell	https://www.trustwell.com/products/food-processor-nutrition-analysis-software/dietitian-purchase/?__hstc=245337562.66dbd18d36f4c f64e594f71fe9ffa176.175502016180 4.1755020161804.1755020161804.1 &__hssc=245337562.1.17550201 61804&__hsfp=4246053562	ESHA Food Processor is a software application that provides comprehensive food and nutrient analysis. The software allows users to analyze recipes, menus, and individual foods for their nutritional content, including calories, macronutrients, and micronutrients.
Computer system	Microsoft	Microsoft 10	Microsoft 10 or higher