Comprehensive evaluation of anthropometric parameters, physical and functional performance, and dietary patterns in patients with chronic heart failure: The DIET PILLARS cohort study
M Vitolo, N Bonini, B Cherubini, B Righi, M Mantovani, P Trapanese, F Baldisserri, E Caliano, J Galloni, M Izzi, M Paolini, G Procaccia, M Ricchiuto, A Russo, G BorianiAbstract
Background
Nutritional status, body composition, physical performance and functional capacity critically influence prognosis of patients with HF. Despite increasing evidence supporting their importance, these domains are rarely evaluated in an integrated manner in routine clinical practice.
Purpose
We aim to provide an integrated evaluation of four key domains in patients with chronic HF, summarized by the DIET acronym: Dietary adherence, Indicators of body composition, Evaluation of physical performance, and Total functional status.
Methods
The DIET PILLARS cohort study enrolled consecutive outpatients with stable chronic HF attending a tertiary care university HF clinic. All patients were on GDMT for at least three months. Dietary adherence was assessed using the Med Diet Adherence Screener. Anthropometric evaluation included height, weight, BMI, BSA, appendicular skeletal muscle mass, circumferences, skinfold thicknesses and derived indices of lean mass. Physical performance and sarcopenia were assessed using the Short Physical Performance Battery (SPPB) and handgrip strength. Functional status and frailty were evaluated using Activities of Daily Living (ADL), Instrumental ADL (IADL) and the Edmonton Frailty Scale (EFS). Quality of life was assessed with the Kansas City Cardiomyopathy Questionnaire.
Results
A total of 109 HF patients were enrolled (median age 68 years, 22% females). Most patients had HF with reduced ejection fraction (47.9%). Overweight or obesity was present in 71.3% of patients. GDMT was prescribed in 62.8% of patients. Marked sex-related differences in body composition emerged (Figure 1): men exhibited higher lean mass and visceral adiposity, while women showed greater subcutaneous fat accumulation, differences not captured by BMI alone. Adherence to the Med diet was low (23.9%). Patients adherent to the Med diet showed significantly higher SPPB scores compared with non-adherent patients (median 10 vs 8 points, p = 0.029), whereas no significant differences were observed in handgrip strength. Nearly 21% of patients had possible or confirmed sarcopenia, with a higher prevalence among non-adherent patients (22.2% vs 11.5%). Most patients were classified as pre-frail (65.9%), with frailty being more prevalent among non-adherent patients (27.5% vs 13.6%). No significant differences were found in ADL, IADL or KCCQ scores; however, patients with ADL < 6 were more frequently observed in the non-adherent group (8.5% vs 4.0%) (Figure 2).
Conclusion
The DIET-PILLARS study highlights the importance of a comprehensive, multidimensional assessment in patients with chronic HF. Low adherence to the Mediterranean diet was associated with poorer physical performance and greater frailty. Integrating dietary assessment, detailed anthropometric evaluation and functional measures into routine care may improve HF patient phenotyping, support personalized interventions, prevent functional decline and improve quality of life.Anthropometric measurementsFor image description, please refer to the figure legend and surrounding text.Multidimensional AssessmentFor image description, please refer to the figure legend and surrounding text.