Impact of a structured outpatient nutritional intervention on nutritional status and quality of life in elderly patients with chronic heart failure: results from the BOCADOS-IC Trial
A Esteban Fernandez, J A Perez-Rivera, J L Bonilla-Palomas, P Diez-Villanueva, C Jimenez-Mendez, R Ayala-Munoz, J C Lopez-Azor, C Robles-Gamboa, M Rodriguez-Santamarta, A Ayesta-Lopez, C Ortiz-Cortes, J Goirigolzarri-Artaza, M Taibo-Uria, E Enriquez-RodriguezAbstract
Background
Malnutrition and risk of malnutrition are highly prevalent among older patients with chronic heart failure (HF) and are associated with worse functional status, increased hospitalizations, and higher mortality. Although nutritional interventions have demonstrated benefits during hospitalization, evidence supporting structured outpatient nutritional strategies remains scarce.
Aim
To evaluate the impact of a structured outpatient nutritional intervention on nutritional status, body composition, and quality of life in elderly patients with chronic heart failure and malnutrition or risk of malnutrition.
Methods
BOCADOS-HF is a prospective clinical trial including ambulatory patients aged ≥65 years with chronic HF and malnutrition (MNA-SF <7) or risk of malnutrition (MNA-SF 7–11). Patients were allocated to a control group receiving usual care or to an intervention group receiving a structured nutritional program. Changes from baseline to 6 months were assessed in nutritional indices (MNA, PNI, GNRI, CONUT), anthropometric parameters, laboratory markers, and quality of life using the Minnesota Living With Heart Failure Questionnaire (MLHFQ). Results are expressed as mean change and standard deviation.
Results
A total of 160 patients were analyzed. Compared with the control group, the intervention group showed a significantly greater improvement in overall nutritional status (Table 1, figure 1) as assessed by the MNA score (+4.99 ± 2.56 vs +3.65 ± 3.04 points; p=0.003). Patients in the intervention group experienced an increase in body mass index (+0.41 ± 1.47 vs −0.26 ± 2.44 kg/m²; p=0.034) and mid-arm muscle circumference (+0.86 ± 4.85 vs −1.38 ± 4.39 cm; p=0.006), indicating preservation of muscle mass. Quality of life improved significantly in the intervention group, with a greater reduction in MLHFQ score (−7.95 ± 15.71 vs −2.44 ± 13.11 points; p=0.028). No significant differences were observed between groups in laboratory nutritional markers or NT-proBNP levels.
Conclusions
In elderly outpatients with chronic HF and malnutrition or risk of malnutrition, a structured nutritional intervention was associated with significant improvements in nutritional status, body composition, and quality of life over 6 months. These findings support the integration of systematic nutritional assessment and intervention into the routine outpatient management of HF.Table 1For image description, please refer to the figure legend and surrounding text.Figure 1For image description, please refer to the figure legend and surrounding text.