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Nutritional Status and Frailty in Patients with Heart Failure

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Dear Colleagues,

Heart failure (HF) is a growing public health challenge worldwide, strongly associated with poor clinical outcomes and high healthcare costs. Among the many factors influencing disease progression and prognosis in HF, nutritional status and frailty have emerged as key, yet often under-recognized, contributors.

Malnutrition, sarcopenia, cachexia, and obesity are prevalent among patients with HF and are linked to worse quality of life, higher re-hospitalization rates, prolonged hospital stays, increased complications, and mortality. Simultaneously, frailty—a multidimensional syndrome often coexisting with nutritional deficits—further complicates the clinical picture and treatment strategies in this population.

This Special Issue aims to explore the complex interplay between nutritional status, frailty, and clinical outcomes in patients with heart failure. We welcome submissions focusing on both observational and interventional studies, reviews, systematic reviews, and meta-analyses.

Topics of interest include, but are not limited to, the following:

Nutritional assessment tools in HF patients;
Malnutrition, sarcopenia, cachexia, and obesity in HF;
Screening and diagnostic criteria for frailty in cardiovascular settings;
The role of nutrition in preventing or reversing frailty;
Personalized nutrition strategies and dietary interventions in HF;
Impact of nutritional status on hospitalization, complications, and mortality;
Interactions between pharmacotherapy and nutrition in HF;
Long-term outcomes related to nutritional interventions in HF patients.

We look forward to hearing from you.

Dr. Michał Czapla
Dr. Bartosz Uchmanowicz
Guest Editors

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16 pages, 2599 KB

Open AccessArticle

Impact of Nutritional Status on Mortality in Older Patients Hospitalized for Acute Heart Failure

by Tsukasa Murakami, Keisuke Kojima, Masanori Takenoya, Kentaro Jujo, Ryusuke Ae and Masanari Kuwabara

Nutrients 2026, 18(4), 623; https://doi.org/10.3390/nu18040623 - 13 Feb 2026

Cited by 1 | Viewed by 644

Abstract

Backgrounds/Objectives: Advances in prevention and medical care in the field of cardiology have led to an increase in the number of older patients with heart failure. In this population, assessment of nutritional status is particularly important. However, the prognostic impact of severity-based nutritional assessment at admission remains unclear. We conducted a study to elucidate the impact of malnutrition severity at admission on the prognosis of older patients hospitalized for acute heart failure (AHF). Methods: This study investigated the relationship between the Geriatric Nutritional Risk Index (GNRI) at admission and prognosis in 214 older patients aged ≥65 years who were hospitalized for AHF (mean age, 85 ± 8 years; male, 49%) between 2019 and 2023. GNRI was assessed by dividing patients into four groups: GNRI > 98 as normal (n = 64), 92 ≤ GNRI < 98 as mild risk (n = 54), 82 ≤ GNRI < 92 as moderate risk (n = 66), and GNRI < 82 as severe risk (n = 30). The discriminative performance of GNRI for 1-year all-cause mortality was compared with that of the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI). Results: During a median follow-up of 356 days, 76 deaths were observed. Worse GNRI categories were associated with older age, underweight, frailty, and anemia. Multivariable Cox proportional hazards models revealed that moderate GNRI risk (hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.34–5.40) and severe GNRI risk (HR, 9.75; 95% CI, 4.30–22.10) were associated with higher all-cause mortality when compared with normal GNRI, along with age (HR per 1-year increase, 1.07; 95% CI, 1.03–1.11). Sensitivity analysis using GNRI as a continuous variable demonstrated similar results; GNRI was inversely associated with all-cause mortality (HR per 1 GNRI increase, 0.92; 95% CI, 0.90–0.95). In a subgroup analysis of age ≥85 years, the inverse association between GNRI and all-cause mortality was consistent. For 1-year all-cause mortality, GNRI showed moderate discrimination (area under the curve (AUC), 0.71; 95% CI, 0.63–0.80). Although the AUC of GNRI was not significantly different from that of the CONUT score or the PNI, GNRI demonstrated significantly better risk reclassification (net reclassification improvement, 0.47 vs. CONUT, p = 0.05; 0.43 vs. PNI, p = 0.02). Conclusions: In older patients with AHF including the oldest-old, nutritional status assessed by the GNRI at admission was predictive of prognosis. The importance of evaluating nutritional status at admission in clinical settings is reaffirmed. Full article

(This article belongs to the Special Issue Nutritional Status and Frailty in Patients with Heart Failure)

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