What are the outcomes of dietary interventions in HFpEF? A systematic review and meta-analysis.

AIM
To determine the efficacy of dietary interventions in Heart Failure with preserved Ejection Fraction (HFpEF).


METHOD AND RESULTS
Key word searches were performed in five bibliographic databases to identify randomised or controlled studies of dietary interventions conducted in HFpEF or mixed heart failure (HF) samples published in the English language. Studies were appraised for bias and synthesised into seven categories based on similarity of the intervention or targeted population. The quality of the body of evidence was assessed via the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework.Twenty-five unique interventions were identified; seventeen were considered for meta-analysis. Most studies were judged to be at high risk of bias. There was moderate quality evidence that caloric restriction led to clinically meaningful improvements in blood pressure and body weight. There was moderate quality evidence carbohydrate restriction resulted in meaningful reductions in blood pressure. There was very low quality evidence protein supplementation improved blood pressure and body weight and moderate quality evidence for clinically meaningful improvements in function.


CONCLUSIONS
Whilst some types of dietary interventions appeared to deliver clinically meaningful change in critical outcomes; the study heterogeneity and overall quality of the evidence makes it difficult to make firm recommendations. Greater transparency when reporting nutritional composition of interventions would enhance ability to pool studies.