Body Composition and Survival in Patients With Heart Failure: A Systematic Review and Meta-Analysis.

Andreia Biolo, Gabriela C Souza, Dimitris V Rados, Dayana D Mendonça, William V R da Silva

Journal: JACC. Heart failure 2025;13(6):943-954

PMID: 40178471

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Body composition is increasingly recognized as an important factor in the prognosis of patients with heart failure (HF). Variations in muscle mass, fat-free mass, and fat mass may influence survival outcomes, but the extent of these associations remains unclear.

OBJECTIVES

This study aims to evaluate the impact of body composition parameters on survival in patients with HF.

METHODS

Five databases were searched through January 2024. Eligible papers reported associations between body composition parameters and survival in HF patients. All-cause mortality was the primary outcome. Risk of bias was evaluated using the Newcastle-Ottawa scale. A random-effects model was used to calculate the 95% CI and HR, with heterogeneity assessed using Cochran's Q and I tests.

RESULTS

The analysis included 39 cohort studies involving 36,176 HF patients, with 21 studies included in the quantitative analysis. Low muscle mass (HR: 1.73 [95% CI: 1.32-2.26]; I = 47%) (7 studies) was significantly associated with increased all-cause mortality risk. The prognostic significance of low muscle mass remained consistent across sensitivity and subgroup analysis. Elevated fat mass was not associated with a risk of death (pooled adjusted HR: 0.75 [95% CI: 0.26-2.12]; I = 77%). Higher abdominal fat showed no significant mortality association.

CONCLUSIONS

The authors found a strong association between body composition parameters and all-cause mortality. Muscular wasting, measured by low muscle mass, was associated with increased mortality, strengthening the role of muscle mass in HF prognosis. In contrast, higher fat mass and abdominal adiposity showed no association. These findings underscore the importance of comprehensive body composition evaluation in HF prognosis. (Association of Body Composition with Overall Survival in Patients with Heart Failure: A Systematic Review and Meta-Analysis; CRD42023488040).

Address: Post-Graduate Program in Cardiology and Cardiovascular Sciences of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: [email protected].; Medicine School of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Post-Graduate Program in Cardiology and Cardiovascular Sciences of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Nutrition in the Medicine School of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.; Medicine School of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Post-Graduate Program in Cardiology and Cardiovascular Sciences of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Medicine School of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine of the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

DOI: 10.1016/j.jchf.2025.01.016