ArticleFrontiers in nutrition2026
Systemic energy metabolism changes in patients with heart failure receiving specific oral nutritional supplements in combination with Mediterranean diet.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Heart failure (HF) is associated with disease-related malnutrition, all of which contribute to impaired functional capacity and adverse outcomes. Nutritional strategies combining Mediterranean diet (MD) patterns with oral nutritional supplements (ONS) have shown clinical and anti-inflammatory benefits in HF. Objectives: To evaluate the impact of MD combined with hypercaloric, hyperproteic, omega-3-enriched ONS vs. MD alone on targeted metabolomic profiles related to energy metabolism, skeletal muscle metabolism, and amino acid handling in patients with HF. Methods: This study is a secondary analysis of a prospective, randomized, open-label clinical trial including patients with chronic HF. Participants were randomized to receive either MD alone or MD plus two hypercaloric, hyperproteic, omega-3-enriched ONS for 24 weeks. Targeted metabolomic profiling was performed using proton nuclear magnetic resonance, assessing glycoproteins, energy metabolism-related metabolites, muscle-related metabolites, and amino acid metabolism-related metabolites. Results: Thirty-eight patients were included, of whom 65.8% presented sarcopenia. Glycoprotein fraction levels significantly decreased over time in the whole cohort, without differences between intervention groups. In energy metabolism-related parameters, glucose and pyruvate significantly decreased in the DM-only group, whereas glycerol levels showed a trend toward increase in the intervention group, reaching statistical significance in patients without sarcopenia. Regarding muscle-related metabolites, leucine levels significantly increased in the intervention group, while isoleucine decreased in the control group ( Conclusions: In patients with HF, nutritional support combining MD with hypercaloric, hyperproteic, omega-3-enriched ONS was associated with distinct metabolomic adaptations, particularly affecting branched-chain amino acid profiles in patients with sarcopenia. These findings suggest a potential role for comprehensive nutritional strategies in modulating systemic and muscle-related metabolic pathways linked to functional status and prognosis in high-risk HF populations.
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