Medically tailored meals in heart failure: a systematic review of the literature 2013-2023

Background: Dietary interventions have potential to improve symptoms and outcomes in patients with heart failure (HF), but there are barriers to eating nutrient-dense diets. One strategy to address challenges is to provide medically-tailored meals (MTMs), fully-prepared meals that align with an individual's nutritional needs. In this systemic review, we examined clinical outcomes of studies that provided MTMs to patients with HF.

Methods and results: We searched CINAH, EBSCO/MEDLINE, EMBASE, PUBMED and the Cochrane Central Register of Controlled Trials to identify MTM interventions published between 2013 and 2023. We included six studies. Five studies involved sodium-restriction. Four of these were randomized control trials and one was a matched cohort study. Sample sizes ranged from 31 to 641. Patient populations included individuals who had heart failure, acute decompensated heart failure and heart failure with preserved ejection fraction. One study involved energy-restriction in patients with heart failure with preserved ejection fraction and obesity. This was a randomized control study and had a sample size of 100. Sodium-restriction interventions, when aligned with Dietary Approaches to Stop Hypertension goals, reduced 90-day HF readmissions in one study and trended towards improving 30-day and 12-week HF readmissions in another. The energy-restriction intervention reduced diastolic blood pressure, weight and inflammatory biomarkers, and improved quality of life (QoL) and cardiorespiratory fitness. Neither intervention had an impact on mortality.

Conclusions: Provision of sodium-restricted MTMs to HF patients may reduce the risk of rehospitalization. Provision of energy-restricted MTMs to HF patients with obesity can improve symptoms, weight loss, QoL and cardiorespiratory fitness. Adequately powered randomized controlled trials are needed to confirm these effects and investigate underlying mechanisms.