EAL

Recommendations Summary

Search Plan and Results

Evidence Analysis Question(s)

In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the relationship between protein intake and nitrogen balance?

In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the relationship between protein intake and nitrogen balance?

Date of Literature Review

August 2014

Inclusion Criteria

Age

All adults (19 and over).

Setting

All settings.

Health Status

Ejection fraction was less than or equal to 45%.

Nutrition-related Problem or Condition

Edema

Fatigue

Shortness of breath

Limited activities

Cachexia

Catabolism.

Study Design Preferences

RCT or clinical controlled trials

Meta-analysis

Cohort studies, retrospective or prospective

At least four weeks or one month in duration.

Size of Study Groups

N was more than 10 in each arm.

Study Dropout Rate

Less than 20%.

Year Range

Range from 2000 to July 2014.

Authorship

If an author is included on more than one primary research article that is similar in content, the most recent article will be accepted and earlier versions will be rejected

If an author is included on more than one primary research article and the content is different, then both articles may be accepted.

Language

Limited to articles in English.

Exclusion Criteria

Age

Children less than 19 years.

Health Status

Ejection fraction higher than 45%

Preserved ejection fraction.

Nutrition-related Problem or Condition

If study was not determining calorie or protein needs.

Study Design Preferences

Review papers (all kinds), and commentaries, case reports

Shorter than four weeks or one month in duration.

Size of Study Groups

Less than 10 individuals in each arm.

Study Dropout Rate

More than 20%.

Year Range

Prior to 2000.

Language

Non-English.

Search Terms: Search Vocabulary

Health Condition (Population of Patients)

Advanced heart failure

Clinically stable

Chronic heart failure

Heart failure

Congestive heart failure

Cardiomyopathy

Postpartum cardiomyopathy

Renal insufficiency

Reduced ejection fraction (HFrEF)

Obesity (paradox)

Overweight

Cachexia

Hypermetabolic.

Intervention

Diet

Nutrition

Protein intake

Dietary proteins.

Outcomes

Anthropometric

Lean body mass (LBM)

Body composition

Weight gain

Undernutrition or malnutrition

Edema.

Anabolism

N-balance

BUN

Creatinine

Uric acid.

Catabolism

IL-6

TNF-alpha

IL-10

CRP.

Activities of daily living

Quality of life

Nutrition support or supplements

Re-admissions

Length of stay

Cardiopulmonary function text (CPX)

Early satiety

Morbidity

Mortality

Functional

Grip strength

Physical activity (six-minute walk).

Cardiorenal syndrome.

Study Design

RCT

Clinical controlled trial

Meta-analysis

Cohort (prospective or retrospective)

A least four weeks or one month in duration.

Limits To Be Applied at the Start of a Search

RCT

Clinical controlled trial

Meta-analysis

Cohort (prospective or retrospective)

Publication range: January 1, 2000 to August, 2014

Humans

Age: 19 years or more

Language: English.

Electronic Databases

Results of Protein Search

Date of Search: 10/28/2014

Database

Search Terms

Hits

Abstracts to Rev

PubMed

("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

91

1

(advanced[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

4

0

(clinically[All Fields] AND stable[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

1

1

(chronic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

32

2

("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields] OR ("congestive"[All Fields] AND "heart"[All Fields] AND "failure"[All Fields]) OR "congestive heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

91

2

("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

10

0

(("postpartum period"[MeSH Terms] OR ("postpartum"[All Fields] AND "period"[All Fields]) OR "postpartum period"[All Fields] OR "postpartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

0

(("peripartum period"[MeSH Terms] OR ("peripartum"[All Fields] AND "period"[All Fields]) OR "peripartum period"[All Fields] OR "peripartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

0

("renal insufficiency"[MeSH Terms] OR ("renal"[All Fields] AND "insufficiency"[All Fields]) OR "renal insufficiency"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

10

0

("obesity"[MeSH Terms] OR "obesity"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

9

0

("overweight"[MeSH Terms] OR "overweight"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

4

0

("cachexia"[MeSH Terms] OR "cachexia"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

2

0

hypermetabolic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

0

("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

9

2

Motie M[Author]

19

0

Evangelista LS[Author]

79

0

(advanced[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

1

0

(clinically[All Fields] AND stable[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

1

1

(chronic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

4

2

("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields] OR ("congestive"[All Fields] AND "heart"[All Fields] AND "failure"[All Fields]) OR "congestive heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

9

4

("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

3

0

(("postpartum period"[MeSH Terms] OR ("postpartum"[All Fields] AND "period"[All Fields]) OR "postpartum period"[All Fields] OR "postpartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

0

(("peripartum period"[MeSH Terms] OR ("peripartum"[All Fields] AND "period"[All Fields]) OR "peripartum period"[All Fields] OR "peripartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

0

("obesity"[MeSH Terms] OR "obesity"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

2

0

("overweight"[MeSH Terms] OR "overweight"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

2

0

("cachexia"[MeSH Terms] OR "cachexia"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

0

hypermetabolic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])

0

Cochrane

Heart failure and protein intake

18 trials

2

Congestive heart failure and protein intake

2 trials

0

Chronic heart failure and protein intake

2

0

Heart failure and dietary proteins

19

1

Chronic heart failure and dietary proteins

5

1

Congestive heart failure and dietary proteins

4

0

Database	Search Terms	Hits	Abstracts to Rev
PubMed	("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	91	1
	(advanced[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	4	0
	(clinically[All Fields] AND stable[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	1	1
	(chronic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	32	2
	("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields] OR ("congestive"[All Fields] AND "heart"[All Fields] AND "failure"[All Fields]) OR "congestive heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	91	2
	("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	10	0
	(("postpartum period"[MeSH Terms] OR ("postpartum"[All Fields] AND "period"[All Fields]) OR "postpartum period"[All Fields] OR "postpartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	0
	(("peripartum period"[MeSH Terms] OR ("peripartum"[All Fields] AND "period"[All Fields]) OR "peripartum period"[All Fields] OR "peripartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	0
	("renal insufficiency"[MeSH Terms] OR ("renal"[All Fields] AND "insufficiency"[All Fields]) OR "renal insufficiency"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	10	0
	("obesity"[MeSH Terms] OR "obesity"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	9	0
	("overweight"[MeSH Terms] OR "overweight"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	4	0
	("cachexia"[MeSH Terms] OR "cachexia"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	2	0
	hypermetabolic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND (("proteins"[MeSH Terms] OR "proteins"[All Fields] OR "protein"[All Fields]) AND intake[All Fields]) AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	0
	("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	9	2
	Motie M[Author]	19	0
	Evangelista LS[Author]	79	0
	(advanced[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	1	0
	(clinically[All Fields] AND stable[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	1	1
	(chronic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	4	2
	("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields] OR ("congestive"[All Fields] AND "heart"[All Fields] AND "failure"[All Fields]) OR "congestive heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	9	4
	("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	3	0
	(("postpartum period"[MeSH Terms] OR ("postpartum"[All Fields] AND "period"[All Fields]) OR "postpartum period"[All Fields] OR "postpartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	0
	(("peripartum period"[MeSH Terms] OR ("peripartum"[All Fields] AND "period"[All Fields]) OR "peripartum period"[All Fields] OR "peripartum"[All Fields]) AND ("cardiomyopathies"[MeSH Terms] OR "cardiomyopathies"[All Fields] OR "cardiomyopathy"[All Fields])) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	0
	("obesity"[MeSH Terms] OR "obesity"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	2	0
	("overweight"[MeSH Terms] OR "overweight"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	2	0
	("cachexia"[MeSH Terms] OR "cachexia"[All Fields]) AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	0
	hypermetabolic[All Fields] AND ("heart failure"[MeSH Terms] OR ("heart"[All Fields] AND "failure"[All Fields]) OR "heart failure"[All Fields]) AND "dietary proteins"[All Fields] AND (("2000/01/01"[PDAT] : "2014/08/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang] AND "adult"[MeSH Terms])	0
Cochrane	Heart failure and protein intake	18 trials	2
	Congestive heart failure and protein intake	2 trials	0
	Chronic heart failure and protein intake	2	0
	Heart failure and dietary proteins	19	1
	Chronic heart failure and dietary proteins	5	1
	Congestive heart failure and dietary proteins	4	0

List of Included Articles

Aquilani R, Opasich C, Gualco A, Verri M, Testa A, Pasini E, Viglio S, Iadarola P, Pastoris O, Dossena M, Boschi F. Adequate energy-protein intake is not enough to improve nutritional and metabolic status in muscle-depleted patients with chronic heart failure. Eur J Heart Fail. 2008; 10(11): 1127-1135.

Included Articles 2008

Aquilani R, Opasich C, Verri M, Boschi F, Febo O, Pasini E, Pastoris O. Is nutritional intake adequate in chronic heart failure patients? J Am Coll Cardiol. 2003, 42 (7): 1, 218-1, 223.

Articles Considered, but Excluded

List of Excluded Articles with Reason

Reference	Reason Excluded
Aquilani R, Viglio S, Iadarola P, Opasich C, Testa A, Dioguardi FS, Pasini E. Oral amino acid supplements improve exercise capabilities in elderly patients with chronic heart failure. Am J Cardiol. 2008; 101(11A): 104E-110E.	Actual protein intake was not reported.
Castillo-Martinez L, Orea Tejeda A, Rosales MT, Ramirez EC, Gonzalez VR, Lafuente EA, Moguel JO, Garcia JD. Anthropometric variables and physical activity as predictors of cardiac cachexia. Int J Cardiol. 2005; 99(2): 239-245.	Protein intake was reported as a percentage of energy; actual protein intake was not reported.
Catapano G, Pedone C, Nunziata E, Zizzo A, Passantino A, Incalzi RA. Nutrient intake and serum cytokine pattern in elderly people with heart failure. Eur J Heart Fail. 2008; 10(4): 428-434.	Nitrogen balance was not measured.
Evangelista LS, Heber D, Li Z, Bowerman S, Hamilton MA, Fonarow GC. Reduced body weight and adiposity with a high-protein diet improves functional status, lipid profiles, glycemic control, and quality of life in patients with heart failure: a feasibility study. J Cardiovasc Nurs. 2009; 24(3): 207-215.	Study population size does not meet minimum.
Frangiosa A, De Santo LS, Saviano C, Anastasio P, Cotrufo M, Capasso G, Adrogue HJ, De Santo NG. The effect of oral protein loading on renal acidification in patients with heart failure. J Nephrol. 2005; 18(3): 294-302.	Study does not answer any evidence analysis questions.
Motie M, Evangelista LS, Horwich T, Hamilton M, Lombardo D, Cooper DM, Galassetti PR, Fonarow GC. Pro-HEART; a randomized clinical trial to test the effectiveness of a high protein diet targeting obese individuals with heart failure: rationale, design and baseline characteristics. Contemp Clin Trials. 2013; 36(2): 371-381.	Study includes HF patients with preserved EF.
Rozentryt P, von Haehling S, Lainscak M, Nowak JU, Kalantar-Zadeh K, Polonski L, Anker SD. The effects of a high-caloric protein-rich oral nutritional supplement in patients with chronic heart failure and cachexia on quality of life, body composition, and inflammation markers: a randomized, double-blind pilot study. J Cachexia Sarcopenia Muscle. 2010; 1(1): 35-42.	Placebo arm only had six subjects.

Excluded Articles 2008

Reference	Reason Excluded
Pasini E, Opasich C, Pastoris O, Aquilani R. Inadequate nutritional intake for daily life activity of clinically stable patients with chronic heart failure, Am J Cardiol. 2004, 93 (Suppl): 41A-43A.	EF of study population was not given.

Search Methods and Results

Identification

Articles Identified Through Database Searching: 432
Additional Articles Identified Through Other Sources: 2

Screening

Articles Screened After Removing Duplicates: 416
Articles Excluded During the Screening Process: 398

Eligibility

Full-text Articles Assessed for Eligibility: 10
Full-text Articles Excluded: 8

Included

Articles Included in Qualitative Synthesis: 2
Articles Included in Quantitative Synthesis (Meta-analysis): 0