Longitudinal Changes in Left Ventricular Structure and Function During a Dietary Weight-Management Trial in Adults with Heart Failure, Type 2 Diabetes, and Obesity: A Secondary Analysis of Pro-HEART.
LVEDD decreased significantly over 15 months in adults with heart failure, type 2 diabetes, and obesity undergoing hypocaloric dietary intervention, while LVEF did not change significantly over time, though an exploratory contrast suggested a possible increase.
Key Findings
Results
Left ventricular end-diastolic dimension (LVEDD) decreased significantly over the 15-month study period.
Overall time effect was statistically significant: F(2, 51.20) = 7.45, p = 0.001
Model-estimated mean LVEDD decreased from 59.00 mm at baseline to 54.56 mm at 15 months
LVEDD decreased from baseline to 15 months by -4.44 mm (95% CI, -6.86 to -2.02; nominal p < 0.001; Holm-adjusted p = 0.002)
LVEDD also decreased from 3 to 15 months by -4.42 mm (95% CI, -7.52 to -1.33; nominal p = 0.006; Holm-adjusted p = 0.012)
LVEDD data at 15 months were available for 31 of 92 participants (33.7%), limiting the longitudinal sample
Results
Left ventricular ejection fraction (LVEF) did not change significantly over time across the study period.
Overall time effect for LVEF was not statistically significant (overall p = 0.074)
An exploratory baseline-to-15-month contrast showed +4.11 percentage points (95% CI, 0.55 to 7.67; Holm-adjusted p = 0.072)
The Holm-adjusted p-value for the exploratory contrast did not meet the threshold for statistical significance
Authors characterized the baseline-to-15-month LVEF contrast as exploratory rather than a primary finding
Results
Left ventricular posterior wall thickness (LVPWT) did not change significantly over the study period.
No significant time effect was observed for LVPWT
LVPWT was assessed at baseline, 3 months, and 15 months using linear mixed-effects models
Results were reported alongside LVEDD and LVEF as part of the longitudinal cardiac structural and functional assessment
Results
No significant diet group by time interaction was observed for any cardiac outcome measure.
Participants were randomized to high-protein or standard-protein hypocaloric diets
Achieved protein intake was similar between randomized groups
No diet group × time interactions were observed for LVEDD, LVEF, or LVPWT
The absence of interaction effects means neither diet type showed differential effects on cardiac remodeling outcomes
Methods
The study sample consisted of 92 adults with concurrent heart failure, type 2 diabetes, and obesity, assessed at baseline, 3 months, and 15 months.
Total randomized sample: 92 participants
Participants had all three conditions: heart failure, type 2 diabetes, and obesity
Linear mixed-effects models were used to test time and diet effects on cardiac outcomes
Longitudinal HF medication data were unavailable, representing a key limitation
There was no non-dietary control group, as both arms received hypocaloric diets
Conclusions
The observed cardiac changes cannot be specifically attributed to weight loss or the dietary intervention due to study design limitations.
Both randomized groups received hypocaloric diets, eliminating a non-dietary control condition
Longitudinal heart failure medication data were unavailable, making it impossible to rule out medication-related changes
High attrition in cardiac imaging data (only 33.7% had LVEDD data at 15 months) is a notable limitation
Authors explicitly state that changes 'cannot be attributed specifically to weight loss or the dietary intervention'
What This Means
This research examined how the heart's structure and pumping function changed over 15 months in people who had heart failure, type 2 diabetes, and obesity and were following a calorie-restricted diet. The study found that one key measure of heart size — the left ventricular end-diastolic dimension (LVEDD), which reflects how enlarged the heart's main pumping chamber is — decreased meaningfully over time, dropping by about 4.4 millimeters on average. This suggests the heart may have become less dilated, which could be a favorable structural change. The heart's pumping efficiency (ejection fraction) did not change in a statistically significant way overall, though an exploratory analysis hinted at a possible improvement.
The study also compared two types of calorie-restricted diets — one higher in protein and one with standard protein levels — but found no meaningful difference between the two diets in terms of cardiac outcomes. Both groups also ended up consuming similar amounts of protein despite their different diet assignments. The study had important limitations: there was no group of participants who did not follow a dietary intervention, medication records over the study period were not available, and many participants did not have complete heart imaging data at all time points (only about one-third had data at 15 months).
This research suggests that adults with heart failure, obesity, and type 2 diabetes who follow a calorie-restricted diet over more than a year may experience a reduction in heart chamber size, which is generally considered a positive sign of cardiac remodeling. However, because of the study design limitations, it is not possible to determine whether these changes were caused by the diet itself, weight loss, changes in heart failure medications, or other factors occurring over the same period.
Evangelista L, Meraz R, Angosta A, Nguyen A, Wierenga K, Kawi J, et al.. (2026). Longitudinal Changes in Left Ventricular Structure and Function During a Dietary Weight-Management Trial in Adults with Heart Failure, Type 2 Diabetes, and Obesity: A Secondary Analysis of Pro-HEART.. Nutrients. https://doi.org/10.3390/nu18193238