Racial and Ethnic Differences in Dietary Intake and Metabolic Profiles Among Adults with Heart Failure, Type 2 Diabetes, and Overweight or Obesity: A Secondary Analysis of the Pro-HEART Trial

Background: Racial and ethnic disparities in heart failure (HF) outcomes are well documented, but little is known about dietary intake and metabolic profiles among individuals with chronic HF and overweight or obesity. This exploratory secondary analysis of baseline data from the Pro-HEART randomized trial compared dietary intake and laboratory biomarkers across racial and ethnic groups. Methods: This secondary analysis used baseline data from the Pro-HEART randomized clinical trial (ClinicalTrials.gov identifier: NCT01423266). Baseline data from 92 adults with chronic HF, type 2 diabetes mellitus (DM), and overweight or obesity were analyzed. Participants self-identified as White (n = 49), Asian/Other (n = 17), Hispanic (n = 14), or Black (n = 12). Dietary intake was assessed using 3-day food records, which were analyzed with the Nutrition Data System for Research. Selected biomarkers included lipid measures, fasting glucose, hemoglobin A1c, albumin, total protein, and creatinine. Group differences were evaluated using one-way analysis of variance and chi-square or Fisher’s exact tests, as appropriate. Because multiple outcomes were examined without a prespecified primary endpoint, p-values were not adjusted for multiplicity and are reported as descriptive. Results: Participants had a mean age of 58.5 ± 9.7 years, were predominantly male (69.6%), married (64.0%), and had New York Heart Association Class II HF (75.0%). Mean age differed across groups (omnibus p = 0.046); no pairwise contrast remained significant after Bonferroni adjustment. No statistically significant between-group differences were identified in the available data for body mass index, waist circumference, left ventricular ejection fraction, dietary intake, or laboratory biomarkers (all p > 0.05); however, the small subgroup sizes and substantial missing dietary data limited the precision of these comparisons. Conclusions: In this exploratory cohort of adults with chronic HF, type 2 DM, and overweight or obesity, no statistically significant racial or ethnic differences were identified in the dietary and laboratory measures examined. However, the small subgroup sizes and substantial missing dietary data limit the precision of these findings, and smaller or clinically meaningful differences cannot be excluded. Larger studies with more complete dietary data are needed to better characterize potential racial and ethnic differences in nutrition and metabolic health in this population.