Dietary Intervention Pilot studies have assessed the safety and feasibility of dietary intervention to achieve weight loss in HF. Evan- gelista et al239 randomized 14 symptomatic patients with HFrEF (NYHA class II III) with type 2 diabetes mel- litus and BMI 27 kg/m2 to 12 weeks of a high-protein diet, standard-protein diet, or control. Although patients in both intervention groups achieved weight loss, more weight loss with greater decreases in waist circumfer- ence and percentage body fat was seen with the high- Furthermore, there was a significant improvement in HF symptoms and QOL associated with weight loss. There was, however, no change in cardiac structure or function.226,239 Recently, Pritchett et al240 studied 20 obese patients with HFrEF randomized for 3 months to standard therapy (control) versus lifestyle modification, including a portion-controlled diet with meal replacements and an unsupervised walking program. In this study, the intervention group did not have weight loss, and there was no significant difference between the intervention and control groups in terms of metabolic, biomarker, or functional parameters.227,240 In both stud- ies, the intervention groups had a mean BMI >35 kg/m2 . Neither study reported adverse events, however, sug- gesting that monitored, healthy dietary intervention pro- grams aiming to achieve weight loss are safe in obese patients with HF. These small studies highlight the need to further investigate the effects of various dietary com- positions on body composition, metabolic risk factors, and long-term outcomes in patients with HF. 