Congestive heart failure (CHF) is often associated with undernutrition. Although loss of lean tissue may be detrimental to the host, a protective effect is conveyed as cardiac demands are reduced by lower whole-body oxygen consumption (VO2) and circulating fluid volume. The aim of this study was to determine if continuous nasoenteric feeding could promote an anabolic state with increments in lean tissue in moderate-severe CHF patients without adversely effecting cardiac performance. Undernourished CHF patients on a metabolic ward were fed a formula diet infused intragastrically for 2 wk. The energy infusion rate was maintained at 1.4-1.8 X measured resting metabolic rate. During the infusion period, body weight, elemental balances, VO2, and cardiac function (echocardiography) were monitored. Results showed a loss in weight and extracellular fluid, gain in lean body mass (eg, + delta N and delta K), unaltered VO2, and unchanged cardiac function. Cardiac cachexia is therefore safely and effectively manageable by maintenance or repletional levels of nasoenteric feeding.