Among them are described neurohormonal hyperstimulation, changes in GH and IGF1, decreased testosterone, insulin resistance, vitamin D deficiency, chronic inflammation (with changes in TNF-alpha, C-reactive protein, interleukin 6), increased oxidative stress, mitochondrial dysfunction, malabsorption secondary to edema, anorexia related to HF itself and the medications used to treat it, low protein intake, loss of ions caused by the use of diuretics, polypharmacy, low mobility, sedentary lifestyle and smoking [39,40]. Here, TNF is linked to vitamin D deficiency.