ABSTRACT Cardiovascular disease (CVD) is related to many risk factors like unhealthy dietary pattern and physical inactivity. Dietary modification has been involved in managing and reducing the risk of CVD. The current study aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in a random sample of 54 individuals aged between 30-60 years enrolled from the outpatient cardiology clinic in Ain Shams University hospital. Study participants were classified into five groups according to heart disease status (normal control, metabolic syndrome, risk factor, compensated CVD, decompensated CVD). A standardized 24-four-hour questionnaire was used to determine dietary intake. Anthropometric measurements, biochemical analysis and echocardiography examination were done for all study subjects. Overall and central obesity was highly prevalent among the metabolic syndrome, risk factor and decompensated CVD groups compared to the other groups. We found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome. Therefore, increasing public awareness of healthy lifestyle and dietary patterns to enhance the prevention of CVD and associated risk factors.