The Effects of Malnutrition on Cardiac Function in African Children

Abstract

Objective: To assess the effect of malnutrition on cardiac function in hospitalized African children. Design: Prospective cross-sectional study. Setting: Public referral hospital in Blantyre, Malawi. Patients: We enrolled 272 stable, hospitalized children ages 6-59 months, with and without WHO-defined severe acute malnutrition. Main outcome measures: Cardiac index, heart rate, mean arterial pressure, stroke volume index, and systemic vascular resistance index were measured by the Ultrasound Cardiac Output Monitor (USCOM, Ltd, NSW, Australia). We used linear regression with generalized estimating equations controlling for age, sex, and anemia. Results: Our primary outcome, cardiac index, was similar between those with and without severe malnutrition: β=0.17 L/min/m2, (95% CI: -0.17, 0.51 L/min/m2). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: β =-8.6 mm Hg (95% CI: -12.7, -4.6 mm Hg) and β =-200 dyne s/cm5/m2 (95% CI: -320, -80 dyne s/cm5/m2), respectively. Conclusions: In this largest study to date of cardiac function in malnourished children we found that that cardiac function is preserved in stable, hospitalized subjects. Lower mean arterial pressure and systemic vascular resistance index may indicate that these children are in a hypermetabolic state due to early effects of refeeding. Further study is needed to determine if cardiac function is diminished in unstable malnourished children.