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Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition

(2014) HYPERTENSION. 64(3). p.664-671
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Abstract
Malnutrition below 5 years remains a global health issue. Severe acute malnutrition (SAM) presents in childhood as oedematous (kwashiorkor) or nonoedematous (marasmic) forms, with unknown long-term cardiovascular consequences. We hypothesized that cardiovascular structure and function would be poorer in SAM survivors than unexposed controls. We studied 116 adult SAM survivors, 54 after marasmus, 62 kwashiorkor, and 45 age/sex/body mass index-matched community controls who had standardized anthropometry, blood pressure, echocardiography, and arterial tonometry performed. Left ventricular indices and outflow tract diameter, carotid parameters, and pulse wave velocity were measured, with systemic vascular resistance calculated. All were expressed as SD scores. Mean (SD) age was 28.8 +/- 7.8 years (55% men). Adjusting for age, sex, height, and weight, SAM survivors had mean (SE) reductions for left ventricular outflow tract diameter of 0.67 (0.16; P<0.001), stroke volume 0.44 (0.17; P=0.009), cardiac output 0.5 (0.16; P=0.001), and pulse wave velocity 0.32 (0.15; P=0.03) compared with controls but higher diastolic blood pressures (by 4.3; 1.2-7.3 mm Hg; P=0.007). Systemic vascular resistance was higher in marasmus and kwashiorkor survivors (30.2 [1.2] and 30.8 [1.1], respectively) than controls 25.3 (0.8), overall difference 5.5 (95% confidence interval, 2.8-8.4 mm Hg min/L; P<0.0001). No evidence of large vessel or cardiac remodeling was found, except closer relationships between these indices in former marasmic survivors. Other parameters did not differ between SAM survivor groups. We conclude that adult SAM survivors had smaller outflow tracts and cardiac output when compared with controls, yet markedly elevated peripheral resistance. Malnutrition survivors are thus likely to develop excess hypertension in later life, especially when exposed to obesity.
Keywords
KINETIC DIFFERENCES, AORTIC STIFFNESS, ARTERIAL STIFFNESS, kwashiorkor, blood supply, protein-energy malnutrition, MIDDLE-AGED MEN, PULSE-WAVE VELOCITY, HYPERTENSIVE PATIENTS, BLOOD-PRESSURE, CHILD UNDERNUTRITION, DEVELOPMENTAL PLASTICITY, BIRTH-WEIGHT

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Chicago
Tennant, Ingrid A, Alan T Barnett, Debbie S Thompson, Jan Kips, Michael S Boyne, Edward E Chung, Andrene P Chung, et al. 2014. “Impaired Cardiovascular Structure and Function in Adult Survivors of Severe Acute Malnutrition.” Hypertension 64 (3): 664–671.
APA
Tennant, I. A., Barnett, A. T., Thompson, D. S., Kips, J., Boyne, M. S., Chung, E. E., Chung, A. P., et al. (2014). Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition. HYPERTENSION, 64(3), 664–671.
Vancouver
1.
Tennant IA, Barnett AT, Thompson DS, Kips J, Boyne MS, Chung EE, et al. Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition. HYPERTENSION. 2014;64(3):664–71.
MLA
Tennant, Ingrid A, Alan T Barnett, Debbie S Thompson, et al. “Impaired Cardiovascular Structure and Function in Adult Survivors of Severe Acute Malnutrition.” HYPERTENSION 64.3 (2014): 664–671. Print.
@article{5800615,
  abstract     = {Malnutrition below 5 years remains a global health issue. Severe acute malnutrition (SAM) presents in childhood as oedematous (kwashiorkor) or nonoedematous (marasmic) forms, with unknown long-term cardiovascular consequences. We hypothesized that cardiovascular structure and function would be poorer in SAM survivors than unexposed controls. We studied 116 adult SAM survivors, 54 after marasmus, 62 kwashiorkor, and 45 age/sex/body mass index-matched community controls who had standardized anthropometry, blood pressure, echocardiography, and arterial tonometry performed. Left ventricular indices and outflow tract diameter, carotid parameters, and pulse wave velocity were measured, with systemic vascular resistance calculated. All were expressed as SD scores. Mean (SD) age was 28.8 +/- 7.8 years (55% men). Adjusting for age, sex, height, and weight, SAM survivors had mean (SE) reductions for left ventricular outflow tract diameter of 0.67 (0.16; P<0.001), stroke volume 0.44 (0.17; P=0.009), cardiac output 0.5 (0.16; P=0.001), and pulse wave velocity 0.32 (0.15; P=0.03) compared with controls but higher diastolic blood pressures (by 4.3; 1.2-7.3 mm Hg; P=0.007). Systemic vascular resistance was higher in marasmus and kwashiorkor survivors (30.2 [1.2] and 30.8 [1.1], respectively) than controls 25.3 (0.8), overall difference 5.5 (95% confidence interval, 2.8-8.4 mm Hg min/L; P<0.0001). No evidence of large vessel or cardiac remodeling was found, except closer relationships between these indices in former marasmic survivors. Other parameters did not differ between SAM survivor groups. We conclude that adult SAM survivors had smaller outflow tracts and cardiac output when compared with controls, yet markedly elevated peripheral resistance. Malnutrition survivors are thus likely to develop excess hypertension in later life, especially when exposed to obesity.},
  author       = {Tennant, Ingrid A and Barnett, Alan T and Thompson, Debbie S and Kips, Jan and Boyne, Michael S and Chung, Edward E and Chung, Andrene P and Osmond, Clive and Hanson, Mark A and Gluckman, Peter D and Segers, Patrick and Cruickshank, J Kennedy and Forrester, Terrence E},
  issn         = {0194-911X},
  journal      = {HYPERTENSION},
  keywords     = {KINETIC DIFFERENCES,AORTIC STIFFNESS,ARTERIAL STIFFNESS,kwashiorkor,blood supply,protein-energy malnutrition,MIDDLE-AGED MEN,PULSE-WAVE VELOCITY,HYPERTENSIVE PATIENTS,BLOOD-PRESSURE,CHILD UNDERNUTRITION,DEVELOPMENTAL PLASTICITY,BIRTH-WEIGHT},
  language     = {eng},
  number       = {3},
  pages        = {664--671},
  title        = {Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition},
  url          = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.114.03230},
  volume       = {64},
  year         = {2014},
}

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