Abstract
BackgroundMalnourished children endure many changes in body composition and lose heart and skeletal muscle mass. Diastolic dysfunction is one of the major causes of heart failure with preserved ejection fraction.AimTo assess left ventricular systolic and diastolic functions in children with severe acute malnutrition using tissue Doppler imaging technique and to evaluate the effect of nutritional rehabilitation.Patients and MethodsA follow-up case-control study conducted on 60 severely malnourished children (WHZ < -3SD) and 120 age and sex-matched healthy children as a control group. Tissue Doppler imaging (TDI) was done for all included malnourished children at admission and for control to measure left ventricular systolic and diastolic functions. Nutritional rehabilitation was done according to WHO protocol and tissue doppler was repeated after rehabilitation when (WHZ > -2SD) to detect any changes in systolic or diastolic functions.ResultsSystolic function was normal in malnourished children and control. Grade I diastolic dysfunction was detected in 40% and grade II in 30% of severely malnourished children in comparison to 100% normal diastolic function in control group. No correlations between diastolic dysfunction and either anthropometric measurements, electrolyte disturbances or Hb% in malnourished children before nutritional rehabilitation. Mortality from sepsis with associated ventricular dysfunction grade II documented in 3.3% of malnourished children. After nutritional rehabilitation diastolic function improved significantly as 65.6% of children attained normal diastolic function, 31% grade1 and 3.4% grade II. Positive correlations between diastolic function and WAZ, HAZ, WHZ and MUAC after rehabilitation.ConclusionSevere acute malnutrition affects diastolic function in children which is reversible in most of these cases with rehabilitation. TDI is an easy and practical method for detection and follow-up of ventricular function in malnourished children.
Highlights
Malnutrition is a major health issue accounting for approximately 3.1 million yearly deaths among children in low and middle-income countries, and it refers to both protein-energy malnutrition (PEM) and micronutrient deficiency [1]
Studied children were subjected to full history taking with detailed nutritional history, clinical examination including anthropometric indices using WHO Z-score growth charts optimal for their age and sex to determine the percentile for each parameter were divided into 2 groups according to their nutritional status: Group 1: included 60 infants and children recruited from inpatient nutritional rehabilitation unit who were admitted with the diagnosis of (SAM) by WHZ < -3 standard deviation (SD), MUAC < 115 mm or presence of bilateral pitting edema
Rural residence was of significant relation to malnutrition as 86.6% of them were belonging to rural residence, 93.4% were of very low and low socioeconomic standards in comparison to 41.7% were of low socioeconomic standards in the healthy group and the rest of them were from middle and high socioeconomic standards (30% & 28.3%)
Summary
Malnutrition is a major health issue accounting for approximately 3.1 million yearly deaths among children in low and middle-income countries, and it refers to both protein-energy malnutrition (PEM) and micronutrient deficiency [1]. Patients with severe PEM have multiple nutritional deficiencies, anaemia and frequent intercurrent illnesses. PEM involves tissue protein all over the body. Tissue Doppler imaging (TDI) is a robust and reproducible ultrasound technique employing the low frequency and high-amplitude ultrasound signals reflected from the myocardium. TDI is useful for screening and detection of subclinical myocardial dysfunction, and for evaluating the efficacy of therapeutic interventions [6, 7]. This study was designed to detect the myocardial affection in children with severe acute malnutrition (SAM) before and after nutritional rehabilitation using echocardiography and tissue Doppler imaging technique. Diastolic dysfunction is one of the major causes of heart failure with preserved ejection fraction
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