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Childhood malnutrition may lead to adult hypertension
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Survivors of severe acute malnutrition in childhood have an elevated risk for high diastolic BP, reduced cardiac output and increased vascular resistance.
Researchers hypothesized that CV structure and function would be compromised in those who experienced severe acute malnutrition compared with those who did not. The study included 116 adult survivors of severe acute malnutrition (mean age, 28.8 years; 55% men) who had either kwashiorkor (n=62) or marasmus (n=54) and 45 community controls who were matched by age, sex and BMI. All participants underwent standardized anthropometry, ECG and arterial tonometry, and had BP checked. The researchers measured left ventricular indices, outflow tract diameter, carotid parameters and pulse wave and calculated systemic vascular resistance.
After adjustment for age, sex, height and weight, survivors of childhood severe acute malnutrition had higher diastolic BP compared with controls (mean difference, 4.3 mm Hg; 95% CI, 1.2-7.3; P=.007).
The malnutrition survivors also had mean reductions in LV outflow tract diameter (0.67 cm; standard deviation, 0.16; P<.001), stroke volume (0.44 mL; standard deviation, 0.17; P=.009), cardiac output (0.5 L/min; standard deviation, 0.16; P=.001) and pulse wave velocity (0.32 m/s; standard deviation, 0.15; P=.001) compared with controls.
In addition, systemic vascular resistance was higher in malnutrition survivors compared with controls (marasmus group, 30.2 mm Hg x min/L; kwashiorkor group, 30.8 mm Hg x min/L; controls, 25.3 mm Hg x min/L; overall difference, 5.5 mm Hg x min/L; 95% CI, 2.8-8.4; P<.0001).
“That result was primarily related to lower [cardiac output] at similar systolic, but higher diastolic, pressures; hence, marginally higher mean pressures were observed,” Ingrid A. Tennant, MD, from the University of the West Indies, Mona, Kingston, Jamaica, and colleagues wrote.
The researchers found no evidence of large vessel or cardiac remodeling.
“We conclude that adult [severe acute malnutrition] survivors had smaller outflow tracts and cardiac output compared with controls, yet markedly elevated peripheral resistance,” Tennant and colleagues wrote. “Malnutrition survivors are thus likely to develop excess hypertension in later life, especially when exposed to obesity.”
Disclosure: The study was funded by the New Zealand Health Research Council. The researchers report no relevant financial disclosures.
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