Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study.
OBJECTIVE
To investigate the prevalence, profile and predictors of severe malnutrition in children with congenital heart defects (CHDs).


METHODS
Case-control, observational study.


METHODS
Tertiary teaching hospital in Lagos, Nigeria (March 2006 to March 2008).


METHODS
Children aged 3-192 months with uncorrected symptomatic CHD and healthy controls, frequency matched for age and sex.


METHODS
Prevalence of malnutrition based on WHO/National Center for Health Statistics/Centers for Disease Control and Prevention z score ≤-2; weight for age, weight for height/length and height for age; proportions of underweight, wasting and stunting in cases and controls, and in acyanotic and cyanotic CHD; and predictors of malnutrition using multivariate logistic analysis.


RESULTS
90.4% of cases and 21.1% of controls had malnutrition (p=0.0001), and 61.2% and 2.6%, respectively, had severe malnutrition (p=0.0001). Wasting, stunting and underweight were identified in 41.1%, 28.8% and 20.5%, and 2.6%, 3.9% and 14.5% of cases and controls, respectively. Wasting was significantly higher (58.3%) in acyanotic CHD (p=0.0001), and stunting (68.0%) in cyanotic CHD (p=0.0001). Age at weaning was significantly lower in cases than controls (3.24±0.88 and 7.04±3.04 months, respectively; p=0.0001) and in acyanotic than cyanotic CHD (2.14±0.33 and 5.33±1.22 months, respectively; p=0.004). Predictors of malnutrition in CHD were anaemia, moderate to severe congestive heart failure (CHF), poor dietary intake of fat and prolonged unoperated disease.


CONCLUSIONS
Severe malnutrition in association with anaemia and moderate to severe CHF is highly prevalent in CHD preoperatively in these children. Early weaning may be a marker of feeding difficulties in heart failure.
Associate Professor and Consultant, Cardiology and Infectious Disease Unit, Department of Paediatrics, College of Medicine, University of Lagos, Surulere, Idi-Araba, Lagos, Nigeria. faimer2004_christy@yahoo.com
Christy A N
CA
Okoromah
Ekanem N
EN
Ekure
Foluso E A
FE
Lesi
Wahab O
WO
Okunowo
Bolande O
BO
Tijani
Jonathan C
JC
Okeiyi
D000293:Adolescent; D000367:Age Factors; D000886:Anthropometry / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004032:Diet; D005260:Female; D006130:Growth Disorders / Q000209:etiology; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D012307:Risk Factors; D012923:Social Class; D014886:Weaning
Acta Paediatr Suppl. 2006 Apr;450:76-85
16817681
Niger Postgrad Med J. 2008 Jun;15(2):82-8
18575478
World Health Organ Tech Rep Ser. 1995;854:1-452
8594834
J Pediatr. 1967 Mar;70(3):413-9
6018395
Heart. 2003 Nov;89(11):1340-3
14594896
Indian Pediatr. 2008 Jul;45(7):541-6
18695271
J Am Diet Assoc. 2008 Jun;108(6):1014-7
18502236
Pediatrics. 2009 Aug;124(2):e294-9
19581268
J Pediatr Gastroenterol Nutr. 1985 Oct;4(5):778-85
4045636
Am J Clin Nutr. 1979 Mar;32(3):607-29
420153
J Am Coll Cardiol. 1991 Aug;18(2):552-8
1856425
Am J Cardiol. 2000 Jun 15;85(12):1472-5
10856395
Trop Med Int Health. 1998 Aug;3(8):678-86
9735938
Am J Dis Child. 1969 May;117(5):564-72
5781709
Am J Public Health. 1993 Aug;83(8):1130-3
8342721
Nutr Rev. 1994 Oct;52(10):348-53
7816352
Nutr Rev. 1994 Oct;52(10):340-7
7816351
Bull World Health Organ. 1994;72(4):569-79
7923536
Pediatr Rev. 2000 Jan;21(1):29-32
10617760
Pediatrics. 1997 Nov;100(5):E8
9347002
Pediatr Cardiol. 1989 Winter;10(1):17-23
2495525
Curr Opin Clin Nutr Metab Care. 2005 May;8(3):249-54
15809526
Pediatr Cardiol. 1992 Apr;13(2):72-5
1614922
Circulation. 1978 Apr;57(4):793-7
564759
J Trop Pediatr. 2009 Oct;55(5):324-7
19261662
Palliat Med. 2007 Jun;21(4):333-9
17656410
J Pediatr. 1962 Sep;61:418-29
14472142
J Am Coll Cardiol. 2003 May 7;41(9):1598-605
12742303
Clin Cardiol. 1993 May;16(5):392-6
8504572
Int J Epidemiol. 2003 Aug;32(4):518-26
12913022
Arch Dis Child. 2009 Jul;94(7):512-6
18977785
J Trop Pediatr (Lond). 1956 Sep;2(2):77-83
24544135
Arch Dis Child. 1985 Dec;60(12):1134-9
4091578
Arch Dis Child. 1949 Dec;24(120):294-302
15401798
Arch Dis Child. 1999 Jul;81(1):49-52
10373135
Acta Paediatr. 1998 Dec;87(12):1250-5
9894825