title: Cardiac Dysfunction in a Porcine Model of Pediatric Malnutrition.
abstract: BACKGROUND
  Half a million children die annually of severe acute malnutrition and cardiac dysfunction may contribute to the mortality. However, cardiac function remains poorly examined in cases of severe acute malnutrition.
  
  
  OBJECTIVE
  To determine malnutrition-induced echocardiographic disturbances and longitudinal changes in plasma pro-atrial natriuretic peptide and cardiac troponin-T in a pediatric porcine model.
  
  
  RESULTS
  Five-week old piglets (Duroc-x-Danish Landrace-x-Yorkshire) were fed a nutritionally inadequate maize-flour diet to induce malnutrition (MAIZE, n = 12) or a reference diet (AGE-REF, n = 12) for 7 weeks. Outcomes were compared to a weight-matched reference group (WEIGHT-REF, n = 8). Pro-atrial natriuretic peptide and cardiac troponin-T were measured weekly. Plasma pro-atrial natriuretic peptide decreased in both MAIZE and AGE-REF during the first 3 weeks but increased markedly in MAIZE relative to AGE-REF during week 5-7 (p ≤ 0.001). There was overall no difference in plasma cardiac troponin-T between groups. However, further analysis revealed that release of cardiac troponin-T in plasma was more frequent in AGE-REF compared with MAIZE (OR: 4.8; 95%CI: 1.2-19.7; p = 0.03). However, when release occurred, cardiac troponin-T concentration was 6.9-fold higher (95%CI: 3.0-15.9; p < 0.001) in MAIZE compared to AGE-REF. At week 7, the mean body weight in MAIZE was lower than AGE-REF (8.3 vs 32.4 kg, p < 0.001), whereas heart-weight relative to body-weight was similar across the three groups. The myocardial performance index was 86% higher in MAIZE vs AGE-REF (p < 0.001) and 27% higher in MAIZE vs WEIGHT-REF (p = 0.025).
  
  
  CONCLUSIONS
  Malnutrition associates with cardiac dysfunction in a pediatric porcine model by increased myocardial performance index and pro-atrial natriuretic peptide and it associates with cardiac injury by elevated cardiac troponin-T. Clinical studies are needed to see if the same applies for children suffering from malnutrition.
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Fabiansen
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Lykke
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Hother
authors.affiliation: Department of Clinical Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Koch
authors.affiliation: Department of Biomedicine, Aarhus University, Aarhus, Denmark.
authors.forename: Ole Bækgaard
authors.initials: OB
authors.lastname: Nielsen
authors.affiliation: Department of Clinical Biochemistry, Rigshospitalet Copenhagen, Copenhagen, Denmark.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hunter
authors.affiliation: Department of Clinical Biochemistry, Rigshospitalet Copenhagen, Copenhagen, Denmark.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Goetze
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Clinical Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thymann
mesh_terms: D000818:Animals; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002648:Child; D015362:Child Nutrition Disorders / Q000097:blood / Q000503:physiopathology; D002675:Child, Preschool; D004195:Disease Models, Animal; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D044342:Malnutrition / Q000097:blood / Q000503:physiopathology*; D013552:Swine; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D009320:Atrial Natriuretic Factor