title: The effects of malnutrition on cardiac function in African children.
abstract: OBJECTIVE
  Cardiac dysfunction may contribute to high mortality in severely malnourished children. Our objective was to assess the effect of malnutrition on cardiac function in hospitalised African children.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  Public referral hospital in Blantyre, Malawi.
  
  
  METHODS
  We enrolled 272 stable, hospitalised children ages 6-59 months, with and without WHO-defined severe acute malnutrition.
  
  
  METHODS
  Cardiac index, heart rate, mean arterial pressure, stroke volume index and systemic vascular resistance index were measured by the ultrasound cardiac output monitor (USCOM, New South Wales, Australia). We used linear regression with generalised estimating equations controlling for age, sex and anaemia.
  
  
  RESULTS
  Our primary outcome, cardiac index, was similar between those with and without severe malnutrition: difference=0.22 L/min/m(2) (95% CI -0.08 to 0.51). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: difference=-8.6 mm Hg (95% CI -12.7 to -4.6) and difference=-200 dyne s/cm(5)/m(2) (95% CI -320 to -80), respectively.
  
  
  CONCLUSIONS
  In this largest study to date, we found no significant difference in cardiac function between hospitalised children with and without severe acute malnutrition. Further study is needed to determine if cardiac function is diminished in unstable malnourished children.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA University of Washington School of Public Health, Seattle, Washington, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Silverman
authors.affiliation: Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Yamikani
authors.initials: Y
authors.lastname: Chimalizeni
authors.affiliation: University of Washington School of Public Health, Seattle, Washington, USA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Hawes
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Wolf
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA University of Washington School of Public Health, Seattle, Washington, USA.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Batra
authors.affiliation: Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Harriet
authors.initials: H
authors.lastname: Khofi
authors.affiliation: Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Molyneux
mesh_terms: D000208:Acute Disease; D000886:Anthropometry / Q000379:methods; D002302:Cardiac Output / Q000502:physiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology
keywords: Cardiology; Nutrition; Physiology; Tropical Paediatrics