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The effects of malnutrition on cardiac function in African children
  1. Jonathan A Silverman1,2,
  2. Yamikani Chimalizeni3,
  3. Stephen E Hawes2,
  4. Elizabeth R Wolf1,
  5. Maneesh Batra1,2,
  6. Harriet Khofi3,
  7. Elizabeth M Molyneux3
  1. 1Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2University of Washington School of Public Health, Seattle, Washington, USA
  3. 3Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
  1. Correspondence to Dr Jonathan A Silverman, Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, P.O. Box 980401, Richmond, VA 23298-0401, USA; jonathan.silverman{at}


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.

Design Prospective cross-sectional study.

Setting Public referral hospital in Blantyre, Malawi.

Patients We enrolled 272 stable, hospitalised children ages 6–59 months, with and without WHO-defined severe acute malnutrition.

Main outcome measures 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/m2 (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/cm5/m2 (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.

  • Tropical Paediatrics
  • Nutrition
  • Cardiology
  • Physiology

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