Muhittin ÇELİK, Nezir ÖZGÜN, Osman AKDENİZ, Erdal YILMAZ

Malnütrisyonlu çocuklarda kardiyak değerlendirme

Amaç: Bu çalışmanın temel amacı malnütrisyonlu çocuklardaki miyokardiyal değişiklikleri ortaya koymaktır. Gereç ve Yöntemler: Bu prospektif çalışma 47 malnütrisyonlu hasta ve 44 sağlıklı kontrol hastasını içermektedir. Malnütrisyonlu olgular Gomez ve Waterlov sınıflamasına göre gruplara ayrıldı. Tüm olgulara elektrokardiyografik ve ekokardiyografik inceleme, 24 saatlik Holter monitörizasyonu ve biyokimyasal değerlendirme yapıldı. Bulgular: Malnütrisyonlu grubun 20’si (%42,5), kontrol grubunun ise 19’u (%43,1) erkek idi (p

Cardiac evaluation in children with malnutrition

Aim: The main purpose of this study was to identify myocardial changes in malnourished children. Material and Methods: This prospective study included 47 patients with malnutrition and 44 healthy controls. The subjects who had malnutrition were classified according to the method of Gomez and Waterlow. Electrocardiographic and echocardiographic examinations, 24-h Holter monitoring, and biochemical assessments were performed in all subjects. Results: The malnutrition group included 20 (42.5%) males, and the control group included 19 (43.1%) males (p

PDF

___

1. Unicef. Malnutrition: Causes, consequences and solutions. In:The States of the World’s Children; Focus on Nutrition. Oxford and New York: Oxford University Press; 1998. p. 7−35. [CrossRef]
2. Saner G. Beslenme ve beslenme bozuklukları. In: Neyzi O, Ertuğrul T, editors. Pediatri, 3rd ed. Istanbul: Nobel Tıp Kitabevi; 2002. p. 204−20.
3. Unicef. Nutrition and Growth. Facts for life. Oxford and New York: Oxford University Press; 2010. p. 80−95.
4. Pelletier DL, Frongillo EA, Schroeder DG, Habicht JP. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 1975; 73: 443−48.
5. Altaş B, Kuloğlu Z. Approach to children with malnutrition. Turkish J Pediatr Dis 2011; 5: 54−64.
6. Olivares JL, Vázquez M, Rodríguez G, Samper P, Fleta J. Electrocardiographic and echocardiographic findings in malnourished children. J Am Coll Nutr 2005; 24: 38−43.
7. Heird WC. Nutrition. In: Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Company; 2004. p. 153−73.
8. Faddan NH, Sayh KI, Shams H, Badrawy H. Myocardial dysfunction in malnourished children. Ann Pediatr Cardiol 2010; 3: 113−8. [CrossRef]
9. Ocal B, Unal S, Zorlu P, Tezic HT, Oğuz D. Echocardiographic evaluation of cardiac functions and left ventricular mass in children with malnutrition. J Paediatr Child Health 2011; 37: 14−7. [CrossRef]
10. Swenne I. Heart risk associated with weight loss in anorexia nervosa and eating disorders: electrocardiographic changes during the early phase of refeeding. Acta Paediatr 2000; 89: 447−52. [CrossRef]
11. Swenne I, Larsson PT. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion. Acta Paediatr 1999; 88: 304−9. [CrossRef]
12. Başkan M, Koçak G, Gürses D, Ergin H. Malnütrisyonlu çocuklarda QT intervali ve dispersiyonu. Turgut Özal Tıp Merkezi Dergisi 2000; 7: 315−21.
13. Fuenmayor AJ, Mora RE, Fuenmayor AC, Fuenmayor AM. QT-ınterval dispersion in malnourished children. Clin Cardiol 1998; 21: 201−5. [CrossRef]
14. El Razaky O, Naeem A, Donia A, El Amrousy D, Elfeky N. Cardiac changes in moderately malnourished children and their correlations with anthropometric and electrolyte changes. Echocardiography 2017; 34: 1674−9. [CrossRef]
15. Goldner B, Brandspiegel HZ, Horwitz L, Jadonath R, Cohen TJ. Utility of QT dispersion combined with the signal-averaged electrocardiogram in detecting patients susceptible to ventricular tachyarrhythmia. Am J Cardiol 1995; 76: 1192−2004. [CrossRef]
16. Goldhammer EI, Zaid G, Tal V, Jaffe M, Abinader EG. QT dispersion in infants with apparent life-threatening events syndrome. Pediatr Cardiol 2002; 23: 605−7. [CrossRef]
17. Kumar N, Pandita A, Sharma D, Kumari A, Pawar S, Digra KK. To Identify Myocardial Changes in Severely Malnourished Children: A Prospective Observational Study. Front Pediatr 2015; 3: 57. [CrossRef]
18. Neyzi O, Gunoz H, Furman H, et al. Weight, height, head circumference and body mass index references for Turkish children. Turkish J Pediatr 2008; 51: 1−14.
19. Gómez F, Ramos Galvan R, Frenk S, Cravioto Muñoz J, Chávez R, Vázquez J. Mortality in second and third degree malnutrition. 1956. Bull World Health Organ 2000; 78: 1275−80.
20. Waterlow JC. Classification and definition of proteincalorie malnutrition. Br Med J 1972; 3: 566−69. [CrossRef]
21. Palla B, Litt IF. Medical complications of eating disorders in adolescents. Pediatrics 1988; 81: 613−23.
22. Bedi M, Babbar R, Chakrabarty AS, Sachdev HP. Comparative study of autonomic nervous system activity in malnourished and normal children in India. Ann Trop Paediatr 1999; 19: 185−9. [CrossRef]
23. Duraković Z, Duraković A, Korsić M. Changes of the corrected Q-T interval in the electrocardiogram of patients with anorexia nervosa. Int J Cardiol 1994; 45: 115−20. [CrossRef]
24. Steinhausen HC, Glanville K. Follow-up studies of anorexia nervosa: a review of research findings. Psychol Med 1983; 13: 239−49. [CrossRef]
25. Tamburrino MB, McGinnis RA. Anorexia nervosa. A review. Panminerva Med 2002; 44: 301−11.
26. Isner JM, Roberts WC, Heymsfield SB, Yager J. Anorexia nervosa and sudden death. Ann Intern Med 1985; 102: 49−52. [CrossRef]
27. Webb JG, Kiess MC, Chan-Yan CC. Malnutrition and the heart current rewiew. CMAJ 1986; 135: 753−58.
28. Thwaites BC, Bose M. Very low calorie diets and prefasting prolonged QT interval. A hidden potential danger. West Indian Med J 1992; 41: 169−71.
29. Surawicz B, Waller BF. The enigma of sudden cardiac death related to dieting. Can J Cardiol 1995; 11: 228−31.
30. Grover Z, Ee LC. Protein energy malnutrition. Pediatr Clin North Am 2009; 56: 1055−68. [CrossRef]
31. Kerpel-Fronius E, Varga F. Dynamics of circulation in infantile malnutrition. Pediatrics 1949; 4: 301−8.
32. El-Sayed HL, Nassar MF, Habib NM, Elmasry OA, Gomaa SM. Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery. Eur J Clin Nutr 2006; 60: 502−10. [CrossRef]
33. Cunha DF, Cunha SF, Reis MA, Teixeira Vde P. Heart weight and heart weight/body weight coefficient in malnourished adults. [Article in English, Portuguese] Arq Bras Cardiol 2002; 78: 382−7. [CrossRef]
34. Kothari SS, Patel TM, Shetalwad AN, Patel TK. Left ventricular mass and function in children with severe protein energy malnutrition. Int J Cardiol 1992; 35: 19−25.
35. Phornphatkul C, Pongprot Y, Suskind R, George V, Fuchs G. Cardiac function in malnourished children. Clin Pediatr (Phila) 1994; 33: 147−54. [CrossRef]
36. Shoukry I, Shoukry AS, Ibrahim MM, Fahmy N, Madkour MA. Cardiac atrophy and ventricular function in infants with protein calorie malnutition. In: Doyle EF, Engle MA, Gersony WM, Rashkind WJ, Talner NS, editors. Pediatric Cardiology; New York: Springer Verlag; 1986. p. 169–71.
37. Schocken DD, Holloway JD, Powers PS. Weight loss and the heart. Effect of anoreksia nervosa and starvation. Arch Intern Med 1989; 149: 877−81. [CrossRef]
38. Fioretto JR, Querioz SS, Padovani CR, Matsubara LS, Okoshi K, Matsubara BB. Ventricular remodeling and diastolic myocardial dysfunction in rats submitted to protein-calorie malnutrition. Am J Physiol 2002; 282: 1327−33. [CrossRef]
39. Uluçay E, Tatlı E. Myocardial performance index. Anadolu Kardiyol Derg 2008; 8: 143−8.