Childhood malnutrition may increase later risk of high blood pressure



Severely malnourished children may be at higher risk for hypertension in adulthood because of potentially irreversible changes in cardiac function, according to a recent study of more than 100 adults.

Adult survivors of severe acute malnutrition in childhood had a mean diastolic blood pressure that was 4.3 mm Hg higher than that of controls (P = .007).

© 2011 American Heart Association, Inc.

Malnourished children may be at higher risk for hypertension in adulthood.

In addition, a "striking" finding was that systemic vascular resistance was 5.5 mm Hg min/L higher in survivors than in controls, the researchers reported.

"A raised systemic vascular resistance suggests relative resistance vessel constriction and reduced density of small resistance arteries," reported Dr. Ingrid Tennant of the University of the West Indies in Kingston, Jamaica, and her associates. "Whatever its origin, increased systemic vascular resistance and diastolic blood pressure put severe acute malnutrition survivors at higher risk of developing hypertension than controls. This may have long-term cardiovascular consequences for the many people in the world who have experienced severe childhood malnutrition," they wrote (Hypertension 2014 June 30 [doi: 10.1161/HYPERTENSIONAHA.114.03230]).

The researchers tracked down 116 adult survivors of severe acute malnutrition who had been treated as children in the University of the West Indies Tropical Metabolism Research Unit between 1963 and 1993. The 62 survivors of edematous (kwashiorkor and marasmic kwashiorkor) and 54 survivors of nonedematous (marasmic) malnutrition were compared with 45 controls matched by age, sex, and body mass index from the same neighborhood as each survivor.

After an overnight fast, including no alcohol, caffeine, or strenuous exercise in the previous 12 hours, participants were assessed for height, weight, and blood pressure. They also received CT scans, vascular ultrasounds, and echocardiograms to measure body composition, arterial stiffness (pulse wave velocity), left ventricular mass, and other left ventricular and carotid artery indices.

The researchers also identified "greater left ventricular outflow tract diameter, stroke volume, cardiac output, and femoral intima-medial thickness" in controls than in survivors. "Their ejection fraction was lower but pulse wave velocity was higher than in severe acute malnutrition survivors," they wrote.

"The decrease in left ventricular outflow tract diameter, stroke volume, and cardiac output in severe acute malnutrition survivors when compared with controls might reflect a combination of pre- and postnatal insults because nutritional insults in both these developmentally plastic periods can limit organ development," Dr. Tennant’s team reported.

The research was funded by the New Zealand Health Research Council and the British Heart Foundation. The authors reported no disclosures.

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