Severe malnutrition in childhood may increase the risk for high blood pressure in adulthood, a possible significant impact on global health, according to a new research in the American Heart Association journal Hypertension. Inadequate nutrition before birth and up to age 5 may harm the heart’s development.
“If nutritional needs are not met during the time when structures of the body are highly susceptible to potentially irreversible change, it could have long-term consequences on heart anatomy and blood flow later in life,” said Terrence Forrester, Ph.D., study senior author and chief scientist, UWI Solutions for Developing Countries at the University of the West Indies, Mona, in Kingston, Jamaica. “We are concerned that millions of people globally who suffer malnutrition before or after birth are at increased risk of hypertension in later life,” Forrester said.
Compared with controls who were not malnourished in childhood, the survivors had significantly smaller left ventricular outflow tracts and lower stroke volume and cardiac output (P≤0.009 for all), according to Terrence Forrester. In addition, the survivors had systemic vascular resistance that was higher by an average of 5.5 mm Hg min/L (P<0.0001), the researchers reported online in Hypertension.
Severe acute malnutrition comes in two forms, kwashiorkor, characterized by moderate to severe wasting and edema and marasmus, characterized by severe wasting without edema. The authors noted that the burden of disease related to childhood malnutrition arises from premature mortality and poor mental development with consequent poorer school performance in childhood and economic performance when individuals enter the labor force but there is little information about potential long-term cardiovascular effects.
Researchers compared 116 adults who endured malnutrition growing up in Jamaica to 45 men and women who were adequately fed as children. The participants, most in their 20s and 30s, were measured for height, weight and blood pressure levels, and underwent echocardiograms or imaging tests to evaluate heart function.
Compared with those who weren’t malnourished, adults who survived early childhood malnutrition had factors all point to an increased risk for high blood pressure, a major risk factor for heart disease and stroke.
All of the participants underwent standardized anthropometry, blood pressure measurement, echocardiography and arterial tonometry.
The differences in cardiovascular structure and function between the survivors of childhood malnutrition and the controls emerged after adjustment for age, sex, height, and weight. The authors noted that the higher systemic vascular resistance in the survivors was primarily related to lower cardiac output at similar systolic but at higher diastolic, pressures, hence marginally higher mean pressures were observed.
Few differences were seen in other measures, including carotid intima-media thickness and left ventricular mass, although the controls had a greater femoral intima-media thickness.
“Such an increase is likely to be unrelated to atherosclerosis because in more muscular arteries, such as the common femoral, intima-media thickness can be more influenced by an increased medial layer, which has not been shown to be a marker of generalized atherosclerosis,” the authors wrote.
“To our knowledge,” they concluded, “this is the first report of abnormal cardiovascular structure and function in survivors of severe acute malnutrition. These findings are relevant to large numbers of people previously exposed to malnutrition across the world. Such effects could originate in utero but may also result from or be exacerbated by the malnutrition insult in early childhood.”
While severe malnutrition is most pervasive in developing countries, poverty and hunger linger in the United States. According to the U.S. Department of Agriculture, 8.3 million children lived in food-insecure households in 2012. Food insecurity means that at times during the year, these households were uncertain of having or unable to acquire, enough food to meet the needs of all their members.
Addressing malnutrition comprehensively could help prevent and manage high blood pressure, Forrester said.
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