Heart Weight and Heart Weight/Body Weight Coefficient in Malnourished Adults

Abstract

Objective -To compare the heart weight and the heart weight/body weight coefficient of adults with and without chronic malnutrition. Chronic malnutrition results from the inadequate intake of nutrients, with the predominance of catabolic processes over the anabolic ones, and the progressive wasting of fat and muscle protein body reserves. In adult individuals, chronic protein-calorie malnutrition manifests as progressive weight loss with hypofunction and hypotrophy of organs, such as the spleen, intestines, and kidneys 1 . Experiments with animals 2 and autopsies of malnourished children show that the heart undergoes hypotrophy proportional to the degree of weight loss 3,4 . Even though studies on heart morphometry and function of malnourished adults are rare 5 , experiments with animals suggest that the myocardium undergoes a milder wasting than striated skeletal muscles do, possibly due to the relative increase in vascularization and oxygenation of the myocardiocytes 6 . However, patients quite frequently develop tachycardia, hydric retention, and cardiac decompensation during nutritional therapy, and this phenomenon has been attributed to myocardial dysfunction associated with cardiac hypotrophy secondary to malnutrition 7 . The heart weight/body weight (HW/BW) coefficient, whose normal value is around 0.5±0.02, has been used for characterizing myocardial hypertrophy 8 and could be used for assessing myocardial hypotrophy. A study carried out by our group 8 , even though with other objectives, showed that individuals dying with cachexia had a HW/BW coefficient greater than normal. However, the relations between the HW/BW coefficient and other parameters of nutritional assessment, such as body weight, height, and body mass index, have not yet been established. Methods -In an initial case series of 210 autopsies performed in adults, we recorded body and heart weights and calculated the heart weight/body weight coefficients (HW/BW x 100Our hypothesis was that, due to the relative preservation of cardiac weight in relation to body mass index, malnourished adults would have a greater HW/BW coefficient than that of non-malnourished control individuals. The objective of our study was to compare heart weight and the HW/BW coefficient of adults with and without chronic malnutrition.

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

“…In the same respect Cunha et al (2002) recorded that malnourished individuals have lighter hearts. Ocal et al (2001) stated that the most significant reduction in LV mass, septal and postwall thickness was found in KWO group.…”

“…This is probably due to the short period of nutritional rehabilitation. According to Cunha et al (2002), the heart may be small in the early stages of the disease but it usually enlarges later.…”

“…This finding indicates a possible preservation of myocardium in relation to the intensity of weight loss. Thus, what happens actually in malnutrition is slow myocardial anabolic rate rather than increased catabolism as in acute myocardial necrosis (Cunha et al, 2002).…”

What affect heart in SAM: structure or function

“…13 Ocal et al stated that the most significant reduction in LV mass, septal and postwall thickness was found in edematous SAM group. 12 In addition, the cardiac involvements in patients with non-edematous and edematous SAM were similar in the study conducted by Kothari et al and Bergman et al stated that, although primary myocardial dysfunction is not present in edematous SAM, there is a decreased myocardial mass, which may lead to an inability of the ventricles to respond to increases in ventricular preload.…”

“…17 In one test series of Smythe et al out of 98 infants with PEM died during therapy. 13,17 Hypervoluemia associated with mobilization of edema fluid and severe anaemia imposed excessive loads on the atrophic myocardium.…”