From the Tropical Medicine Research Institute (D.S.T., M.S.B.), Departments of Surgery, Radiology, Anaesthesia, and Intensive Care (I.A.T., A.T.B.), Medicine (Cardiology) (E.E.C., A.P.C.), and UWI Solutions for Developing Countries (T.E.F.), University of the West Indies, Mona, Kingston, Jamaica; Institute Biomedical Technology, Ghent University, Gent, Belgium (J.K., P.S.); MRC Lifecourse Epidemiology Unit (C.O.) and DOHAD Division (M.A.H.), University of Southampton, Southampton, United Kingdom; Centre for Human Evolution, Adaptation, and Disease, Liggins Institute, University of Auckland, Auckland, New Zealand (P.D.G.); and Division of Diabetes, Cardiovascular Medicine, and Nutrition, King's College and King's Health Partners, London, United Kingdom (J.K.C.).
Hypertension. 2014 Sep;64(3):664-71. doi: 10.1161/HYPERTENSIONAHA.114.03230. Epub 2014 Jun 30.
Malnutrition below 5 years remains a global health issue. Severe acute malnutrition (SAM) presents in childhood as oedematous (kwashiorkor) or nonoedematous (marasmic) forms, with unknown long-term cardiovascular consequences. We hypothesized that cardiovascular structure and function would be poorer in SAM survivors than unexposed controls. We studied 116 adult SAM survivors, 54 after marasmus, 62 kwashiorkor, and 45 age/sex/body mass index-matched community controls who had standardized anthropometry, blood pressure, echocardiography, and arterial tonometry performed. Left ventricular indices and outflow tract diameter, carotid parameters, and pulse wave velocity were measured, with systemic vascular resistance calculated. All were expressed as SD scores. Mean (SD) age was 28.8±7.8 years (55% men). Adjusting for age, sex, height, and weight, SAM survivors had mean (SE) reductions for left ventricular outflow tract diameter of 0.67 (0.16; P<0.001), stroke volume 0.44 (0.17; P=0.009), cardiac output 0.5 (0.16; P=0.001), and pulse wave velocity 0.32 (0.15; P=0.03) compared with controls but higher diastolic blood pressures (by 4.3; 1.2-7.3 mm Hg; P=0.007). Systemic vascular resistance was higher in marasmus and kwashiorkor survivors (30.2 [1.2] and 30.8 [1.1], respectively) than controls 25.3 (0.8), overall difference 5.5 (95% confidence interval, 2.8-8.4 mm Hg min/L; P<0.0001). No evidence of large vessel or cardiac remodeling was found, except closer relationships between these indices in former marasmic survivors. Other parameters did not differ between SAM survivor groups. We conclude that adult SAM survivors had smaller outflow tracts and cardiac output when compared with controls, yet markedly elevated peripheral resistance. Malnutrition survivors are thus likely to develop excess hypertension in later life, especially when exposed to obesity.
5 岁以下儿童营养不良仍然是全球健康问题。严重急性营养不良（SAM）在儿童时期表现为水肿型（夸西奥科尔）或非水肿型（消瘦型），其长期心血管后果尚不清楚。我们假设 SAM 幸存者的心血管结构和功能会比未暴露的对照组差。我们研究了 116 名成年 SAM 幸存者，其中 54 名是消瘦型，62 名是夸西奥科尔型，还有 45 名年龄、性别、体重指数匹配的社区对照者，他们进行了标准化的人体测量、血压、超声心动图和动脉张力测量。测量了左心室指数和流出道直径、颈动脉参数和脉搏波速度，并计算了全身血管阻力。所有数据均表示为 SD 分数。平均（SD）年龄为 28.8±7.8 岁（55%为男性）。调整年龄、性别、身高和体重后，SAM 幸存者的左心室流出道直径平均（SE）减少了 0.67（0.16；P<0.001），每搏量减少了 0.44（0.17；P=0.009），心输出量减少了 0.5（0.16；P=0.001），脉搏波速度减少了 0.32（0.15；P=0.03），而对照组的舒张血压较高（增加 4.3；1.2-7.3 mm Hg；P=0.007）。消瘦型和夸西奥科尔型幸存者的全身血管阻力（分别为 30.2[1.2]和 30.8[1.1]）高于对照组 25.3（0.8），总体差异为 5.5（95%置信区间，2.8-8.4 mm Hg min/L；P<0.0001）。除了前消瘦型幸存者的这些指数之间存在更密切的关系外，没有发现大血管或心脏重构的证据。SAM 幸存者组之间的其他参数没有差异。我们得出结论，与对照组相比，成年 SAM 幸存者的流出道和心输出量较小，但外周阻力明显升高。因此，营养不良幸存者在以后的生活中很可能会发展为高血压，尤其是在肥胖的情况下。
