2.4 Vascular and Cardiac Structure and Function in Adult Survivors of Severe Acute Malnutrition

Severe acute malnutrition (SAM) has oedematous or non-oedematous phenotypes and their metabolic effects may persist into adulthood. We hypothesised that cardiovascular structure and function would differ between phenotypes as young adults and between survivors and persons never exposed to SAM. Methods We recruited 54 non-oedematous and 62 oedematous adult survivors of SAM, and 45 age/sex/BMI-matched community controls. Standardised measures of anthropometry, blood pressure (BP), 2D-echocardiography, carotid and femoral artery ultrasound, brachial, radial and carotid tonometry were performed. Cardiac output (CO), stroke volume (SV), left ventricular mass (LVM) index and outflow tract (LVOT) diameter, carotid and femoral intima-media thickness (IMT), carotid-femoral pulse wave velocity (PWV) and augmentation index were derived. Visceral fat mass was assessed by CT scan. Results Mean (SD) age was 28.8 (7.8) years; 55% were male. Visceral fat mass and BP did not differ significantly between groups. There were no significant differences in cardiovascular measures between oedematous and non-oedematous survivors. After adjusting for age, sex, height and weight, measurements in controls exceeded survivors’ expressed in mean (SE) standardized units, as follows: PWV 0.35 (0.14, p = 0.02), CO 0.53 (0.16, p = 0.001), LVOT diameter 0.71 (0.16, p<0.001), SV 0.44 (0.16, p = 0.009), and femoral IMT 0.76 (0.19, p<0.001). Conclusions Adult survivors of SAM had less arterial stiffness and decreased CO (due mainly to a smaller SV) compared to controls. The nutritional insult in early childhood may have effects on organ growth and therefore cardiac function. However, at this young age there was no impact on vascular structure and function.