Nutritional status of children with congenital heart diseases at the University College Hospital, Ibadan, Nigeria

Abstract

Background: Congenital Heart Disease (CHD) is an important cause of childhood morbidity and mortality. Poor nutritional status is one of the clinical manifestations. The extent of deviation from the normal weight and/or height has not been adequately documented in Nigeria. Study design: This cross-sectional study, conducted between April 2011 and June 2012 (fourteen months), involved151 Nigerian children comprising 96 males and 55 females aged between one and 60 months. Nutritional status of the children was assessed using weight, height, mid-upper arm
circumference (where appropriate), triceps and subscapular skin fold thicknesses. The z-scores of the anthropometric data were compared with the World Health Organisation (WHO) Standard reference charts.

Results: The mean age of the children was 17.3±15.7 months. The male: female ratio was 1.7:1. Theoverall frequency of malnutrition was 72.8%.Severe malnutrition was found in 36.4% of the children, with the frequency of underweight being 64.2%, that of wasting 37.7% and of stunting 57.0%.

Conclusion: The prevalence of malnutrition in Nigerian children with CHD is very high. Appropriate management of the heart disease together with routine nutritional screening and counselling are likely to benefit children with CHD in order to improve management outcomes. Early corrective interventions, including surgery, need to be intensified.

Keywords: Congenital heart disease; anthropometry; nutritional status; malnutrition; children.

Résumé
Contexte: La Maladie Cardiaque Congénitale (MCC) est une cause importante de morbidité et de mortalité infantile. Le mauvais état nutritionnel est l’une des manifestations cliniques. L’étendue de l’écart par rapport au poids et / ou à la taille normale n’a pas été suffisamment documentée au Nigeria. Conception de l’étude: Cette étude transversale, menée entre avril 2011 et juin 2012 (quatorze mois), impliquait 151 enfants nigérians comprenant 96 garçons et 55 filles âgés entre l’intervalle de 1 à 60 mois. L’état nutritionnel des enfants a été évalué à l’aide du poids, de la taille, de la circonférence du milieu de la partie supérieure du bras (le cas échéant), du triceps et de l’épaisseur de plis de la peau sous-calcique. Les scores-z des données anthropométriques étaient comparés aux tableaux de référence standard de l’Organisation Mondiale de la Santé (OMS).

Résultats: L’âge moyen des enfants était de 17,3 ± 15,7 mois. Le rapport garçon : fille était de 1,7: 1. La fréquence globale de la malnutrition était de 72,8%. Une malnutrition sévère était trouvée dans 36,4% des enfants, avec la fréquence de sous-pondération étant 64,2%, celle du gaspillage 37,7% et de rabougri 57,0%.

Conclusion: La prévalence de la malnutrition chez les enfants nigérians atteints de MCC est très élevée. Une gestion appropriée de la maladie cardiaque, ainsi que le dépistage et le conseil nutritionnels de routine, sont susceptibles de bénéficier aux enfants atteints de MCC afin d’améliorer les résultats de la gestion. Les interventions correctives précoces, y compris la chirurgie, doivent être intensifiées.

Mots-clés: Maladie cardiaque congénitale; anthropométrie; l’état nutritionnel; malnutrition; les enfants.

Correspondence: Dr. Oluwatoyin O. Ogunkunle, Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria. Email: ooogunkunle2004@yahoo.co.uk

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References

van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(21):2241-2247.

Nydegger A and Bines JE. Energy metabolism in infants with congenital heart disease. Nutrition. 2006;22(7-8):697-704.

Varan B, Tokel K and Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child. 1999;81(1):49-52.

Mitchell IM, Logan RW, Pollock JC, et al. Nutritional status of children with congenital heart disease. Br Heart J. 1995;73(3):277-783.

Cameron JW, Rosenthal A and Olson AD. Malnutrition in hospitalized children with congenital heart disease. Arch Pediatr Adolesc Med. 1995;149(10):1098-1102.

Daymont C, Neal A, Prosnitz A, et al. Growth in children with congenital heart disease. Pediatrics. 2013;131(1):e236-42.

Janes MD and Antia AU. Physical growth of children with congenital malformation of heart and great vessels. Nig J Paediatr 1975;2:1-8.

Hassan BA, Albanna EA, Morsy SM, et al. Nutritional Status in Children with un-operated Congenital Heart Diseases: An Egyptian Center Experience. Frontiers in Pediatrics. 2015;3:53.

Sjarif DR, Anggriawan SL and Djer MM. Anthropometric profiles of children with congenital heart disease Med J Indones. 2011;20(1):40-45.

Okoromah CA, Ekure EN, Lesi FE, et al. Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study. Arch Dis Child. 2011;96(4):354-360.

Tin H, Nhan L, Hoa N, et al. Prevalence and risk factors for malnutrition in children with congenital heart disease, Ho Chi Minh City, Viet Nam (620.12). The FASEB Journal. 2014;28(1 Supplement):620, 12.

Venugopalan P, Akinbami FO, Al-Hinai KM, et al. Malnutrition in children with congenital heart defects. Saudi Med J. 2001;22(11):964-967.

Shrivastava S. Malnutrition in congenital heart disease. Indian Pediatr. 2008;45(7):535-536.

Costello CL, Gellatly M, Daniel J, et al. Growth Restriction in Infants and Young Children with Congenital Heart Disease. Congenit Heart Dis. 2014.

Vaidyanathan B, Nair SB, Sundaram KR, et al. Malnutrition in children with congenital heart disease (CHD) determinants and short term impact of corrective intervention. Indian Pediatr. 2008;45(7):541-546.

WHO Expert Committee on Physical Status. Physical status: the use and interpretation of anthropometry. Geneva; 1995. Report No.: 0512-3054 (Print)0512-3054 (Linking) Contract No.: 854.

Hornby ST, Nunes QM, Hillman TE, et al. Relationships between structural and functional measures of nutritional status in a normally nourished population. Clin Nutr. 2005; 24(3): 421-426.

Venugopalan P and Akinbami FO. Anthropometric measurements in children with congenital heart disease. Trop Doct. 2001; 31(3): 186-188.

WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76-85.

de Onis M and Blossner M. World Health Organization Global Database on Child Growth and Malnutrition. In: Nutrition. Po, editor. Geneva, 1997.

National Population Commission, ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission Nigeria and ICF Macro; 2009.

Vaidyanathan B, Radhakrishnan R, Sarala DA, et al. What determines nutritional recovery in malnourished children after correction of congenital heart defects? . Pediatrics 2009; 124: e294-9.

Begic H and Tahirovic H. The impact of delayed cardiac surgery on the postnatal growth of children with congenital heart disease in Bosnia and Herzegovina. Coll Antropol. 2013; 37(2): 507-513.

Falase B, Sanusi M, Majekodunmi A, et al. The cost of open heart surgery in Nigeria. PAMJ 2013;14:61.doi:10.11604/pamj.2013.14.61.2162

Cheung MM, Davis AM, Wilkinson JL, et al. Long term somatic growth after repair of tetralogy of Fallot: evidence for restoration of genetic growth potential. Heart. 2003; 89 (11): 1340–1343.