Mehzivi and Drash106 reported 55 and 52% prevalence of acute and chronic malnutrition, respectively, in children with CHD. Cameron et al.107 later found that both types of malnutrition still occurred in 33 and 64%, respectively, of hospitalized children with CHD even in the U.S. In Turkey, the frequency rates of acute and chronic malnutrition were reported as 65 and 42%, respectively,108 while chronic malnutrition was documented in 76% of patients in a hospital-based study from Spain.109
Recent reports also have placed the prevalence of acute and chronic malnutrition among children with CHD attending a pediatric cardiology outpatient clinic at more than 20%.110 The reports also noted that symptomatic infants are more severely affected, namely those with heart failure or cyanosis.106,108,110 This is understandable because symptomatic infants have severe forms of CHD that can interfere with growth to a greater extent. Also infants were more severely affected than older children, as the symptomatic infants either underwent surgical intervention for their heart disease or had subsidence of symptoms secondary to the natural history of the CHD (e.g., reduction in size of ventricular septal defect).
Autopsy studies confirmed the frequent occurrence of malnutrition in CHD. Naeye111 evaluated 220 individuals with congenital heart disease aged 1 month to 44 years and found that their body and organ weights were significantly reduced when compared to those of controls without CHD. Children aged 1 month to 8 years dying from congenital heart disease exhibited growth retardation and organ and cellular abnormalities seen in chronic malnutrition. Brain weights on autopsy showed growth retardation related to the degree of undernutrition. Measurements of brain weight, cell number, and cell size correlated with head circumference in infants. Winick et al.112 showed that a reduction in head circumference was proportional to losses of brain weight, protein, and DNA content.
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