Nutritional Status in Congenital Heart Disease

P. Amelia

1,2

, B. Lubis

, R. Adriansyah

1,2

, T. C. L. Tobing

1,2

, M. Ali

and H. Z. Abdillah

Division of Cardiology, Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Indonesia

Division of Cardiology, Functional Medical Unit of Child Health, H Adam Malik Central Hospital, Medan, Indonesia

Department of Anesthesiology, Faculty of Medicine, Universitas Sumatera Utara, Indonesia

zakkyabdillah@gmail.com

Keywords: Acyanotic, Congenital Heart Disease, Cyanotic, Nutritional Status.

Abstract: Background : Congenital heart disease (CHD) is the most common congenital anomaly, affecting 8 in 1000

children. Nutritional status of patients with CHD is influenced nutrient inputs, energy requirements, dietary

components. Objective : To describe the prevalence of malnutrition in children with cyanotic and acyanotic

congenital heart disease . Method : This report is part of ongoing study of association between nutritional

status and congenital heart disease. A cross-sectional study was conducted from January to July 2018. All

patients aged 1 month to 18 years who were came to pediatric cardiology outpatient clinic with congenital

heart disease were included. Echocardiography was evaluated in first coming. Patients were categorized

according to cyanotic and acyanotic congenital heart disease. The data were taken in the form of gender, age,

weight and height as well as nutritional status. Result : During the study period, 65 children were admitted,

consisting of 31 (47.7%) males and 34 (52.3%) females, with a median age of 61.8 months. There were 40

(41.5%) patients with malnutrition and 14 (21.5%) patients with severe malnutrition. Conclusion : Children

with CHD develop malnutrition and growth failure. Further studies studying its usefulness as correlation

between nutritional status and CHD are still needed.

1 INTRODUCTION

Congenital heart disease (CHD) is the most common

congenital anomaly, which affects 8 in 1000

children (Linde, 2011). In addition to the

management of the specific heart defect, practitioners

are often challenged by issues related to the

facilitation of normal growth and development in this

population. Growth status in these vulnerable

children may be associated with neurodevelopmental

outcomes in addition to adult height and weight

(Gale, 2004; Galle, 2006; Yang, 2011).

Malnutrition in children with CHD has been

associated with increased morbidity and mortality

indicated by frequent hospitalization, poor surgical

outcomes, and increased death (Forchielli, 1994;

Freeman, 1994). Children with CHD are become to

malnutrition for several reasons including decreased

energy intake, increased energy requirements, or both

(Schuurmans, 1998). For instance, children with

malnutrition due to cyanotic CHD like ventricular

septal defects (VSD) need more energy (Varan, 1999;

Leitch, 2000).

Considering the close association between

congenital heart disease and malnutrition. In

children, the commonly used growth charts are CDC

2000 and WHO 2006. The aim of this study was to

describe the prevalence of malnutrition in children

with congenital heart disease.

2 METHODS

This report is part of ongoing study of association

between nutritional status and congenital heart

disease. A cross-sectional study was conducted

between February to July 2018 in pediatric cardiology

outpatient clinic at the Haji Adam Malik Hospital,

Medan. The inclusion criteria were all patients

younger than 18 years, with diagnosed congenital

heart disease from echocardiography. Patients with

congenital syndrome were excluded. Informed

consent was obtained from subjects’ parents or

guardian after explanation of the study was given.

Purposive sampling was done on patients who

met the inclusion criteria. Patients were categorized

based on cardiac diagnosis from echocardiography:

cyanotic and acyanotic congenital heart disease.

Amelia, P., Lubis, B., Adriansyah, R., Tobing, T., Ali, M. and Abdillah, H.

Nutritional Status in Congenital Heart Disease.

DOI: 10.5220/0010102909330935

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

933-935

ISBN: 978-989-758-449-7

933

Standardized measurements of weight and length

were taken by nurse was classified as mild - moderate

and severe malnutrition when patient weight was 90 -

70%, and <70% of ideal weight for length based on

the CDC 2000 standard for child above 5 years old,

and which is same <-2 SD >-3, and <-3 SD based on

WHO 2006 standard for child below 5 year old.

Data were analyzed using SPSS version 18.0. The

quantitative variable was expressed as means and

standard deviations. The categorical variables were

described by their absolute (n) and relative (%)

frequencies. This study was approved by the Ethics

Committee of the University of North Sumatra

Medical School.

3 RESULTS

During the study period, 65 patients met the inclusion

criteria and were eligible for analysis. Of the 65

patients in this study, 47.7% were males. Sixty-one

point five patients developed malnutrition. Tetralogy

of Fallot (TOF) was a major cardiac lesion among all

cases of CHD (43.1%) and accounted for 77.8% of

cases in the cyanotic group. Ventricular septal defect

(VSD) was the most frequent acyanotic defect among

all cases of CHD (20.0%) and among the acyanotic

group (68.9%) (Table 1).

Of the 65 CHD patients, 36 of 65 patients were

severe malnutrition. In this study, nutritional classes

were classified into normal, mild – moderate, and

severe malnutrition groups comprising of 20, 9, and 7

subjects, respectively in cyanotic patients (Table 2).

Table 1: Characteristics of subjects

Characteristics

Mean age (SD),

months

61.8 (56.9)

Gender, n (%)

Male

Female

31 (47.7)

34 (52.3)

Diagnosis, n (%)

VSD

ASD

PDA

TOF

DORV

PA – VSD

13 (20)

5 (7.7)

11 (16.9)

28 (43.1)

4 (6.2)

Nutritional status, n

(%)

Normal nutrition

Malnutrition

25 (38.5)

40 (61.5)

Table 2: Nutritional classes of subjects with CHD

Nutritional

classes

Cyanotic CHD

(n= 36)

Acyanotic

CHD

(n = 29)

Normal 20 6

Mild – moderate 9 16

Severe 7 7

4 DISCUSSION

The prevalence of malnutrition in our study was

61.5%, similar to the prevalence in South India (59%)

(Vaidyanathan, 2008). Previous reports indicated that

malnutrition caused by CHD is common in

developing countries, but prevalence varies from 27%

up to 90.4%. Another study from Turkey reported

prevalence of malnutrition in children with CHD was

27% (Mehrizi, 1962), while a more recent Turkish

study described a prevalence of 85% (Tokel, 2010).

However study in Nigeria found higher prevalence of

malnutrition in children with uncorrected

symptomatic CHD (90.4%) (Okoromah, 2011).

In this study showed that severe malnutrition was

common in acyanotic CHD (24.1%). The case –

control observational study in Nigeria showed that

children with acyanotic CHD were more likely to be

wasted, while those with cyanotic CHD were more

likely to be stunted (Okoromah, 2011). Previous

reports on the patterns of malnutrition in acyanotic

and cyanotic CHD vary widely (Linde, 1967; Salzer,

1989; Varan, 1999). In contrast to this study, Linde

and colleagues reported that malnutrition were more

common in cyanotic CHD (Linde, 1967)

The cause of malnutrition in CHD is

multifactorial (Unger, 1992). Inadequate caloric

intake, increased energy requirements caused by

increased metabolism, and malabsorption may all

contribute. However, the most important cause of

malnutrition in CHD was inadequate caloric intake

(Krieger, 1970).

There were some limitations in our study. We had

relatively small sample size and this was single center

study, which may have led bias due to specific

environmental characteristics in the population.

Additionally, we have to analyze the association

between nutritional status and congenital heart

disease.

5 CONCLUSION

Children with CHD develop severe malnutrition and

growth failure. Further studies studying its

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

934

usefulness as correlation between nutritional status

and CHD are still needed.

ACKNOWLEDGEMENTS

This study received funding from the TALENTA

2018, which is sponsored by the University of

Sumatera Utara.

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