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Cardiac Dysfunction in a Porcine Model of Pediatric Malnutrition
Christian Fabiansen1, Mikkel Lykke1, Anne-Louise Hother1
1Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
Insights
Severe acute malnutrition causes cardiac dysfunction and injury in piglets, indicated by increased myocardial performance index and cardiac troponin-T levels. Further research is needed to confirm these findings in malnourished children.
Area of Science:
- Pediatric cardiology
- Nutritional science
- Animal models in research
Background:
- Severe acute malnutrition (SAM) affects millions of children globally, with cardiac dysfunction potentially contributing to mortality.
- Cardiac function in SAM remains inadequately understood.
- This study investigates cardiac changes in a pediatric porcine model of malnutrition.
Purpose of the Study:
- To assess malnutrition-induced echocardiographic disturbances.
- To longitudinally analyze plasma pro-atrial natriuretic peptide and cardiac troponin-T levels.
- To utilize a pediatric porcine model for studying cardiac effects of malnutrition.
Main Methods:
- Piglets were fed a maize-based diet to induce malnutrition (MAIZE) or a reference diet (AGE-REF) for 7 weeks.
- A weight-matched reference group (WEIGHT-REF) was included for comparison.
- Echocardiography, plasma pro-atrial natriuretic peptide, and cardiac troponin-T were measured weekly.
Main Results:
- Malnourished piglets (MAIZE) showed a marked increase in plasma pro-atrial natriuretic peptide compared to controls.
- While overall cardiac troponin-T levels did not differ, its release was more frequent in the AGE-REF group, but concentrations were significantly higher in the MAIZE group when released.
- The myocardial performance index was significantly higher in malnourished piglets.
Conclusions:
- Malnutrition is associated with cardiac dysfunction and injury in a pediatric porcine model.
- Elevated myocardial performance index and pro-atrial natriuretic peptide indicate dysfunction.
- Increased cardiac troponin-T release suggests cardiac injury, warranting clinical studies in malnourished children.
Background:
Half a million children die annually of severe acute malnutrition and cardiac dysfunction may contribute to the mortality. However, cardiac function remains poorly examined in cases of severe acute malnutrition.
Objective:
To determine malnutrition-induced echocardiographic disturbances and longitudinal changes in plasma pro-atrial natriuretic peptide and cardiac troponin-T in a pediatric porcine model.
Methods And Results:
Five-week old piglets (Duroc-x-Danish Landrace-x-Yorkshire) were fed a nutritionally inadequate maize-flour diet to induce malnutrition (MAIZE, n = 12) or a reference diet (AGE-REF, n = 12) for 7 weeks. Outcomes were compared to a weight-matched reference group (WEIGHT-REF, n = 8). Pro-atrial natriuretic peptide and cardiac troponin-T were measured weekly. Plasma pro-atrial natriuretic peptide decreased in both MAIZE and AGE-REF during the first 3 weeks but increased markedly in MAIZE relative to AGE-REF during week 5-7 (p ≤ 0.001). There was overall no difference in plasma cardiac troponin-T between groups. However, further analysis revealed that release of cardiac troponin-T in plasma was more frequent in AGE-REF compared with MAIZE (OR: 4.8; 95%CI: 1.2-19.7; p = 0.03). However, when release occurred, cardiac troponin-T concentration was 6.9-fold higher (95%CI: 3.0-15.9; p < 0.001) in MAIZE compared to AGE-REF. At week 7, the mean body weight in MAIZE was lower than AGE-REF (8.3 vs 32.4 kg, p < 0.001), whereas heart-weight relative to body-weight was similar across the three groups. The myocardial performance index was 86% higher in MAIZE vs AGE-REF (p < 0.001) and 27% higher in MAIZE vs WEIGHT-REF (p = 0.025).
Conclusions:
Malnutrition associates with cardiac dysfunction in a pediatric porcine model by increased myocardial performance index and pro-atrial natriuretic peptide and it associates with cardiac injury by elevated cardiac troponin-T. Clinical studies are needed to see if the same applies for children suffering from malnutrition.
