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Jornal de Pediatria
On-line version ISSN 1678-4782
AZEVEDO, Vitor M. P. et al. The impact of malnutrition on idiopathic dilated cardiomyopathy in children. J. Pediatr. (Rio J.) [online]. 2004, vol.80, n.3, pp.211-216. ISSN 1678-4782. http://dx.doi.org/10.1590/S0021-75572004000400009.
OBJECTIVE: To analyze the prognostic value of malnutrition in children with idiopathic dilated cardiomyopathy. METHODS: This is a retrospective study of 165 patients with idiopathic dilated cardiomyopathy, diagnosed from September 1979 to March 2003. It analyzed the following variables: gender, age, previous viral illness in the preceding 3 months, functional class according to the New York Heart Association (NYHA), evaluation of nutritional status (normal vs malnutrition), percentile and standard deviation (z index) of weight. Weight was measured 744 times during the first 72 months, 93 during the first month. Statistical analysis was performed by chi-squared, Student t test and analysis of variance for repeated measures (ANOVA). Ninety-five percent confidence intervals (CI95) and odds ratios (OR) were calculated. An alpha value of 0.05 and beta of 0.80 were used. RESULTS: Mean age at presentation was 2.2±3.2 years with higher incidence in those younger than 2 years (75.8%-CI95 = 68.5% to 82.1%) (p < 0.0001). NYHA classes III and IV were observed in 81.2% (CI95 = 74.4% to 86.9%) (p < 0.0001) and all 40 deaths were this group (p = 0.0008). At presentation, myocarditis occurred in 39.4% (CI95 = 31.9% to 47.3%) (p = 0.0001) and a high level of association between myocarditis and previous viral illness was observed (p = 0.0005) (OR = 3.15-CI95 = 1.55 to 6.44). Malnutrition at presentation did not influence death (p= 0.10), however progressive malnutrition was a marker for death (p = 0.02) (OR = 3.21-CI95 = 1.04 to 9.95). No significant differences weight percentiles (p = 0.15) or in z scores (p = 0.14) were observed. Observed mean weight percentiles (34.9+32.6 vs 8.6+16.0) (p < 0.0001) and z scores (-0.62+1.43 vs -2.02+1.12) (p < 0.0001) during the study period were greater among survivors. ANOVA demonstrated significant differences in weight percentile progression (p = 0.0417) and z scores (p = 0.0005) from the first month onwards. CONCLUSION: The evaluation of nutritional status. is easy to performer, it does not imply additional costs and should become routine for children with chronic heart failure.
Keywords : Dilated cardiomyopathy; children; malnutrition; heart failure.