Impact of malnutrition on cardiac autonomic modulation in children<sup>,</sup>

Barreto, Gláucia Siqueira Carvalho; Vanderlei, Franciele Marques; Vanderlei, Luiz Carlos Marques; Leite, Álvaro Jorge Madeiro

doi:10.1016/j.jped.2016.03.005

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Original articles • J. Pediatr. (Rio J.) 92 (6) • Nov-Dec 2016 • https://doi.org/10.1016/j.jped.2016.03.005 copy

Impact of malnutrition on cardiac autonomic modulation in children^☆ ☆ Please cite this article as: Barreto GS, Vanderlei FM, Vanderlei LC, Leite ÁJ. Impact of malnutrition on cardiac autonomic modulation in children. J Pediatr (Rio J). 2016;92:638-44. ^,^☆☆ ☆☆ Institution to which this work is linked: Universidade Estadual do Ceará, Fortaleza, CE, Brazil.

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Abstract

Objective:

To compare the autonomic behavior between malnourished children and a control group using analysis of heart rate variability (HRV).

Method:

Data were analyzed from 70 children who were divided into two groups: malnourished and eutrophic, according to the Z-score nutritional status for height and age. For analysis of HRV indices, heart rate was recorded beat to beat with the child in the supine position for 20 min. The analysis of these indices was performed using linear methods, analyzed in the time and frequency domains. Student's t-test for unpaired data and the Mann-Whitney test were used to compare variables between groups, with a significance level of 5%.

Results:

A reduction in systolic and diastolic blood pressure and an increase in heart rate were found in malnourished children compared to eutrophic children. The HRV indices suggested that malnourished children present reductions in both sympathetic and parasympathetic autonomic nervous system activity. The SDNN, rMSSD, NN50, pNN50, SD1, SD2, TINN, LF (ms²), and HF (ms²) indices were lower in malnourished children.

Conclusion:

Malnourished children present changes in cardiac autonomic modulation, characterized by reductions in both sympathetic and parasympathetic activity, as well as increased heart rate and decreased blood pressure.

KEYWORDS
Autonomic nervous system; Heart rate; Malnutrition; Heart rate variability; Child health

Variables	Malnourished	Eutrophic	p-Value
Age (years)	3.71 ± 0.75 (4.00) [3.46 to 3.97]	4.09 ± 0.85 (4.00) [3.79 to 4.38]	0.057
Weight (kg)	13.02 ± 1.71 (12.90) [12.43 to 13.61]	17.89 ± 3.04 (17.50) [16.85 to 18.94]	<0.001^a a Significant difference between the malnourished group and the eutrophic group (Student's t-test for unpaired data).
Height (cm)	91.53 ± 5.47 (91.00) [89.65 to 93.41]	106.83 ± 8.15 (108.00) [104.03 to 109.63]	<0.001^a a Significant difference between the malnourished group and the eutrophic group (Student's t-test for unpaired data).
Z-score	−2.80 ± 0.588 (−2.79) [−3.00 to −2.60]	0.191 ± 1.28 (0.00) [−0.25 to 0.63]	<0.001^a a Significant difference between the malnourished group and the eutrophic group (Student's t-test for unpaired data).
SBP (mmHg)	102.14 ± 6.56 (100.00) [99.89 to 104.40]	107.14 ± 8.60 (110.00) [104.19 to 110.10]	0.008^a a Significant difference between the malnourished group and the eutrophic group (Student's t-test for unpaired data).
DBP (mmHg)	63.43 ± 6.84 (60.00) [61.08 to 65.78]	68.00 ± 8.68 (70.00) [65.02 to 70.98]	0.0256^b b Significant difference between the malnourished group and the eutrophic group (Mann-Whitney).
HR (bpm)	113.46 ± 14.132 (111.00) [108.60 to 118.32]	104.66 ± 10.55 (105.00) [101.03 to 108.28]	0.0054^b b Significant difference between the malnourished group and the eutrophic group (Mann-Whitney).

Variables	Malnourished	Eutrophic	p-Value
LF (ms²)	343.43 ± 259.06 (260.00) [254.38-432.48]	798.20 ± 749.71 (612.00) [540.49-1055.9]	<0.001^a a Significant difference between groups (Mann-Whitney).
HF (ms²)	208.69 ± 176.01 (142.00) [148.18-269.19]	464.46 ± 299.14 (422.00) [361.63-567.29]	<0.001^a a Significant difference between groups (Mann-Whitney).
LF (nu) (%)	63.17 ± 14.19 (59.70) [58.29-68.04]	61.65 ± 12.40 (65.10) [57.39-65.92]	0.8006
HF (nu) (%)	35.98 ± 14.19 (36.30) [31.11-40.86]	38.12 ± 12.30 (34.70) [33.89-42.35]	0.5769
LF/HF	2.33 ± 1.67 (1.75) [1.75-2.90]	1.92 ± 1.15 (1.88) [1.52-2.31]	0.6638

Variables	Malnourished	Eutrophic	p-Value
RR interval (ms)	537.59 ± 49.92 (521.50) [520.43-554.75]	591.20 ± 57.56 (577.60) [571.41-610.98]	0.0001^a a Significant difference between groups (Mann-Whitney).
SDNN (ms)	32.09 ± 11.16 (29.90) [28.25-35.92]	47.16 ± 15.22 (44.90) [41.93-52.39]	<0.001^a a Significant difference between groups (Mann-Whitney).
rMSSD (ms)	21.54 ± 9.48 (21.20) [18.28-24.79]	32.75 ± 11.35 (31.90) [28.85-36.66]	<0.001^b b Significant difference between groups (Student's t-test for unpaired data).
NN50 (ms)	53.91 ± 65.94 (31.00) [31.25-76.58]	140.46 ± 109.92 (118.00) [102.67-178.24]	0.0001^a a Significant difference between groups (Mann-Whitney).
pNN50 (%)	5.35 ± 6.62 (3.10) [3.08-7.63]	13.88 ± 10.72 (11.80) [10.20-17.56]	0.0001^a a Significant difference between groups (Mann-Whitney).

Variables	Malnourished	Eutrophic	p-Value
SD1 (ms)	15.50 ± 6.43 (15.00) [13.29-17.71]	23.16 ± 8.02 (22.50) [20.40-25.92]	<0.001^a a Significant difference between groups (Student's t-test for unpaired data).
SD2 (ms)	42.47 ± 14.93 (39.80) [37.34-47.61]	62.34 ± 20.56 (58.30) [55.27-69.40]	<0.001^b b Significant difference between groups (Mann-Whitney).
SD1/SD2	0.37 ± 0.10 (0.36) [0.33-0.40]	0.375 ± 0.09 (0.35) [0.34-0.41]	0.7601
Triangular index	8.85 ± 3.14 (8.48) [7.77-9.23]	12.75 ± 3.54 (12.67) [11.54-13.97]	<0.001^b b Significant difference between groups (Mann-Whitney).
TINN (ms)	151.43 ± 59.61 (140.00) [130.94-171.92]	220.86 ± 63.90 (215.00) [198.89-242.82]	<0.001^b b Significant difference between groups (Mann-Whitney).

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[1] * Corresponding author. E-mail:glauciasiqueirabarreto@gmail.com (G.S. Barreto).