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. 1986 Oct 1;135(7):753–758.

Malnutrition and the heart.

J G Webb, M C Kiess, C C Chan-Yan
PMCID: PMC1491347  PMID: 3093042

Abstract

Earlier concepts that the heart is spared in malnutrition have been shown to be incorrect. Inadequate intake of protein and energy results in proportional loss of skeletal and myocardial muscle. As myocardial mass decreases, so does the ability to generate cardiac output; however, various compensatory factors come into play. Nutritional supplementation for malnourished patients reverses the compensatory factors and may increase the short-term potential for heart failure. Severe cardiac debility results in poor nutrition, which may in turn produce unsuspected but clinically significant myocardial atrophy. Nutritional support may play a role in improving cardiac function in selected patients with cardiac cachexia who are being prepared for cardiac surgery and in patients with rapid weight loss who are at risk for sudden death due to arrhythmias. Malnutrition is common in hospitalized patients, and many patients in hospital now receive nutritional supplementation; both facts have important cardiac implications.

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Selected References

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  1. Abel R. M., Fisch D., Horowitz J., van Gelder H. M., Grossman M. L. Should nutritional status be assessed routinely prior to cardiac operation? J Thorac Cardiovasc Surg. 1983 May;85(5):752–757. [PubMed] [Google Scholar]
  2. Abel R. M., Fischer J. E., Buckley M. J., Austen W. G. Hyperalimentation in cardiac surgery. A review of sixty-four patients. J Thorac Cardiovasc Surg. 1974 Feb;67(2):294–300. [PubMed] [Google Scholar]
  3. Abel R. M., Fischer J. E., Buckley M. J., Barnett G. O., Austen W. G. Malnutrition in cardiac surgical patients. Results of a prospective, randomized evaluation of early postoperative parenteral nutrition. Arch Surg. 1976 Jan;111(1):45–50. doi: 10.1001/archsurg.1976.01360190047008. [DOI] [PubMed] [Google Scholar]
  4. Abel R. M., Paul J. Failure of short-term nutritional convalescence to reverse the adverse hemodynamic effects of protein-calorie malnutrition in dogs. JPEN J Parenter Enteral Nutr. 1979 Jul-Aug;3(4):211–214. doi: 10.1177/014860717900300401. [DOI] [PubMed] [Google Scholar]
  5. Alleyne G. A. The effect of severe protein calorie malnutrition on the renal function of Jamaican children. Pediatrics. 1967 Mar;39(3):400–411. [PubMed] [Google Scholar]
  6. Amatruda J. M., Biddle T. L., Patton M. L., Lockwood D. H. Vigorous supplementation of a hypocaloric diet prevents cardiac arrhythmias and mineral depletion. Am J Med. 1983 Jun;74(6):1016–1022. doi: 10.1016/0002-9343(83)90804-5. [DOI] [PubMed] [Google Scholar]
  7. Bistrian B. R., Blackburn G. L., Vitale J., Cochran D., Naylor J. Prevalence of malnutrition in general medical patients. JAMA. 1976 Apr 12;235(15):1567–1570. [PubMed] [Google Scholar]
  8. Bistrian B. Anthropometric norms used in assessment of hospitalized patients. Am J Clin Nutr. 1980 Oct;33(10):2211–2214. doi: 10.1093/ajcn/33.10.2211. [DOI] [PubMed] [Google Scholar]
  9. Blackburn G. L., Gibbons G. W., Bothe A., Benotti P. N., Harken D. E., McEnany T. M. Nutritional support in cardiac cachexia. J Thorac Cardiovasc Surg. 1977 Apr;73(4):489–496. [PubMed] [Google Scholar]
  10. Blackburn G. L., Harvey K. B. Nutritional assessment as a routine in clinical medicine. Postgrad Med. 1982 May;71(5):46–63. doi: 10.1080/00325481.1982.11716062. [DOI] [PubMed] [Google Scholar]
  11. Bloom W. L., Azar G., Smith E. G., Jr Changes in heart size and plasma volume during fasting. Metabolism. 1966 May;15(5):409–413. doi: 10.1016/0026-0495(66)90081-3. [DOI] [PubMed] [Google Scholar]
  12. Chauhan S., Nayak N. C., Ramalingaswami V. The heart and skeletal muscle in experimental protein malnutrition in rhesus monkeys. J Pathol Bacteriol. 1965 Jul;90(1):301–309. doi: 10.1002/path.1700900134. [DOI] [PubMed] [Google Scholar]
  13. DAVIDSON J. D., WALDMANN T. A., GOODMAN D. S., GORDON R. S., Jr Protein-losing gastroenteropathy in congestive heart-failure. Lancet. 1961 Apr 29;1(7183):899–902. doi: 10.1016/s0140-6736(61)91768-8. [DOI] [PubMed] [Google Scholar]
  14. Edozien J. C., Rahim-Khan M. A. Anaemia in protein malnutrition. Clin Sci. 1968 Apr;34(2):315–326. [PubMed] [Google Scholar]
  15. Einhorn D., Young J. B., Landberg L. Hypotensive effect of fasting: possible involvement of the sympathetic nervous system and endogenous opiates. Science. 1982 Aug 20;217(4561):727–729. doi: 10.1126/science.7100917. [DOI] [PubMed] [Google Scholar]
  16. Field S., Kelly S. M., Macklem P. T. The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis. 1982 Jul;126(1):9–13. doi: 10.1164/arrd.1982.126.1.9. [DOI] [PubMed] [Google Scholar]
  17. Fleming C. R., Lie J. T., McCall J. T., O'Brien J. F., Baillie E. E., Thistle J. L. Selenium deficiency and fatal cardiomyopathy in a patient on home parenteral nutrition. Gastroenterology. 1982 Sep;83(3):689–693. [PubMed] [Google Scholar]
  18. Frank A., Graham C., Frank S. Fatalities on the liquid-protein diet: an analysis of possible causes. Int J Obes. 1981;5(3):243–248. [PubMed] [Google Scholar]
  19. Garnett E. S., Barnard D. L., Ford J., Goodbody R. A., Woodehouse M. A. Gross fragmentation of cardiac myofibrils after therapeutic starvation for obesity. Lancet. 1969 May 3;1(7601):914–916. doi: 10.1016/s0140-6736(69)92546-x. [DOI] [PubMed] [Google Scholar]
  20. Gibbons G. W., Blackburn G. L., Harken D. E., Valdes P. J., Moorehead D., Bistrian B. R. Pre- and postoperative hyperalimentation in the treatment of cardiac cachexia. J Surg Res. 1976 May;20(5):439–444. doi: 10.1016/0022-4804(76)90117-7. [DOI] [PubMed] [Google Scholar]
  21. Heymsfield S. B., Bethel R. A., Ansley J. D., Gibbs D. M., Felner J. M., Nutter D. O. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J. 1978 May;95(5):584–594. doi: 10.1016/0002-8703(78)90300-9. [DOI] [PubMed] [Google Scholar]
  22. Heymsfield S. B., Head C. A., McManus C. B., 3rd, Seitz S., Staton G. W., Grossman G. D. Respiratory, cardiovascular, and metabolic effects of enteral hyperalimentation: influence of formula dose and composition. Am J Clin Nutr. 1984 Jul;40(1):116–130. doi: 10.1093/ajcn/40.1.116. [DOI] [PubMed] [Google Scholar]
  23. Heymsfield S. B., Smith J., Redd S., Whitworth H. B., Jr Nutritional support in cardiac failure. Surg Clin North Am. 1981 Jun;61(3):635–652. doi: 10.1016/s0039-6109(16)42442-4. [DOI] [PubMed] [Google Scholar]
  24. Isner J. M., Roberts W. C., Heymsfield S. B., Yager J. Anorexia nervosa and sudden death. Ann Intern Med. 1985 Jan;102(1):49–52. doi: 10.7326/0003-4819-102-1-49. [DOI] [PubMed] [Google Scholar]
  25. Isner J. M., Sours H. E., Paris A. L., Ferrans V. J., Roberts W. C. Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval. Circulation. 1979 Dec;60(6):1401–1412. doi: 10.1161/01.cir.60.6.1401. [DOI] [PubMed] [Google Scholar]
  26. Johnson R. A., Baker S. S., Fallon J. T., Maynard E. P., 3rd, Ruskin J. N., Wen Z., Ge K., Cohen H. J. An occidental case of cardiomyopathy and selenium deficiency. N Engl J Med. 1981 May 14;304(20):1210–1212. doi: 10.1056/NEJM198105143042005. [DOI] [PubMed] [Google Scholar]
  27. Landsberg L., Young J. B. Fasting, feeding and regulation of the sympathetic nervous system. N Engl J Med. 1978 Jun 8;298(23):1295–1301. doi: 10.1056/NEJM197806082982306. [DOI] [PubMed] [Google Scholar]
  28. Lantigua R. A., Amatruda J. M., Biddle T. L., Forbes G. B., Lockwood D. H. Cardiac arrhythmias associated with a liquid protein diet for the treatment of obesity. N Engl J Med. 1980 Sep 25;303(13):735–738. doi: 10.1056/NEJM198009253031305. [DOI] [PubMed] [Google Scholar]
  29. Meakins J. L., Pietsch J. B., Bubenick O., Kelly R., Rode H., Gordon J., MacLean L. D. Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma. Ann Surg. 1977 Sep;186(3):241–250. doi: 10.1097/00000658-197709000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Miller C. L. Immunological assays as measurements of nutritional status: a review. JPEN J Parenter Enteral Nutr. 1978 Sep;2(4):554–566. doi: 10.1177/014860717800200406. [DOI] [PubMed] [Google Scholar]
  31. Moss A. J. Caution: very-low-calorie diets can be deadly. Ann Intern Med. 1985 Jan;102(1):121–123. doi: 10.7326/0003-4819-102-1-121. [DOI] [PubMed] [Google Scholar]
  32. Mullen J. L., Buzby G. P., Matthews D. C., Smale B. F., Rosato E. F. Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support. Ann Surg. 1980 Nov;192(5):604–613. doi: 10.1097/00000658-198019250-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Mullen J. L., Gertner M. H., Buzby G. P., Goodhart G. L., Rosato E. F. Implications of malnutrition in the surgical patient. Arch Surg. 1979 Feb;114(2):121–125. doi: 10.1001/archsurg.1979.01370260011001. [DOI] [PubMed] [Google Scholar]
  34. Müller J. M., Brenner U., Dienst C., Pichlmaier H. Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet. 1982 Jan 9;1(8263):68–71. doi: 10.1016/s0140-6736(82)90212-4. [DOI] [PubMed] [Google Scholar]
  35. Narasimhan N., Bennett W. M. Very-low-calorie diets and electrocardiographic changes. Ann Intern Med. 1985 May;102(5):716–716. doi: 10.7326/0003-4819-102-5-716_1. [DOI] [PubMed] [Google Scholar]
  36. O'Connor L. R., Wheeler W. S., Bethune J. E. Effect of hypophosphatemia on myocardial performance in man. N Engl J Med. 1977 Oct 27;297(17):901–903. doi: 10.1056/NEJM197710272971702. [DOI] [PubMed] [Google Scholar]
  37. PITTMAN J. G., COHEN P. THE PATHOGENESIS OF CARDIAC CACHEXIA. N Engl J Med. 1964 Aug 20;271:403–CONTD. doi: 10.1056/NEJM196408202710807. [DOI] [PubMed] [Google Scholar]
  38. Potts J. L., Dalakos T. G., Streeten D. H., Jones D. Cardiomyopathy in an adult with Bartter's syndrome and hypokalemia. Hemodynamic, angiographic and metabolic studies. Am J Cardiol. 1977 Dec;40(6):995–999. doi: 10.1016/0002-9149(77)90051-0. [DOI] [PubMed] [Google Scholar]
  39. Pringle T. H., Scobie I. N., Murray R. G., Kesson C. M., Maccuish A. C. Prolongation of the QT interval during therapeutic starvation: a substrate for malignant arrhythmias. Int J Obes. 1983;7(3):253–261. [PubMed] [Google Scholar]
  40. Quercia R. A., Korn S., O'Neill D., Dougherty J. E., Ludwig M., Schweizer R., Sigman R. Selenium deficiency and fatal cardiomyopathy in a patient receiving long-term home parenteral nutrition. Clin Pharm. 1984 Sep-Oct;3(5):531–535. [PubMed] [Google Scholar]
  41. RAPOPORT A., FROM G. L., HUSDAN H. METABOLIC STUDIES IN PROLONGED FASTING. I. INORGANIC METABOLISM AND KIDNEY FUNCTION. Metabolism. 1965 Jan;14:31–46. doi: 10.1016/0026-0495(65)90079-x. [DOI] [PubMed] [Google Scholar]
  42. Rochester D. F., Esau S. A. Malnutrition and the respiratory system. Chest. 1984 Mar;85(3):411–415. doi: 10.1378/chest.85.3.411. [DOI] [PubMed] [Google Scholar]
  43. SMYTHE P. M., SWANEPOEL A., CAMPBELL J. A. The heart in kwashiorkor. Br Med J. 1962 Jan 13;1(5271):67–73. doi: 10.1136/bmj.1.5271.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Sours H. E., Frattali V. P., Brand C. D., Feldman R. A., Forbes A. L., Swanson R. C., Paris A. L. Sudden death associated with very low calorie weight reduction regimens. Am J Clin Nutr. 1981 Apr;34(4):453–461. doi: 10.1093/ajcn/34.4.453. [DOI] [PubMed] [Google Scholar]
  45. Sowers J. R., Nyby M., Stern N., Beck F., Baron S., Catania R., Vlachis N. Blood pressure and hormone changes associated with weight reduction in the obese. Hypertension. 1982 Sep-Oct;4(5):686–691. doi: 10.1161/01.hyp.4.5.686. [DOI] [PubMed] [Google Scholar]
  46. Spencer I. O. Death during therapeutic starvation for obesity. Lancet. 1968 Jun 15;1(7555):1288–1290. doi: 10.1016/s0140-6736(68)92299-x. [DOI] [PubMed] [Google Scholar]
  47. Van Itallie T. B., Yang M. U. Cardiac dysfunction in obese dieters: a potentially lethal complication of rapid, massive weight loss. Am J Clin Nutr. 1984 May;39(5):695–702. doi: 10.1093/ajcn/39.5.695. [DOI] [PubMed] [Google Scholar]
  48. WRIGHT H. K., GANN D. S., ALBERTSEN K. EFFECT OF GLUCOSE ON SODIUM EXCRETION AND RENAL CONCENTRATING ABILITY AFTER STARVATION IN MAN. Metabolism. 1963 Sep;12:804–811. [PubMed] [Google Scholar]
  49. Wadden T. A., Stunkard A. J., Brownell K. D. Very low calorie diets: their efficacy, safety, and future. Ann Intern Med. 1983 Nov;99(5):675–684. doi: 10.7326/0003-4819-99-5-675. [DOI] [PubMed] [Google Scholar]
  50. Ware A. J. The liver when the heart fails. Gastroenterology. 1978 Mar;74(3):627–628. [PubMed] [Google Scholar]
  51. Weinsier R. L., Hunker E. M., Krumdieck C. L., Butterworth C. E., Jr Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr. 1979 Feb;32(2):418–426. doi: 10.1093/ajcn/32.2.418. [DOI] [PubMed] [Google Scholar]
  52. Wharton B. A., Howells G. R., McCance R. A. Cardiac failure in kwashiorkor. Lancet. 1967 Aug 19;2(7512):384–387. doi: 10.1016/s0140-6736(67)92006-5. [DOI] [PubMed] [Google Scholar]
  53. Yokota Y., Ota K., Ageta M., Ishida S., Toshima H., Kimura N. Effect of low protein diet on cardiac function and ultrastructure of spontaneously hypertensive rats loaded with sodium chloride. Recent Adv Stud Cardiac Struct Metab. 1976 May 26;12:157–162. [PubMed] [Google Scholar]

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