Introduction

Nutritional deficiencies or malnutrition refer to an inadequate level of nutrients present in someone’s diet is not a very common occurrence in Western regions having a higher socioeconomic status than certain tropical or subtropical regions. 

In some specific cases, inadequate nutritional intake can result in health deterioration and the development of a secondary disease. One of the rarer diseases associated with nutritional deficiency is endomyocardial fibrosis (EMF). This disease is relatively rare, and its endemic (most commonly affected) regions often suffer from poverty and poor access to healthcare. EMF and the link to nutritional deficiencies are under-recognised and undertreated. 

This article will explore endomyocardial fibrosis, the underlying risks and mechanisms involved in this disease, its links to diet and nutritional deficiencies, who is at risk, symptoms of these conditions, and potential treatments.

Nutritional deficiences 

Having a good nutritional state requires a balance between macronutrients, ensuring that there is a good amount of proteins, fats, carbohydrates and micronutrients like vitamins and minerals. Requirements of what ‘good’ proportions of nutrients within a diet are will vary throughout the course of a person’s life. Babies and children under the age of 5 need a much greater quantity of food and nutrients in proportion to their size in comparison to adults to enable growth. Similarly, the elderly may need more energy to maintain daily activities.¹

Nutritional deficiencies are defined as a significant reduction in the intake of essential nutrients leading to lowered energy, significant health impairment and an increased risk of developing associated diseases. 

Unfortunately, the incidence of nutritional deficiencies is increasing around the world. Those most at risk include groups of people in lower socioeconomic categories, the elderly who are above the age of 65 and those with autoimmune or malabsorptive disorders. ² Some of the more common diseases related to malabsorption are coeliac disease and cystic fibrosis, as there is a reduction in the body's ability to absorb the vital nutrients, leading to poor health.³

Endomyocardial fibrosis 

Endomyocardial Fibrosis (EMF) is a type of cardiomyopathy (disease of the heart muscle) typically seen in areas affected by poverty. Endemic areas include tropical and subtropical regions such as Africa and China.⁴ EMF presents in children or young adults who experience nutritional deficiency and low socioeconomic status.⁵

Certain studies have identified a correlation between a higher risk of parasitic infection in endemic areas of EMF and nutritional deficiency/malnutrition being a significant risk factor for EMF progression. Unfortunately, since patients usually arrive at very advanced stages of the condition, standard treatments for heart failure may not be fully effective. Nonetheless, these treatments can help in managing related symptoms. In exceptionally severe instances, a heart transplant might be the only treatment.⁷

Nutritional challenges and cardiac disease

Health and nutrition are key components in maintaining good heart health, and following a cardioprotective diet is essential.

Cardioprotective diets are those that include a wide variety of heart-healthy foods such as fruits and vegetables, whole grains, lean meats and ‘good’ fats and a minimal amount of processed foods and saturated ‘bad’ fats.⁸ There is a direct increased risk of poor cardiac morbidity and mortality rates with a poor diet. In certain endemic countries to EMF, access to cardioprotective diets is limited.

FAQs

What are the symptoms of nutritional deficiencies?

Nutritional deficiencies can affect several organ systems throughout the body. We normally require nine amino acids from our diet, which we cannot synthesise (make) ourselves. Without these, the body is unable to produce enough energy, leading to fatigue, weakness, and neurological issues.

Nutritional deficiency can also lead to many secondary conditions, such as:

• Scurvy - particularly linked to vitamin C deficiency
• Rickets and osteoporosis (brittle bone disease) - particularly linked to vitamin D and calcium deficiencies
• Decreased cognitive function
• Immune impairment - leading to more frequent and serious infections
• Vision impairments - particularly linked to vitamin A deficiency⁹

What are the symptoms of endomyocardial fibrosis (EMF)?

Symptoms of EMF include symptoms related to heart failure, such as:

• Shortness of breath (especially during activity/exercise)
• Fatigue and/or weakness of the muscles and body
• Swelling of the lower limbs (oedema) due to fluid congestion

Other associated symptoms more specific to EMF may include:

• A persistent cough or wheezing
• Nausea
• Chest pain (angina)
• Increased susceptibility to abnormal heart rhythms (arrhythmias)

While it is not 100% certain you have EMF based on whether you have any of these symptoms, you should always contact a healthcare professional if you are experiencing issues with breathing or chest pain.

What is the prognosis for EMF?

Due to the possibility of EMF leading to heart failure or arrhythmia, there is a generally poor prognosis for advanced cases of EMF. Atrial fibrillation (AF) in particular has been shown to negatively impact survival.

Early identification of the disease through patient compliance and vigilance is therefore crucial as well as necessary to enable accurate diagnosis and onset of treatment. Symptoms can be combatted using medication and surgical intervention, which can drastically improve prognosis, and should be considered in severe cases.

What is the treatment for EMF?

Medical therapy is mainly used for the management of symptoms, primarily those associated with heart failure. This may include: 

• Diuretics (e.g. furosemide) - to counter fluid buildup and congestion
• ACE inhibitors (e.g. ramipril) - to treat high blood pressure 
• Beta blockers (e.g. propranolol) - to treat high heart rate
• Anticoagulants (e.g. warfarin) - to help combat thrombosis (blood clot formation) and the event of a heart attack or stroke
• Anti-arrhythmics - can be several drug classes, including beta blockers and calcium channel blockers

Surgical resection (removal) of fibrotic scar tissue may also be considered. Surgery involves the removal of the fibrotic endocardium and the correction of any affected nearby heart valves. This can be done either with the conservation of the valve (valve repair) or with full valve replacement. Methods that involve conserving the native (already present) heart valve tend to lead to better outcomes.

Summary

Endomyocardial fibrosis (EMF) is rare and mostly found in regions suffering from poverty and limited healthcare. This article discusses EMF, its causes, the link to nutrition, who is at risk, its symptoms, and possible treatments. A balanced diet includes the right amounts of macronutrients (proteins, fats, carbohydrates) and micronutrients (vitamins and minerals). Different age groups have different nutritional needs. For example, young children require more nutrients relative to their size, while older adults may need extra energy for daily activities. Nutritional deficiencies are defined as a significant drop in essential nutrient intake, leading to lower energy levels, health impairments, and increased chances of related diseases. The number of people affected by these deficiencies is rising globally, especially among those in low-income groups, the elderly over 65, and individuals with specific disorders that impair nutrient absorption. EMF is a heart muscle disease common in poor regions, especially in tropical and subtropical areas like Africa and China. It mainly affects children and young adults with nutritional deficiencies and low socioeconomic status. Studies show a connection between parasitic infections in these areas and the progression of EMF, with malnutrition being a considerable risk factor.

Many patients present with late-stage symptoms, making typical heart failure treatments less effective. In severe cases, a heart transplant may be required. Good nutrition is vital for heart health. People should follow a heart-healthy diet rich in fruits, vegetables, whole grains, lean meats, and healthy fats while avoiding processed foods. Poor diets can lead to increased risk of heart-related issues, and access to nutritious food is often limited in areas where EMF is prevalent. Common symptoms of nutritional deficiencies include fatigue, weakness, and issues related to various organ systems. These deficiencies can lead to conditions such as scurvy, rickets, cognitive decline, and weakened immune function. EMF symptoms often mirror heart failure symptoms, like shortness of breath, fatigue, and swelling in the legs. Despite the poor prognosis for advanced EMF cases, early detection is vital for improving outcomes through medical treatment and possible surgery, including the removal of damaged heart tissue.