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Teng C, Shu D, Faerber JA, Goldenring J, Butto A, Tam V, Olsen R, Glatz AC, Cohen MS. Factors Associated with Growth in a Cohort of Children with Complex Biventricular Congenital Heart Disease. J Pediatr 2024; 267:113901. [PMID: 38181978 DOI: 10.1016/j.jpeds.2024.113901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024]
Abstract
OBJECTIVES To evaluate patterns and determinants of longitudinal growth among children requiring complex biventricular repair for congenital heart disease, as well as to assess for associations of growth with early feeding modality, comorbidities, postoperative complications, and socioeconomic characteristics. STUDY DESIGN A single-institution retrospective cohort study was performed in children born February 1999 to March 2009 with complex congenital heart disease who underwent biventricular repair before age 4 years, defined by Risk Adjustment in Congenital Heart Surgery-1 category 3-5. Clinical characteristics, height, weight, and body mass index (BMI) from ages 2-12 years were collected by chart review. Neighborhood-level socioeconomic data were identified using a geographic information system approach. The adjusted association of covariates with growth outcomes was estimated using multivariable linear regression models using generalized estimating equations. RESULTS Compared with population growth curves, the cohort (n = 150) trended toward early decrease in age-adjusted weight and height. Early tube feeding was significantly associated with decreased BMI before adolescence (-0.539; 95% CI -1.02, -0.054; P = .029). In addition, other clinical and perioperative characteristics had significant associations with growth, including low birth weight, preoperative tube feeds, need for multiple bypass runs, and diagnosis of feeding disorder. CONCLUSIONS Early childhood growth in children with complex biventricular repair may be impaired. Early tube feeding was associated with decreased BMI over the course of early childhood, which may indicate a need for continued close nutrition follow-up and support even beyond the duration of tube feeds.
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Affiliation(s)
- Christopher Teng
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Di Shu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jennifer A Faerber
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jacob Goldenring
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arene Butto
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, GA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert Olsen
- Center for Healthcare and Quality Analytics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Andrew C Glatz
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Meryl S Cohen
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Barracano R, Ciriello GD, Sarubbi B. Pharmacological therapy in adult congenital heart disease with coronary artery disease and atrial fibrillation. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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Jordan CAL, Alizadeh F, Ramirez LS, Kimbro R, Lopez KN. Obesity in Pediatric Congenital Heart Disease: The Role of Age, Complexity, and Sociodemographics. Pediatr Cardiol 2023:10.1007/s00246-023-03148-3. [PMID: 36964218 DOI: 10.1007/s00246-023-03148-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/11/2023] [Indexed: 03/26/2023]
Abstract
The prevalence of obesity in children with congenital heart disease (CHD) is greater than 25%, putting these patients at-risk for increased surgical morbidity and mortality. Our goal was to determine the association between CHD complexity, sociodemographic factors, and obesity. Our hypothesis was that among CHD patients, the odds of obesity would be highest in older children with simple CHD, and in all children with a lower socioeconomic status. We conducted a retrospective cohort study, reviewing electronic medical records of children aged 2-17 years from over 50 outpatient pediatric clinics in Houston, TX. Children were classified as simple or moderate/complex CHD, and obesity was defined by BMI ≥ 95th percentile for age and sex. Logistic regression was used to determine the association between sociodemographic factors and CHD complexity with obesity. We identified 648 CHD and 369,776 non-CHD patients. Children with simple CHD had a similar odds of obesity as non-CHD children. Children with CHD had a higher prevalence of obesity if they were older, male, Black, Hispanic, and publicly insured. Children with moderate/complex CHD had lower odds of obesity [OR 0.24 (95% CI 0.07-0.73)], however their predicted probability of obesity approached that of the general population as they aged. Additionally, there was an incremental relationship with poverty and obesity [1.01 (1.01-1.01)]. Awareness of which patients with CHD are at highest risk of obesity may help in targeting interventions to assist at-risk patients maintain a healthy lifestyle.
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Affiliation(s)
| | - Faraz Alizadeh
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Keila Natilde Lopez
- Texas Children's Hospital, Houston, TX, USA.
- Baylor College of Medicine, Houston, TX, USA.
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Moderate and Severe Congenital Heart Diseases Adversely Affect the Growth of Children in Italy: A Retrospective Monocentric Study. Nutrients 2023; 15:nu15030484. [PMID: 36771190 PMCID: PMC9919582 DOI: 10.3390/nu15030484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Children with congenital heart disease (CHD) are at increased risk for undernutrition. The aim of our study was to describe the growth parameters of Italian children with CHD compared to healthy children. We performed a cross-sectional study collecting the anthropometric data of pediatric patients with CHD and healthy controls. WHO and Italian z-scores for weight for age (WZ), length/height for age (HZ), weight for height (WHZ) and body mass index (BMIZ) were collected. A total of 657 patients (566 with CHD and 91 healthy controls) were enrolled: 255 had mild CHD, 223 had moderate CHD and 88 had severe CHD. Compared to CHD patients, healthy children were younger (age: 7.5 ± 5.4 vs. 5.6 ± 4.3 years, p = 0.0009), taller/longer (HZ: 0.14 ± 1.41 vs. 0.62 ± 1.20, p < 0.002) and heavier (WZ: -0,07 ± 1.32 vs. 0.31 ± 1.13, p = 0.009) with no significant differences in BMIZ (-0,14 ± 1.24 vs. -0.07 ± 1.13, p = 0.64) and WHZ (0.05 ± 1.47 vs. 0.43 ± 1.07, p = 0.1187). Moderate and severe CHD patients presented lower z-scores at any age, with a more remarkable difference in children younger than 2 years (WZ) and older than 5 years (HZ, WZ and BMIZ). Stunting and underweight were significantly more present in children affected by CHD (p < 0.01). In conclusion, CHD negatively affects the growth of children based on the severity of the disease, even in a high-income country, resulting in a significant percentage of undernutrition in this population.
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Ningsih FF, Abdillah HZ, Nafianti S. Comparison of lipid profile values in pediatric patients with cyanotic and acyanotic congenital heart disease. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.6.2022.404-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Incidence of congenital heart disease (CHD) is about 0.8% of every child born. This heart defect is associated with dyslipidemia in children. Lipid profiles examination in patients with CHD can be used to determine risk factors for atherosclerosis.
Objective To examine differences in lipid profiles in children with cyanotic and acyanotic CHD.
Methods This was a cross-sectional study on 60 pediatric CHD patients at Haji Adam Malik Hospital, Medan, North Sumatera, from December 2020 to March 2021. Subjects were included by consecutive sampling. Data of patient’s age, gender, weight, height, complete blood count, blood glucose, and lipid profiles were recorded. Unpaired T-test analysis and Mann-Whitney test were then performed to analyze variables in cyanotic and acyanotic CHD patients.
Results Of a total of 60 CHD children, 26 subjects had a diagnosis of cyanotic CHD and 34 subjects had a diagnosis of acyanotic CHD. The most common cause of cyanotic CHD was tetralogy of Fallot (76.9%), while the most common cause of acyanotic CHD were ventricular septal defect and patent ductus arteriosus (32.4% each). Analysis of lipid profiles on both groups revealed that low density lipoprotein (LDL) was significantly lower in the cyanotic group than in the acyanotic group (P<0.05). However, other lipid profile values, were not significantly different between groups. In addition, there was no significant difference in incidence of dyslipidemia between cyanotic and acyanotic CHD.
Conclusion Low density lipoprotein is significantly lower in the cyanotic CHD group than in the acyanotic CHD group. But there are no significant differences in the other lipid profiles measurement and incidence of dyslipidemia between groups.
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Prescription medication use after congenital heart surgery. Cardiol Young 2022; 32:1786-1793. [PMID: 34986916 DOI: 10.1017/s1047951121005060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. METHODS Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. RESULTS Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7-2.1; severe hazard ratio 6.5, 95% confidence interval 5.3-8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8-3.7; severe hazard ratio 38.8, 95% CI 27.5-54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. CONCLUSIONS The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.
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Schipper HS, de Ferranti S. Atherosclerotic Cardiovascular Risk as an Emerging Priority in Pediatrics. Pediatrics 2022; 150:189711. [PMID: 36217888 DOI: 10.1542/peds.2022-057956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Over the last decades, childhood and adolescence have emerged as an important window of opportunity to prevent atherosclerotic cardiovascular disease (ASCVD) later in life. Here, we discuss the underlying advances in the field. First, atherosclerosis development starts as early as childhood. Atherogenesis initiates in the iliac arteries and abdominal aorta and subsequently develops in higher regions of the arterial tree, as has been demonstrated in nonhuman primate studies and human autopsy studies. Obesity, hypertension, hyperlipidemia, and hyperglycemia at a young age can accelerate atherogenesis. Children and adolescents with obesity have a relative risk of ∼ 2.5 for ASCVD mortality later in life, compared to peers with a normal weight. Conversely, early prevention improves long-term cardiovascular outcomes. Second, we review disease-associated factors that add to the traditional risk factors. Various pediatric disorders carry similar or even higher risks of ASCVD than obesity, including chronic inflammatory disorders, organ transplant recipients, familial hypercholesterolemia, endocrine disorders, childhood cancer survivors, chronic kidney diseases, congenital heart diseases, and premature birth, especially after fetal growth restriction. The involved disease-associated factors that fuel atherogenesis are diverse and include inflammation, vascular, and endothelial factors. The diverse and growing list of pediatric groups at risk underscores that cardiovascular risk management has solidly entered the realm of general pediatrics. In a second review in this series, we will, therefore, focus on recent advances in cardiovascular risk assessment and management and their implications for pediatric practice.
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Affiliation(s)
- Henk S Schipper
- Department of Pediatric Cardiology.,Center for Translational Immunology, Wilhelmina Children's Hospital and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah de Ferranti
- Department of Cardiology, Boston Children's Hospital and Harvard University Medical School, Boston, Massachusetts
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8
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Pacheco MA, Cardoso SM, Honicky M, Moreno YMF, Lima LRAD, Marcos CS, Back IDC. HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Abstract
INTRODUCTION With increased survival, children with CHD are reaching adulthood, however, obesity amongst this cohort is an emerging problem. Making every contact count encourages clinicians to utilise contact to elicit behaviour change. The aim of this work was to identify whether the body habitus of children classified as obese was addressed during a clinical review. METHODS A retrospective observational cohort study was completed using a cardiology outpatient dataset from 2010 to 2019. Inclusion criteria are all children with a body mass index z score classified as obese (≥ 2 z scores). Individual electronic patient records were reviewed to identify long-term anthropometric measures including (i) recognition of body habitus, (ii) prescription of physical activity or dietary intervention, and (iii) referral to a weight management programme or dietitian. RESULTS From the cohort of 95 patients, 285 "obese clinical encounters" were identified, at the time of a cardiology clinic attendance. Of those, obesity was acknowledged in 25 clinic letters (8.65%), but only 8 used the correct terms "obese" or "obesity" (2.77%). Action to tackle obesity was recorded in 9.3% of cases with a direct referral to a dietitian being made on 3 occasions (1.04%). CONCLUSIONS Body habitus is not being routinely addressed by cardiologists caring for paediatric and young adult cardiac patients. This study has recognised an alarmingly high incidence of missed opportunities to make every contact count, to manage those with obesity and associated risk factors.
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van Egmond-van Dam JC, Vliet Vlieland TPM, Kuipers IM, Blom NA, Ten Harkel ADJ. Improvement of physical activity levels in children and adolescents after surgery for congenital heart disease: preferences and use of physical therapy. Disabil Rehabil 2021; 44:5101-5108. [PMID: 34100664 DOI: 10.1080/09638288.2021.1924298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE After surgery for congenital heart disease in children and adolescents, an active lifestyle is important to achieve and maintain good physical fitness. This study aimed to describe physical activity, as well as the use of patients' and parents' preferences for rehabilitative care after surgery for congenital heart disease. METHODS This cross-sectional study included patients aged 4-16 years old, who had undergone surgery for congenital heart disease 2 years prior to the study onset. Patients and/or parents were invited to complete questionnaires on physical activity, and on their preferences for, and -use of, rehabilitative care after surgery. RESULTS Forty-five of the 92 eligible patients and/or parents completed the questionnaires. The median age of the children was 12.2 years (IQR 7.8-16.1). Two children (4%) met the recommendations for taking part in moderate physical activity and 13 (29%) having done so for vigorous physical activity. Postoperatively 15 children (33%) had had physical therapy in primary care. More than 50% of the patients/parents would have preferred to have had more information on physical activity and to have taken part in an individual exercise program delivered during their primary care. CONCLUSION The majority of eligible patients do not meet public health recommendations for engaging in physical activity and do not use physical therapy after surgery for congenital heart disease. The majority of patients and parents preferred more information as well as individual physical therapy treatments.Implications for rehabilitationsTwo years after surgery for congenital heart disease children and adolescents are less active compared to typically developing peers.Patients with a congenital heart disease and their parents need more information and support regarding stimulation of physical activity and physical fitness after heart surgery.In the postoperative process, a well-structured and supportive (individual) rehabilitation program should be introduced to improve physical activity and physical fitness.
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Affiliation(s)
- J C van Egmond-van Dam
- Department of Orthopaedics, Rehabilitation and Physical therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical therapy, Leiden University Medical Center, Leiden, The Netherlands.,Basalt Revalidatie, Leiden, The Netherlands
| | - I M Kuipers
- Department of Pediatrics, Division of Pediatric Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - N A Blom
- Department of Pediatrics, Division of Pediatric Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Pediatrics, Division of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A D J Ten Harkel
- Department of Pediatrics, Division of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Berkman E, Wightman A, Friedland-Little JM, Albers EL, Diekema D, Lewis-Newby M. An ethical analysis of obesity as a determinant of pediatric heart transplant candidacy. Pediatr Transplant 2021; 25:e13913. [PMID: 33179426 DOI: 10.1111/petr.13913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Inclusion of BMI as criterion in the determination of heart transplant candidacy in children is a clinical and ethical challenge. Childhood obesity is increasing and children with heart disease are not spared. Currently, many adult heart transplant centers consider class II obesity and higher (BMI > 35 kg/m2 ) to be a relative contraindication for transplantation due to risk of poor outcome after transplant. No national guidelines exist regarding consideration of BMI in pediatric heart transplant and outcomes data are limited. This leaves decisions about transplant candidacy in obese pediatric patients to individual institutions or on a case-by-case basis, allowing for bias and inequity. METHODS We review (a) the prevalence of childhood obesity, including among heart transplant candidates, (b) the lack of existing BMI guidelines, and (c) relevant literature on BMI and pediatric heart transplant outcomes. We discuss the ethical considerations of using obesity as a criterion using the principles of utility, justice, and respect for persons. RESULTS Existing transplant outcomes data do not show that obese children have different or poor enough outcomes compared to non-obese children to warrant exclusion. Moreover, obesity in the United States is unequally distributed by race and socioeconomic status. Children already suffering from health disparities are therefore doubly penalized if obesity denies them access to life-saving transplant. CONCLUSION Insufficient data exist to support using any BMI cutoff as an absolute contraindication for heart transplant in children. Attention should be paid to health equity issues when considering excluding a patient for transplant based on obesity.
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Affiliation(s)
- Emily Berkman
- Division of Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Aaron Wightman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA.,Division of Pediatric Nephrology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Joshua M Friedland-Little
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Erin L Albers
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Douglas Diekema
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA.,Division of Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Mithya Lewis-Newby
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA.,Division of Pediatric Cardiac Critical Care, University of Washington School of Medicine Ι Seattle Children's Hospital, Seattle, WA, USA
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Zaqout M, Vandekerckhove K, De Wolf D, Panzer J, Bové T, François K, De Henauw S, Michels N. Determinants of Physical Fitness in Children with Repaired Congenital Heart Disease. Pediatr Cardiol 2021; 42:857-865. [PMID: 33484289 DOI: 10.1007/s00246-021-02551-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
The aim of this study was to determine factors associated with physical fitness (PF) in children who underwent surgery for congenital heart disease (CHD). Sixty-six children (7-14 years) who underwent surgery for ventricular septal defect (n = 19), transposition of great arteries (n = 22), coarctation of aorta (n = 10), and tetralogy of Fallot (n = 15) were included. All children performed PF tests: cardiorespiratory fitness, upper- and lower-limb muscle strength, speed, balance, and flexibility. Cardiac evaluation was done via echocardiography and cardiopulmonary exercise test. Factors related to child's characteristics, child's lifestyle, physical activity motivators/barriers, and parental factors were assessed. Linear regression analyses were conducted. The results showed no significant differences in physical activity (PA) level by CHD type. Boys had better cardiorespiratory fitness (difference = 1.86 ml/kg/min [0.51;3.22]) and were more physically active (difference = 19.40 min/day [8.14;30.66]), while girls had better flexibility (difference = - 3.60 cm [- 7.07;- 0.14]). Physical activity motivators showed an association with four out of six PF components: cardiorespiratory fitness, coefficient = 0.063 [0.01;0.11]; upper-limb muscle strength, coefficient = 0.076 [0.01;0.14]; lower-limb muscle strength, coefficient = 0.598 [0.07;1.13]; and speed, coefficient = 0.03 [0.01;0.05]. Age, sex, and motivators together reached a maximum adjusted R2 = 0.707 for upper-limb strength. Adding other possible determinants did not significantly increase the explained variance. Apart from age and sex as non-modifiable determinants, the main target which might improve fitness would be the introduction of an intervention which increases the motivation to be active.
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Affiliation(s)
- Mahmoud Zaqout
- Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium. .,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Joseph Panzer
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nathalie Michels
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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13
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Niwa K. Metabolic syndrome and coronary artery disease in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:563-576. [PMID: 33968634 DOI: 10.21037/cdt-20-781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In adults with congenital heart disease (ACHD), conditions acquired with aging, such as metabolic syndrome, hypertension, diabetes mellitus, and obesity, can negatively influence the original cardiovascular disease. Metabolic syndrome has a higher prevalence in ACHD than in the general population. In contrast, coronary artery disease shows a similar prevalence in adults with acyanotic CHD and the general population, while adults with cyanotic CHD, even after repair, have an even lower incidence of coronary artery disease than the general population/adults with acyanotic CHD. However, even in those with cyanotic CHD, coronary artery disease can develop when they have risk factors such as obesity, dyslipidemia, hypertension, diabetes mellitus, smoking habit, or limited exercise. The prevalence of risk factors for cardiovascular disease is similar between ACHD and the general population, but an increased risk of coronary atherosclerosis has been observed for congenital coronary artery anomalies, dextro-transposition of the great arteries after arterial switch operation, Ross procedure, and coarctation of the aorta. Aortopathy may be an additional risk factor for cardiovascular disease. As ACHD have other abnormalities that may make the heart more vulnerable to both the development of atherosclerosis and adverse cardiovascular sequelae, regular evaluation of their cardiovascular disease risk status is recommended. Metabolic syndrome is more common among ACHD than in the general population, and may therefore increase the future incidence of atherosclerotic coronary artery disease even in ACHD. Thus, ACHD should be screened for metabolic syndrome to eliminate risk factors for atherosclerotic coronary artery disease.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo 104-8560, Japan
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Siddiqui S, Anderson BR, LaPar DJ, Kalfa D, Chai P, Bacha E, Freud L. Weight impacts 1-year congenital heart surgery outcomes independent of race/ethnicity and payer. Cardiol Young 2021; 31:279-285. [PMID: 33208210 PMCID: PMC8711065 DOI: 10.1017/s1047951120003911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Body mass index, race/ethnicity, and payer status are associated with operative mortality in congenital heart disease (CHD). Interactions between these predictors and impacts on longer term outcomes are less well understood. We studied the effect of body mass index, race/ethnicity, and payer on 1-year outcomes following elective CHD surgery and tested the degree to which race/ethnicity and payer explained the effects of body mass index. Patients aged 2-25 years who underwent elective CHD surgery at our centre from 2010 to 2017 were included. We assessed 1-year unplanned cardiac re-admissions, re-interventions, and mortality. Step-wise, multivariable logistic regression was performed.Of the 929 patients, 10.4% were underweight, 14.9% overweight, and 8.5% obese. Non-white race/ethnicity comprised 40.4% and public insurance 29.8%. Only 0.5% died prior to hospital discharge with one additional death in the first post-operative year. Amongst patients with continuous follow-up, unplanned re-admission and re-intervention rates were 14.7% and 12.3%, respectively. In multivariable analyses adjusting for surgical complexity and surgeon, obese, overweight, and underweight patients had higher odds of re-admission than normal-weight patients (OR 1.40, p = 0.026; OR 1.77, p < 0.001; OR 1.44, p = 0.008). Underweight patients had more than twice the odds of re-intervention compared with normal weight (OR 2.12, p < 0.001). These associations persisted after adjusting for race/ethnicity, payer, and surgeon.Pre-operative obese, overweight, and underweight body mass index were associated with unplanned re-admission and/or re-intervention 1-year following elective CHD surgery, even after accounting for race/ethnicity and payer status. Body mass index may be an important modifiable risk factor prior to CHD surgery.
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Affiliation(s)
- Saira Siddiqui
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett R Anderson
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Damien J LaPar
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - David Kalfa
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Chai
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Emile Bacha
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Lindsay Freud
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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Cao JY, Tran D, Briody J, Attard C, Hassan EB, Simm P, Burchill L, Twigg SM, Fiatarone-Singh MA, Ayer J, Celermajer DS, d'Udekem Y, Cordina R. Impact of adiposity on clinical outcomes in people living with a Fontan circulation. Int J Cardiol 2020; 329:82-88. [PMID: 33387555 DOI: 10.1016/j.ijcard.2020.12.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/22/2020] [Accepted: 12/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND To assess the association between body composition and the risk of adverse outcomes in Fontan patients. METHODS Participants from the Australian and New Zealand Fontan Registry with dual-energy X-ray absorptiometry scans were included. Appendicular lean mass (ALM), appendicular lean mass index (ALM divided by height squared; ALMI) and total body fat mass percentage (%BF) were calculated. ALMI and %BF z-scores were derived using age- and sex-matched reference ranges. The primary outcome was Fontan failure (death, transplantation, New York Heart Association functional class III/IV, protein-losing enteropathy, and plastic bronchitis) or moderate-or-severe ventricular dysfunction. RESULTS 144 patients were included. Mean %BF was 29% (SD 10) with 50% having increased adiposity. Mean ALMI z-score was -1.4 (SD 1.1); one third of patients had skeletal muscle deficiency (ALMI z-score < -1 and -2) and another third had Fontan-associated myopaenia (ALMI z-score < -2). Age and %BF were associated with the risk of the endpoint in univariable regression (age: HR 1.09 per year, 95% CI 1.02-1.17, p = 0.01; %BF: HR 1.08, 95% CI 1.01-1.17, p = 0.03). On multivariable regression, every 1% increase in %BF was associated with a 10% increased risk of reaching the clinical endpoint (HR 1.10, 95% CI 1.01-1.19; p = 0.03). ALM was not associated with the endpoint (HR 1.02 per kg, 95% CI 0.88-1.20, p = 0.77). CONCLUSIONS Increased adiposity is associated with higher risk for adverse outcomes. Prospective studies to assess lifestyle interventions to optimise body composition should be prioritised.
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Affiliation(s)
- Jacob Y Cao
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Derek Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chantal Attard
- Haematology Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ebrahim Bani Hassan
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia; Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Peter Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Luke Burchill
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Stephen M Twigg
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Maria A Fiatarone-Singh
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julian Ayer
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Yves d'Udekem
- Department of Paediatrics, Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Royal Children's Hospital, Melbourne, VIC, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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16
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Jokinen E. Coronary artery disease in patients with congenital heart defects. J Intern Med 2020; 288:383-389. [PMID: 32391638 DOI: 10.1111/joim.13080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
The prognosis of patients with congenital heart defects has improved significantly: more and more patients reach adulthood and old age. At the same time, the possibility of cardiovascular morbidity increases. The conventional risk factors for coronary artery disease are at least as high or even higher in patients than in the general population. Obesity and sedentary life style are more common in adults with congenital heart defect (ACHD) than in general population. In some patients, for example those with coarctation of the aorta or patients with operated coronary arteries in the infancy, the incidence of coronary artery disease (CAD) is clearly increased. In some patients with cyanotic heart defects (e.g. Fontan), the incidence of CAD might be lower, but it usually returns to the average level or higher after correction of the defect. Coronary artery disease is one of the most important reasons for mortality also in ACHD patients, and the consequences of a coronary event might be more fateful in a patient with a corrected congenital heart defect than in her/his peer. There should be a paradigm shift from operative mortality and short-term outcome to long-term morbidity and prevention of cardiovascular disease - a task that often has been forgotten during follow-up visits.
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Affiliation(s)
- E Jokinen
- Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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17
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Jackson JL, Fox KR, Cotto J, Harrison TM, Tran AH, Keim SA. Obesity across the lifespan in congenital heart disease survivors: Prevalence and correlates. Heart Lung 2020; 49:788-794. [PMID: 32980629 DOI: 10.1016/j.hrtlng.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) survivors are at risk for cardiovascular comorbidities exacerbated by obesity. OBJECTIVES Determine relationships between overweight/obesity and medical factors across the lifespan of CHD. METHODS Lesion severity, weight, blood pressure, cardiac and other comorbidities, and cardiac medications were abstracted from the medical records of 3790 CHD patients, aged ≥6 years, who attended CHD care in the Midwestern U.S. RESULTS The proportion of patients with overweight/obesity increased across the lifespan, with 73% of adults affected by overweight/obesity. Obesity was more prevalent among patients with moderate lesions (29%). Overweight/obesity was associated with elevated blood pressure across age and lesion severity. Young adults with obesity and simple or moderate lesions had more comorbidities (simple: IRR = 3.1, moderate: IRR = 2.3) and cardiac medications (simple: IRR = 2.2, moderate: IRR = 1.7). CONCLUSIONS Obesity and its cardiovascular correlates are present across the lifespan for CHD survivors, highlighting the need for early prevention and intervention.
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Affiliation(s)
- Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA.
| | - Kristen R Fox
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA.
| | - Jennifer Cotto
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA
| | - Tondi M Harrison
- College of Nursing, The Ohio State University, 1585 Neil Ave., Columbus, OH 43210, USA.
| | - Andrew H Tran
- Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA; The Heart Center, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA.
| | - Sarah A Keim
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3(rd) Floor, 431 S. 18(th) St., Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA; Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave, Columbus, OH 43210, USA.
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18
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Physical Activity Promotion in Pediatric Congenital Heart Disease: Are We Running Late? Can J Cardiol 2020; 36:1406-1416. [DOI: 10.1016/j.cjca.2020.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
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19
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Rombeek M, De Jesus S, Prapavessis H, Dempsey AA, Fraser D, Welisch E, Altamirano-Diaz L, Norozi K. Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study. PATIENT EDUCATION AND COUNSELING 2020; 103:1326-1334. [PMID: 32089389 DOI: 10.1016/j.pec.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children. METHODS Thirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified. RESULTS There was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change. CONCLUSIONS The study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children. PRACTICE IMPLICATIONS Remote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.
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Affiliation(s)
- Meghan Rombeek
- Department of Paediatrics, Western University, London, Canada
| | - Stefanie De Jesus
- Department of Paediatrics, Western University, London, Canada; School of Kinesiology, Western University, London, Canada
| | | | - Adam A Dempsey
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada
| | - Douglas Fraser
- Department of Paediatrics, Western University, London, Canada; Children's Health Research Institute, London, Canada; Translational Research Centre, London, Canada; Lawson Health Research Institute, London, Canada
| | - Eva Welisch
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada
| | - Luis Altamirano-Diaz
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada; Lawson Health Research Institute, London, Canada; Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany.
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20
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Honicky M, Cardoso SM, de Lima LRA, Ozcariz SGI, Vieira FGK, de Carlos Back I, Moreno YMF. Added sugar and trans fatty acid intake and sedentary behavior were associated with excess total-body and central adiposity in children and adolescents with congenital heart disease. Pediatr Obes 2020; 15:e12623. [PMID: 32050058 DOI: 10.1111/ijpo.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/07/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past three decades, the prevalence rate of overweight and obesity has increased in survivors with congenital heart disease, and little is known about the body composition and its association with clinical characteristics and lifestyle factors. OBJECTIVES To evaluate excess total-body adiposity and central adiposity and, to describe associated factors. METHODS Cross-sectional study with children and adolescents who underwent procedure to treat congenital heart disease, from January to July 2017. Sociodemographic and clinical characteristics, and lifestyle factors (dietary intake, physical activity, and sedentary behavior) were assessed. Adiposity was assessed using air-displacement plethysmography and waist circumference. Factors associated with excess total-body adiposity and central adiposity were analyzed using logistic regression models. RESULTS Of 232 patients, 22.4% were identified with excess total-body adiposity and 24.6% with central adiposity. Significant factors positively associated with excess total-body adiposity were intake of added sugar and trans fatty acids, adjusted for confounding factors. Similarly, lifestyle factors were positively associated with central adiposity: intake of added sugar and trans fatty acids, sedentary behavior, and family history of obesity. CONCLUSIONS Lifestyle factors were associated with excess total-body adiposity and central adiposity. Assessment of body composition and healthy-lifestyle counseling into outpatient care may be the key point to prevent obesity in children and adolescents with congenital heart disease.
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Affiliation(s)
- M Honicky
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - S M Cardoso
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - L R A de Lima
- Department of Physical Education, University of State Santa Catarina, Laguna, South Carolina, Brazil
| | - S G I Ozcariz
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - F G K Vieira
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - I de Carlos Back
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - Y M F Moreno
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
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21
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Yang FL, Gau BS, Yang HL, Lin MT, Moons P. Energy Balance-Related Behaviors and Body Mass Index in Asian School-Aged Children With Congenital Heart Disease. J Cardiovasc Nurs 2020; 35:291-299. [PMID: 32221146 DOI: 10.1097/jcn.0000000000000666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health. Most studies on CCHD have taken place in Western societies, leaving Asian populations understudied, especially children. OBJECTIVE We sought (1) to determine body mass index distribution among school-aged CCHD in Taiwan, (2) to ascertain whether the body mass index of CCHD differs from that of the general population, (3) to describe EBRBs in CCHD, and (4) to identify factors associated with underweight and overweight/obesity among CCHD. METHODS In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age, 9.73 years; 25.8% moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurements were taken in the hospital. Independent predictors of EBRBs and health conditions were calculated through logistic regression analysis. RESULTS Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obese. Children with moderate-to-severe heart defects were more often underweight. Body mass index did not differ between CCHD and children in the general population. More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the New York Heart Association classification II to IV were associated with being overweight/obese. CONCLUSIONS Sedentary lifestyle is seemingly the only EBRB correlated with being overweight. Physical activity programs for children may help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries.
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22
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Andonian C, Langer F, Beckmann J, Bischoff G, Ewert P, Freilinger S, Kaemmerer H, Oberhoffer R, Pieper L, Neidenbach RC. Overweight and obesity: an emerging problem in patients with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S360-S368. [PMID: 31737542 PMCID: PMC6837933 DOI: 10.21037/cdt.2019.02.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
Due to technological and medical advances the population of adults with congenital heart disease (ACHD) is constantly growing. Worldwide, congenital heart disease (CHD) affects 1.35-1.5 million children each year and the number of ACHD meanwhile exceeds the number of CHD children. It has been found that a substantial number of ACHD present problematic health behaviors, such as physical inactivity and bad nutritional habits. Recent studies document alarming rates of overweight and obesity among CHD patients which may consequently lead to further health complications in this population. The present article focuses on the distinct psychosocial effects resulting from the diagnosis of CHD and their impact on developing disordered eating patterns and excess weight. It seeks to identify unique risk factors and relevant explanations associated with the increasing prevalence of obesity among CHD patients. This review suggests a vital need to establish clinical guidelines for nutrition and weight management in this patient population as part of a holistic treatment approach.
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Affiliation(s)
- Caroline Andonian
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
- Technical University Munich, Munich, Germany
- Sigmund Freud University, Vienna, Austria
| | - Fabian Langer
- Department of Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder, Munich, Germany
| | - Jürgen Beckmann
- Technical University Munich, Munich, Germany
- University of Queensland, Brisbane, Australia
| | - Gert Bischoff
- Department of Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Sebastian Freilinger
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
- Technical University Munich, Munich, Germany
| | - Lars Pieper
- Department of Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Rhoia Clara Neidenbach
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
- Technical University Munich, Munich, Germany
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Shustak RJ, Cohen MS. What influences outcomes in pediatric and congenital cardiovascular disease?: A healthy lifestyle; obesity and overweight. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Niwa K. Metabolic Syndrome in Adult Congenital Heart Disease. Korean Circ J 2019; 49:691-708. [PMID: 31347322 PMCID: PMC6675699 DOI: 10.4070/kcj.2019.0187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
In adult congenital heart disease (ACHD), residua and sequellae after initial repair develop late complications such as cardiac failure, arrhythmias, thrombosis, aortopathy, pulmonary hypertension and others. Acquired lesions with aging such as hypertension, diabetes mellitus, obesity can be negative influence on original cardiovascular disease (CVD). Also, atherosclerosis may pose an additional health problem to ACHD when they grow older and reach the age at which atherosclerosis becomes clinically relevant. In spite of the theoretical risk of atherosclerosis in ACHD due to above mentioned factors, cyanotic ACHDs even after repair are noted to have minimal incidence of coronary artery disease (CAD). Acyanotic ACHD has similar prevalence of CAD as the general population. However, even in cyanotic ACHD, CAD can develop when they have several risk factors for CAD. The prevalence of risk factor is similar between ACHD and the general population. Risk of premature atherosclerotic CVD in ACHD is based, 3 principal mechanisms: lesions with coronary artery abnormalities, obstructive lesions of left ventricle and aorta such as coarctation of the aorta and aortopathy. Coronary artery abnormalities are directly affected or altered surgically, such as arterial switch in transposition patients, may confer greater risk for premature atherosclerotic CAD. Metabolic syndrome is more common among ACHD than in the general population, and possibly increases the incidence of atherosclerotic CAD even in ACHD in future. Thus, ACHD should be screened for metabolic syndrome and eliminating risk factors for atherosclerotic CAD.
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Affiliation(s)
- Koichiro Niwa
- Cardiovascular Center, Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
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25
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Abstract
OBJECTIVES Previous cross-sectional studies have demonstrated obesity rates in children with CHD and the general paediatric population. We reviewed longitudinal data to identify factors predisposing to the development of obesity in children, hypothesising that age may be an important risk factor for body mass index growth.Study designRetrospective electronic health records were reviewed in all 5-20-year-old CHD patients seen between 2011 and 2015, and in age-, sex-, and race/ethnicity-matched controls. Subjects were stratified into aged cohorts of 5-10, 11-15, and 15-20. Annualised change in body mass index percentile (BMI%) over this period was compared using paired Student's t-test. Linear regression analysis was performed with the CHD population. RESULTS A total of 223 CHD and 223 matched controls met the inclusion criteria for analysis. Prevalence of combined overweight/obesity did not differ significantly between the CHD cohort (24.6-25.8%) and matched controls (23.3-29.1%). Univariate analysis demonstrated a significant difference of BMI% change in the age cohort of 5-10 (CHD +4.1%/year, control +1.7%/year, p=0.04), in male sex (CHD +1.8%/year, control -0.3%/year, p=0.01), and status-post surgery (CHD 2.03%/year versus control 0.37%, p=0.02). Linear regression analysis within the CHD subgroup demonstrated that age 5-10 years (+4.80%/year, p<0.001) and status-post surgery (+3.11%/year, p=0.013) were associated with increased BMI% growth. CONCLUSIONS Prevalence rates of overweight/obesity did not differ between children with CHD and general paediatric population over a 5-year period. Longitudinal data suggest that CHD patients in the age cohort 5-10 and status-post surgery may be at increased risk of BMI% growth relative to peers with structurally normal hearts.
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Perin F, Carreras Blesa C, Rodríguez Vázquez del Rey MDM, Cobo I, Maldonado J. Overweight and obesity in children treated for congenital heart disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Steele JM, Preminger TJ, Erenberg FG, Wang L, Dell K, Alsaied T, Zahka KG. Obesity trends in children, adolescents, and young adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:517-524. [PMID: 30698365 DOI: 10.1111/chd.12754] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the prevalence, age of onset, and risk factors for overweight and obesity in children with congenital heart disease (CHD). STUDY DESIGN Children with CHD who were seen at our institution from 1996 to 2017 were studied. Patients were full-time residents of the United States and were receiving all cardiac care at our institution. Patients were categorized by age and CHD diagnosis. The date of last normal weight for age and the date of first recorded weight in the range of overweight and obese were documented. RESULTS Nine hundred sixty-eight patients with CHD were included. The prevalence of overweight and obesity was 31.5% and 16.4%, respectively. For patients who became overweight or obese, the last recorded normal weight was between 6 and 10 years of age. Electrophysiologic disease and older age were risk factors for obesity. CONCLUSIONS Children with CHD have an increasing risk of becoming overweight and obese in early childhood. This study provides important information and identifies critical period to implement preventative measures and counsel families about the risk of obesity in CHD.
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Affiliation(s)
- Jeremy M Steele
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.,Cleveland Clinic Children's, Cleveland, Ohio
| | - Tamar J Preminger
- Department of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lu Wang
- Department of Pediatric Cardiology, Quantitative Health Sciences Department, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Tarek Alsaied
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio
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Zaqout M, Vandekerckhove K, Michels N, Demulier L, Bove T, François K, De Backer J, De Henauw S, De Wolf D. Body mass index in adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:479-486. [PMID: 30681771 DOI: 10.1111/chd.12751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the status of body mass index (BMI) in adult people with congenital heart disease (ACHD). METHODS Five hundred thirty-nine adults with CHD (53.8% men) were seen in the outpatient clinic from 2013 to 2015 and compared to a reference population (n = 1737). The severity of CHD was categorized as mild, moderate, and severe according to standard guidelines. Patients were categorized based on BMI as underweight (<18.5), overweight (25-30), or obese (>30). Echocardiography and magnetic resonance imaging were used to measure ventricular function while exercise capacity was estimated via cardiopulmonary exercise test. RESULTS Adults with CHD had slightly lower BMI than the reference group (24.1 ± 4.3 vs 24.6 ± 4.3; P = .012). Men in the mild and severe group (23.9 ± 3.6; 23.3 ± 4.4 vs 25.1 ± 3.7; P = .007; P = .023) and women in the severe group (21.6 ± 3.3 vs 24.2 ± 4.7; P < .001) had lower BMI compared to the reference group. In the subgroups, men with ventricular septal defect, coarctation of aorta/ventricular septal defect and Fontan circulation and women with Fontan circulation had lower BMI than the reference group. Underweight was more prevalent in women with severe lesions compared to the reference group (22.2% vs 3.8%; P < .001). BMI was associated with age and exercise capacity in patients with mild and moderate lesions, while higher BMI was related to better ventricular function in women with Fontan circulation. CONCLUSION Underweight was more prevalent in ACHD patients with severe lesions. Special attention should be paid to the possible existence of underweight-related comorbidities.
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Affiliation(s)
- Mahmoud Zaqout
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laurent Demulier
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Julie De Backer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Stefaan De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
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Harris KC, Voss C, Rankin K, Aminzadah B, Gardner R, Mackie AS. Modifiable cardiovascular risk factors in adolescents and adults with congenital heart disease. CONGENIT HEART DIS 2018; 13:563-570. [DOI: 10.1111/chd.12612] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin C. Harris
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Christine Voss
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Kathryn Rankin
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Basmina Aminzadah
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Ross Gardner
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Andrew S. Mackie
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
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Perin F, Carreras Blesa C, Rodríguez Vázquez Del Rey MDM, Cobo I, Maldonado J. [Overweight and obesity in children treated for congenital heart disease]. An Pediatr (Barc) 2018; 90:102-108. [PMID: 29691131 DOI: 10.1016/j.anpedi.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/28/2018] [Accepted: 03/07/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The negative impact of overweight and obesity is potentially greater in children affected by a congenital heart disease (CHD). The aim of this study is to calculate the proportion of overweight and obesity in children who underwent an intervention for CHD, and to investigate systolic arterial hypertension as a possible early cardiovascular complication. PATIENTS AND METHODS A retrospective study was conducted on patients aged 6-17 years treated for CHD, and healthy control subjects, followed-up in a Paediatric Cardiology Clinic. Body mass index percentiles were calculated according to the criteria of WHO. A review was performed on the anthropometric and clinical data, as well as the systolic blood pressure (SBP). RESULTS A total of 440 patients were included, of which 220 had CHD. The proportion of combined obesity and overweight (body mass index percentile ≥85) was 36.4% (37.3% in healthy subjects and 35.4% in patients with CHD, P=.738). A higher prevalence of obesity (body mass index percentile ≥97) was found in CHD patients (22.7%) compared to 15.5% in healthy subjects (P=.015). SBP percentiles were higher in overweight compared to normal-weight patients (P < .001). The prevalence of SBP readings ≥ the 95th percentile was greater in overweight than in normal weight CHD patients (29.5% versus 7.7%, P < .001) and also in the overweight healthy controls compared to those of normal weight (12.2% versus 0.7%, P < .001). CONCLUSIONS The proportion of obesity is high in children treated for CHD and it is associated with elevated SBP levels. The risk of long-term complications needs to be reduced by means of prevention and treatment of obesity in this vulnerable population.
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Affiliation(s)
- Francesca Perin
- Unidad de Cardiología Infantil, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - Carmen Carreras Blesa
- Unidad de Cardiología Infantil, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | - Inmaculada Cobo
- Unidad de Cardiología Infantil, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España
| | - José Maldonado
- Unidad de Gastroenterología, Hepatología y Nutrición, Servicio de Pediatría, Hospital Universitario Virgen de las Nieves, Granada, España; Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, España; Instituto de Investigación Biosanitaria (ibs), Granada, España; Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, España
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Ryan TD, Zafar F, Siegel RM, Villa CR, Bryant R, Chin C. Obesity class does not further stratify outcome in overweight and obese pediatric patients after heart transplantation. Pediatr Transplant 2018; 22. [PMID: 29377429 DOI: 10.1111/petr.13161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/28/2022]
Abstract
The effect of obesity stratification on pediatric heart transplant outcomes is unknown. The UNOS database was queried for patients ≥2-<18 years listed for heart transplant and stratified by BMI: normal (BMI>5%-≤85 percentile), overweight (BMI=86%-95 percentile), class 1 (BMI=100%-120% of 95 percentile), class 2 (BMI=121%-140% of 95 percentile), and class 3 obesity (BMI>140% of 95 percentile). A total of 5056 individuals were listed for transplant, with 71% normal, 13% overweight, 10% class 1, 4% class 2, and 2% class 3 obesity. Waitlist survival was not different between groups. Post-transplant survival was decreased in overweight and combined obese groups vs normal, with no further difference between overweight and obese classes. Overweight and obese patients had higher listing status and were more likely to have ventilator, inotrope, and mechanical circulatory support at listing. After transplant, there was an association of overweight-obese patients with diabetes and rejection requiring hospitalization. Stricter definition of normal weight reveals overweight-obese status was an independent risk factor for poorer post-transplant survival, without further effect by stratification of weight class. However, because there is no difference in waitlist survival, this study does not allow the selection of absolute weight-based criteria regarding transplant listing and suggests the need to look further for modifiable risk factors post-transplant.
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Affiliation(s)
- Thomas D Ryan
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Farhan Zafar
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert M Siegel
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chet R Villa
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Roosevelt Bryant
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Clifford Chin
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Simpson SA, Field SL, Xu M, Saville BR, Parra DA, Soslow JH. Effect of Weight Extremes on Ventricular Volumes and Myocardial Strain in Repaired Tetralogy of Fallot as Measured by CMR. Pediatr Cardiol 2018; 39:575-584. [PMID: 29238854 PMCID: PMC5831485 DOI: 10.1007/s00246-017-1793-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
Pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF-TAP) is often based on cardiac MRI (CMR) right ventricular (RV) volumes indexed to body surface area (BSA). Weight extremes result in increased patient morbidity and affect indexed measurements. We hypothesized that patients with rTOF-TAP at extremes of weight have (1) over- or underestimated indexed volumes and (2) altered parameters of cardiac function. CMRs in patients with rTOF-TAP were retrospectively reviewed; analysis included right and left ventricular (LV) volumes and ejection fractions (EF) and peak global LV circumferential strain (ε cc) from myocardial tagged images. Indexed volumes were recalculated using ideal BSA. Weight categories were assigned: underweight, appropriate weight, overweight, and obese. Linear regression models with weight category, spline of age, and gender were created to assess the association of weight and parameters of volume and function. When RV volumes were corrected for ideal BSA, 11 (31%) additional overweight and obese patients met published criteria for PVR and 3 (38%) underweight patients no longer met criteria. Obese and overweight patients had larger absolute LV and RV diastolic volumes, but no difference in volumes indexed to ideal BSA. Modeling demonstrated no difference in LVEF or RVEF by weight categories but significant differences in global LV ε cc. Extremes of body weight may result in inappropriate timing of PVR. Extremes of weight lead to abnormalities in global LV ε cc. Although clinical implications of abnormal ε cc are unclear, these patients may be at higher risk for early ventricular dysfunction.
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Affiliation(s)
- Scott A. Simpson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | - Suzanne L. Field
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Benjamin R. Saville
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - David A. Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan H. Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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O’Byrne ML, McBride M, Paridon S, Goldmuntz E. Association of Habitual Activity and Body Mass Index in Survivors of Congenital Heart Surgery: A Study of Children and Adolescents With Tetralogy of Fallot, Transposition of the Great Arteries, and Fontan Palliation. World J Pediatr Congenit Heart Surg 2018; 9:177-184. [PMID: 29544424 PMCID: PMC6154798 DOI: 10.1177/2150135117752122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Obesity is associated with increased lifelong morbidity and reduced life span and is increasingly prevalent in the congenital heart disease population. Habitual exercise is an important aspect of a healthy lifestyle and primary prevention of obesity in the general population. The association between habitual activity and body mass index (BMI) has not been studied in children with congenital heart disease. METHODS A cross-sectional analysis of two previously collected cohorts was performed, including participants 8 to 18 years old with tetralogy of Fallot, transposition of the great arteries, and single ventricle heart disease after a Fontan operation. The association between BMI and duration of habitual exercise (measured by questionnaire) was studied. Secondary analyses assessing the effect of other possible factors for BMI were performed. RESULTS In total, 172 participants were studied (45% Tetralogy of Fallot, 12% transposition of the great arteries, and 43% Fontan). Median BMI was 18.2, and 29% of the participants were obese or overweight. Median habitual exercise was 5.9 h/wk. Thirty-eight percent of participants reported having their activity restricted by their cardiologist. Increasing exercise duration was associated with lower BMI ( P = .01) in univariate analysis. In secondary analyses, restriction to mild exertion and participation in low-intensity exercise were both associated with increased BMI. CONCLUSION Increased habitual activity was associated with lower BMI, emphasizing the potential role of recreational sport in the health of children with congenital heart disease.
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Affiliation(s)
- Michael L O’Byrne
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia PA
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia PA
- Leonard Davis Institute, The University of Pennsylvania, Philadelphia PA
| | - Michael McBride
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia PA
| | - Stephen Paridon
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia PA
| | - Elizabeth Goldmuntz
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia PA
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Obesity and Exercise Recommendations in Adult Congenital Heart Disease. ADULT CONGENITAL HEART DISEASE IN CLINICAL PRACTICE 2018. [DOI: 10.1007/978-3-319-67420-9_35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Altamirano-Diaz L, Rombeek M, De Jesus S, Welisch E, Prapavessis H, Dempsey AA, Fraser D, Miller MR, Norozi K. Remote Lifestyle Counseling Influences Cardiovascular Health Outcomes in Youth with Overweight or Obesity and Congenital Heart Disease. Front Pediatr 2017; 5:269. [PMID: 29326907 PMCID: PMC5741592 DOI: 10.3389/fped.2017.00269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/01/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children with overweight/obesity and congenital heart disease (CHD) are at increased cardiovascular risk. A lifestyle intervention may help reduce these risks. We sought to determine the feasibility of a smartphone-based lifestyle intervention to improve cardiovascular health outcomes in children with overweight/obesity and CHD. METHODS We examined the effect of bi-weekly nutrition and fitness counseling delivered via smartphone over 12 months. Thirty-four youth, previously diagnosed with CHD and with overweight or obesity, participated in the intervention. They were divided into two groups depending on whether the heart disease required surgical correction (operated, n = 19) or not (non-operated, n = 15). Anthropometry, body composition cardiorespiratory exercise capacity, and cardio-metabolic risk factors were assessed at baseline, 6 months, and 12 months. RESULTS Statistically significant decreases in waist circumference (WC), body mass index z-score, WC z-score, and waist to height ratio z-score were observed at 6 and 12 months in the operated group. A significant linear increase in lean body mass was observed in both groups. The study also had a high retention rate and a low attrition rate. CONCLUSION The observed changes in anthropometry were positive with significant improvement to some cardiovascular and metabolic risk indicators. However, this was only observed in the operated group suggesting that other factors, such as perception of condition and self-efficacy, may influence lifestyle behaviors. The results from this pilot study clearly demonstrate the feasibility to perform a larger controlled study on remote lifestyle intervention in children with congenital heart defects and overweight or obesity.
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Affiliation(s)
- Luis Altamirano-Diaz
- Department of Paediatrics, Western University, London, ON, Canada
- Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, ON, Canada
- Children’s Health Research Institute, London, ON, Canada
| | - Meghan Rombeek
- Department of Paediatrics, Western University, London, ON, Canada
| | - Stefanie De Jesus
- Department of Paediatrics, Western University, London, ON, Canada
- School of Kinesiology, Western University, London, ON, Canada
| | - Eva Welisch
- Department of Paediatrics, Western University, London, ON, Canada
- Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, ON, Canada
- Children’s Health Research Institute, London, ON, Canada
| | | | - Adam A. Dempsey
- Department of Paediatrics, Western University, London, ON, Canada
- Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, ON, Canada
| | - Douglas Fraser
- Department of Paediatrics, Western University, London, ON, Canada
- Children’s Health Research Institute, London, ON, Canada
- Translational Research Centre, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Michael R. Miller
- Department of Paediatrics, Western University, London, ON, Canada
- Children’s Health Research Institute, London, ON, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Western University, London, ON, Canada
- Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, ON, Canada
- Children’s Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany
- Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Goettingen, Germany
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Zaqout M, Vandekerckhove K, Michels N, Bove T, François K, De Wolf D. Physical Fitness and Metabolic Syndrome in Children with Repaired Congenital Heart Disease Compared with Healthy Children. J Pediatr 2017; 191:125-132. [PMID: 28965732 DOI: 10.1016/j.jpeds.2017.08.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine whether children who underwent surgery for congenital heart disease (CHD) are as fit as their peers. STUDY DESIGN We studied 66 children (6-14 years) who underwent surgery for ventricular septal defect (n = 19), coarctation of aorta (n = 10), tetralogy of Fallot (n = 15), and transposition of great arteries (n = 22); and 520 healthy children (6-12 years). All children performed physical fitness tests: cardiorespiratory fitness, muscular strength, balance, flexibility, and speed. Metabolic score was assessed through z-score standardization using 4 components: waist circumference, blood pressure, blood lipids, and insulin resistance. Assessment also included self-reported and accelerometer-measured physical activity. Linear regression analyses with group (CHD vs control) as a predictor were adjusted for age, body mass index, physical activity, and parental education. RESULTS Measured physical activity level, body mass index, cardiorespiratory fitness, flexibility, and total metabolic score did not differ between children with CHD and controls, whereas reported physical activity was greater in the CHD group than control group. Boys with CHD were less strong in upper muscular strength, speed, and balance, whereas girls with CHD were better in lower muscular strength and worse in balance. High-density lipoprotein was greater in boys and girls with CHD, whereas boys with CHD showed unhealthier glucose homeostasis. CONCLUSION Appropriate physical fitness was achieved in children after surgery for CHD, especially in girls. Consequently, children with CHD were not at increased total metabolic risk. Lifestyle counseling should be part of every patient interaction.
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Affiliation(s)
- Mahmoud Zaqout
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
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Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
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Exercise restriction is not associated with increasing body mass index over time in patients with anomalous aortic origin of the coronary arteries. Cardiol Young 2017; 27:1538-1544. [PMID: 28460658 DOI: 10.1017/s104795111700066x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anomalous aortic origin of the coronary arteries is associated with exercise-induced ischaemia, leading some physicians to restrict exercise in patients with this condition. We sought to determine whether exercise restriction was associated with increasing body mass index over time. From 1998 to 2015, 440 patients ⩽30 years old were enrolled into an inception cohort. Exercise-restriction status was documented in 143 patients. Using linear mixed model repeated-measures regression, factors associated with increasing body mass index z-score over time, including exercise restriction and surgical intervention as time-varying covariates, were investigated. The 143 patients attended 558 clinic visits for which exercise-restriction status was recorded. The mean number of clinic visits per patient was 4, and the median duration of follow-up was 1.7 years (interquartile range (IQR) 0.5-4.4). The median age at first clinic visit was 10.3 years (IQR 7.1-13.9), and 71% (101/143) were males. All patients were alive at their most recent follow-up. At the first clinic visit, 54% (78/143) were exercise restricted, and restriction status changed in 34% (48/143) during follow-up. The median baseline body mass index z-score was 0.2 (IQR 0.3-0.9). In repeated-measures analysis, neither time-related exercise restriction nor its interaction with time was associated with increasing body mass index z-score. Surgical intervention and its interaction with time were associated with decreasing body mass index z-score. Although exercise restriction was not associated with increasing body mass index over time, surgical intervention was associated with decreasing body mass index z-score over time in patients with anomalous aortic origin of the coronary arteries.
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Abstract
BACKGROUND The prevalence of overweight in children with CHD is about 26.9%. Increase in adipose tissue is related to the secretion of proinflammatory markers such as C-reactive protein. Assuming that children with CHD are exposed to other inherent risk factors for heart disease, our objective was to evaluate the correlation between levels of C-reactive protein and body mass index in children and adolescents with CHD. METHODS A cross-sectional study with 377 children and adolescents with CHD in a clinical setting of a reference hospital was carried out. C-reactive protein data were collected after 12 hours of fasting. Nutritional status was classified according to body mass index. The patients were divided into three groups: cyanotic, acyanotic, and minimal heart defects (controls). RESULTS The mean age was 9.9±4.2 years, and 53.6% of the sample included males. The cyanotic group represented 22.3%, acyanotic 42.2%, and minimal defects 35.5% of the sample. The average body mass index percentile was 57.23±32.06. The median values of C-reactive protein were as follows: cyanotic 0.340, acyanotic with clinical repercussion 0.203, and minimal defects 0.128. There was a significant difference between the minimal defects and the cyanotic groups (p=0.023). There was a significant correlation between C-reactive protein and body mass index percentile (r=0.293, p<0.01). C-reactive protein levels were higher in girls (p=0.034). There were no significant correlations between C-reactive protein and age or birth weight. CONCLUSION The correlation between body mass index percentile and C-reactive protein was confirmed in this population. The prevention of overweight is paramount to avoid overlapping modifiable risk factors to those already inherent to the CHD.
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O'Byrne ML, Kim S, Hornik CP, Yerokun BA, Matsouaka RA, Jacobs JP, Jacobs ML, Jonas RA. Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults: An Analysis of Data From the Society of Thoracic Surgeons Database. Circulation 2017. [PMID: 28626087 DOI: 10.1161/circulationaha.116.026778] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Extreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated. METHODS A multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression. RESULTS Of 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (P=0.04) and composite outcome (P<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28; P=0.008), severely underweight (odds ratio, 1.29; P<0.0001), and underweight (odds ratio, 1.39; P=0.002) subjects were associated with increased risk of composite outcome. CONCLUSIONS Obesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.
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Affiliation(s)
- Michael L O'Byrne
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.).
| | - Sunghee Kim
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.)
| | - Christoph P Hornik
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.)
| | - Babatunde A Yerokun
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.)
| | - Roland A Matsouaka
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.)
| | - Jeffrey P Jacobs
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.)
| | - Marshall L Jacobs
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.)
| | - Richard A Jonas
- From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.)
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Abstract
Subspecialty pediatric practice provides comprehensive medical care for a range of ages, from premature infants to children, and often includes adults with complex medical and surgical issues that warrant multidisciplinary care. Normal physiologic variations involving different body systems occur during sleep and these vary with age, stage of sleep, and underlying health conditions. This article is a concise review of the cardiovascular (CV) physiology and pathophysiology in children, sleep-disordered breathing (SDB) contributing to CV morbidity, congenital and acquired CV pathology resulting in SDB, and the relationship between SDB and CV morbidity in different clinical syndromes and systemic diseases in the expanded pediatric population.
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Affiliation(s)
- Grace R Paul
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Swaroop Pinto
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
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Lerman JB, Parness IA, Shenoy RU. Body Weights in Adults With Congenital Heart Disease and the Obesity Frequency. Am J Cardiol 2017; 119:638-642. [PMID: 27931725 DOI: 10.1016/j.amjcard.2016.10.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 12/15/2022]
Abstract
Obesity may associate with greater cardiovascular risk in adults with congenital heart disease (ACHD) than in the general population. As ACHD often have exercise limitations, they may be uniquely predisposed to obesity. Nevertheless, obesity prevalence in ACHD, compared with the general population, has not been quantified in a large US cohort. Hence, we sought to determine the prevalence of obesity (30 ≤ body mass index <40) and morbid obesity (body mass index ≥40), in a large cohort of ACHD, compared with matched controls. Retrospective analysis was thus performed on all ACHD seen in an academic system in 2013. CHD severity was classified as simple, complex, or unclassified, using recently published criteria. A control group without CHD was randomly generated matching for age, gender, and race/ethnicity; 1,451 ACHD met inclusion criteria; 59.5% of ACHD were overweight to morbidly obese. Compared with controls, ACHD had similar prevalence of overweight (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.89 to 1.22, p = 0.63) and obesity (OR 0.96, 95% CI 0.81 to 1.15, p = 0.69) but lower prevalence of morbid obesity (OR 0.24, 95% CI 0.16 to 0.34, p <0.001). These relationships were not attenuated by adjustment for CHD severity. In conclusion, ACHD are at equal risk as their matched peers to be overweight and obese. This is the largest study of obesity in US ACHD and the highest reported obesity prevalence in ACHD to date. As obesity is associated with significant cardiovascular risk, our findings indicate a need for improved lifestyle counseling in patients with CHD of all ages.
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Schwartz S, Olsen M, Woo JG, Madsen N. Congenital heart disease and the prevalence of underweight and obesity from age 1 to 15 years: data on a nationwide sample of children. BMJ Paediatr Open 2017; 1:e000127. [PMID: 29637147 PMCID: PMC5862232 DOI: 10.1136/bmjpo-2017-000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We examined the prevalence of underweight and obesity in children with congenital heart disease (CHD) compared with the general population. METHODS Using the Danish National Patient Registry, we identified individuals born and diagnosed with CHD in Denmark during 1996-2012 who were alive at 1 year of age. A unique personal identifier enabled identification of CHD subjects, as well as birth year and sex-matched (1:10) general population controls. The Children's Database has recorded height and weight measured by clinical providers at preventive health checks offered to all children in Denmark. Data recording were made mandatory in 2011. Obesity was defined as body mass index (BMI) above the 95thpercentile and underweight as BMI below the fifth percentile for age and sex. We determined the prevalence of underweight and obesity at study subjects' first height and weight recording. For those underweight at age 1 year, prevalence of underweight and obesity at later recordings was assessed. RESULTS We identified 9194 children with CHD of which 2679 (29%) had at least one recording of height and weight. The control cohort demonstrated a similar portion of anthropometric data: 30 047 (31%) of 96 585 controls. The prevalence of underweight and obesity at CHD study subjects' first height and weight recording was 9.7% (95% CI 8.7 to 11) and 4.1% (95% CI 3.4 to 4.9), respectively. Among individuals with CHD who were underweight at age 1 year (n=78), 51 (65%) had additional BMI recordings between ages 2 and 5 years with a subsequently diminished prevalence of underweight of 27% (95% CI 20 to 35) and none were obese. CONCLUSION The CHD population had an increased prevalence of underweight compared with the general population. Data indicated potential for BMI normalisation among those initially underweight at age 1 year. The prevalence of obesity in children with CHD was comparable with that of the general population.
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Affiliation(s)
- Sara Schwartz
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark, Europe
| | - Morten Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark, Europe
| | - Jessica G Woo
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nicolas Madsen
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Elias MD, Meza J, McCrindle BW, Brothers JA, Paridon S, Cohen MS. Effects of Exercise Restriction on Patients With Anomalous Aortic Origin of a Coronary Artery. World J Pediatr Congenit Heart Surg 2016; 8:18-24. [DOI: 10.1177/2150135116674444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Management of young patients with anomalous aortic origin of a coronary artery (AAOCA) may involve exercise restriction. We sought to identify the association of exercise restriction with changes over time in body mass index (BMI) and exercise capacity in this cohort. Methods: We performed a retrospective review of patients with AAOCA seen at The Children’s Hospital of Philadelphia between January 1, 1998, and August 31, 2014. Linear mixed model repeated-measures analysis assessed changes in BMI and exercise capacity. Results: We included 72 patients with a median age at presentation of 12.6 years (interquartile range: 10.1-15.8) and mean follow-up of 3.6 ± 3.0 years. The majority had an anomalous right coronary artery (71%) and interarterial ± intramural coronary course (90%). Surgery was performed in 54%, more often in those with interarterial/intramural course ( P < .001) and symptoms ( P = .003). Most patients (82%) were exercise-restricted on presentation, and restricted patients were older than those who were not restricted ( P = .01). There was no significant difference between restricted and nonrestricted patients in initial BMI z scores, percentage of patients with BMI over 85th percentile (26%) or exercise capacity variables. In univariable analysis, exercise restriction over time was not associated with change in BMI z score ( P = .25) or change in exercise variables. Restriction was not associated with significant change in these variables in multivariable analysis. Conclusions: Although further investigation is warranted to determine the degree of adherence to exercise restriction, the recommendation of restriction alone is not associated with increasing BMI or decreasing exercise performance in the short-term.
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Affiliation(s)
- Matthew D. Elias
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - James Meza
- Congenital Heart Surgeons’ Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian W. McCrindle
- Congenital Heart Surgeons’ Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie A. Brothers
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Paridon
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meryl S. Cohen
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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46
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Shamszad P, Rossano JW, Marino BS, Lowry AW, Knudson JD. Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals. CONGENIT HEART DIS 2016; 11:409-414. [PMID: 26887350 DOI: 10.1111/chd.12325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess how obesity or diabetes mellitus impacts outcomes in patients undergoing cardiac surgery in pediatric hospitals. DESIGN A multi-institutional, matched case-control study of the Pediatric Health Information System database was performed. SETTING Tertiary children's hospitals in the United States. PATIENTS All cardiac surgical cases in patients with obesity or diabetes mellitus between 2004 and 2012 were included. Cases were matched to controls by age, sex, race, and Risk Adjustment for Congenital Heart Surgery score. OUTCOME MEASURES Mortality, surgical complications, and hospital utilization. Differences in outcome measures were assessed by chi-square and Mann-Whitney tests. P value < .05 was significant. RESULTS Six hundred twenty-nine cardiac surgical cases (median age 17 years [IQR 12-32]) with obesity or diabetes mellitus were matched to 629 controls. Cases demonstrated lower median household income than those in the control group ($38,031 [IQR $31,900-$48,844] vs. ($41,896 [IQR $32,854-$56,020], P < .001). Mortality was similar between cases and controls (22% vs. 1.9%, P =.692). Surgical complications occurred similarly between cases and controls (13.5% vs. 12.4%, P = .535). Cases had longer intensive care unit length of stay than controls (3 vs. 2 days, P = .001), resulting in longer overall hospital length of stay (5 vs. 4 days, P < .001). Cases also had a higher odds of undergoing mechanical ventilation for >96 hours (OR 2.0, 95% CI 1.1-3.7) and higher rate of total parenteral nutrition use (7.2% vs. 4.5%, P = .040). Median hospital charges were higher in cases (clinical: $6,696 vs. $5,872; laboratory: $14,168 vs. $12,251; pharmacy: $12,971 vs. $10,426; imaging: $6,259 vs. $5,660; P ≤ .030 for all). CONCLUSIONS The presence of obesity or diabetes mellitus was associated with increased postoperative morbidity, hospital utilization, and cost in patients undergoing cardiac surgery in pediatric hospitals.
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Affiliation(s)
- Pirouz Shamszad
- Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA.
| | - Joseph W Rossano
- Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA
| | - Bradley S Marino
- Department of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA
| | - Adam W Lowry
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Jarrod D Knudson
- Department of Pediatrics, Children's Heart Center, Division of Critical Care, Children's of Mississippi, University of Mississippi Medical Center, Jackson, Miss, USA
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High Overweight and Obesity in Fontan Patients: A 20-Year History. Pediatr Cardiol 2016; 37:192-200. [PMID: 26377100 PMCID: PMC6260821 DOI: 10.1007/s00246-015-1265-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/09/2015] [Indexed: 12/18/2022]
Abstract
The prevalence of obesity in long-term survivors with complex congenital heart disease may be increasing, and little is known about the timing and onset of weight gain and growth patterns in these high-risk patients. Prevalence rates of overweight/obesity and longitudinal changes in body mass index (BMI) with age were determined in 606 patients with Fontan circulation seen at a tertiary care cardiology center from 1992 to 2012. The number of clinic encounters (n) was stratified by age group (n = 401, 2-5 years; n = 333, 6-11 years; n = 217, 12-19 years; and n = 129, >20 years). Among adults, 39% were overweight/obese at last clinic visit; 22% overweight, and 17% obese. Childhood anthropometric data were available for 82 adults, of which 15% (n = 12/82) were overweight/obese in childhood. The likelihood of being overweight/obese as an adult was three times higher if there was a BMI ≥ 85th percentile in childhood (CI 2.1-4.5, P < 0.01). Overweight/obesity in adulthood was associated with lower heart failure rates (4 vs. 19%, P = 0.03). Pediatric rates of overweight/obesity were comparable to national data (NHANES 2011-2012) in every age group: at 2-5 years, (25 vs. 23%), 6-11 years (26 vs. 34%), and 12-19 years (15 vs. 35%). Systolic blood pressure was higher in overweight/obese children as young as 2-5 years of age. Childhood and adult survivors with Fontan circulation have high rates of overweight/obesity. Childhood obesity is a strong predictor of future adiposity and is linked to changes in systolic blood pressure at a very young age.
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Freud LR, Webster G, Costello JM, Tsao S, Rychlik K, Backer CL, Deal BJ. Growth and Obesity Among Older Single Ventricle Patients Presenting for Fontan Conversion. World J Pediatr Congenit Heart Surg 2015; 6:514-20. [PMID: 26467864 PMCID: PMC7050720 DOI: 10.1177/2150135115598212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Long-term growth outcomes and the prevalence of obesity among older single ventricle (SV) patients have not been well characterized. We investigated these parameters, as well as the impact of obesity on survival, in an older cohort of SV patients presenting for Fontan conversion. METHODS We analyzed preoperative height, weight, and body mass index (BMI) of patients who underwent Fontan conversion. Overweight and obese were defined as BMI ≥85 percentile and ≥95 percentile for patients <20 years and BMI 25 to 30 kg/m(2) and ≥30 kg/m(2) for patients ≥20 years, respectively. Postoperative transplant-free survival was assessed among obese, overweight, and normal weight patients. RESULTS We evaluated 139 patients presenting for Fontan conversion at a median age of 23.2 years. Patients had shorter stature compared to the normal population (mean Z score -0.6, P < .001). Younger patients had lower BMI compared to the normal population (<20 years: mean Z score -0.5, P = .02), while older patients had elevated BMI (≥20 years: mean Z score +0.4, P < .001). The mean BMI among older patients approached overweight at 24.6 kg/m(2). The prevalence of obesity increased with advancing age, with 36% overweight and 14% obese at >30 years. At a median of 8.2 years following Fontan conversion, obesity and overweight status were not associated with transplant-free survival. CONCLUSION Older SV patients presenting for Fontan conversion had shorter stature compared to the normal population as well as a high prevalence of overweight and obesity. Although there was no relationship between weight status and early postoperative survival, further investigation of long-term outcomes is warranted.
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Affiliation(s)
- Lindsay R Freud
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Webster
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John M Costello
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sabrina Tsao
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Rychlik
- Biostatistics Research Core, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl L Backer
- Department of Surgery, Division of Cardiovascular Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Barbara J Deal
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sandberg C, Rinnström D, Dellborg M, Thilén U, Sörensson P, Nielsen NE, Christersson C, Wadell K, Johansson B. Height, weight and body mass index in adults with congenital heart disease. Int J Cardiol 2015; 187:219-26. [DOI: 10.1016/j.ijcard.2015.03.153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/26/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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Prevalence of overweight and obesity among patients with congenital and acquired heart disease in Kocaeli, Turkey. Cardiol Young 2015; 25:533-8. [PMID: 24666805 DOI: 10.1017/s1047951114000377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Childhood obesity has increased in the last half of the century. The aim of this study was to evaluate the frequency of obesity in the children with congenital or acquired heart disease. METHODS A total of 1410 children were assessed in this study. The study population was composed of 518 children (289 boys, 229 girls) as control group and 892 children (477 boys, 415 girls) as heart disease group. Patients were grouped into four categories: (I) "Clinic control subjects"; (II) "mild heart disease" that has not been treated with either surgical or catheter intervention; (III) congenital heart disease treated with surgical and/or catheter intervention; and (IV) "arrhythmias". A body mass index ⩾85th percentile was defined as overweight, ⩾95th percentile as obese, and <5th percentile was defined as underweight. RESULTS We did not detect any association between heart disease and obesity. There was no difference in the rates of overweight, obesity, and underweight between the healthy control subjects and patients with heart disease (8.1%, 13.3%, and 5.0%; 9.0%, 10.7%, and 4.7%, respectively, p=0.145). All subgroups had a similar prevalence of underweight, overweight, and obesity as the healthy control population. Within the heart disease population, the overall prevalence rates for overweight, obesity, and underweight were similar between the boys and girls. CONCLUSION Obesity is a common problem in children with heart disease, at least in general population. It is an important additional risk factor for long-term cardiovascular morbidity and mortality in children with heart disease. Precautions to prevent obesity should be a part of paediatric cardiologist's examination.
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