Changes in nutritional status and the development of obesity and metabolic syndrome following pediatric heart transplantation

BACKGROUND

Nutritional status in pediatric patients undergoing heart transplantation (HT) is frequently a focus of clinical management and requires high resource utilization. Pre-operative nutrition status has been shown to affect post-operative mortality but no studies have been performed to assess how nutritional status may change and the risk of developing nutritional comorbidities long-term in the post-transplant period.

METHODS

A single-center retrospective chart review of patients ≥2 years of age who underwent heart transplantation between 1/1/2005 and 4/30/2020 was performed. Patient data were collected at listing, time of transplant, 1-year, and 3-year follow-up post-transplant. Nutrition status was classified based on body mass index (BMI) percentile in the primary analysis. Alternative nutritional indices, namely the nutrition risk index (NRI), prognostic nutrition index (PNI), and BMI z-score, were utilized in secondary analyses.

RESULTS

Of the 63 patients included, the proportion of patients with overweight/obese status increased from 21% at listing to 41% at 3-year follow-up. No underweight patients at listing became overweight/obese at follow-up. Of patients who were overweight/obese at listing, 88% maintained that status at 3-year follow-up. Overweight/obese status at listing, 1-year, and 3-year post-transplantation were significantly associated with developing metabolic syndrome. In comparison to the alternative nutritional indices, BMI percentile best predicted post-transplant metabolic syndrome.

CONCLUSIONS

The results suggest that pediatric patients who undergo heart transplantation are at risk of developing overweight/obesity and related nutritional sequelae (ie, metabolic syndrome). Improved surveillance and interventions targeted toward overweight/obese HT patients should be investigated to reduce the burden of associated comorbidities.

[Effects of nine prescriptions on fever in rats induced by endotoxin]

In this paper in is reported that nine prescriptions often used in traditional Chinese medicine for the treatment of diseases with fever were tested experimentally for the effect on fever of rats induced by endotoxin. The results are as follows: Da-yuan-decoction, Gan-lu-xiao-du-pill, Lian-pu-decoction, Cai-hao-mixture, Da-huang-huang-lian-jie-du-decoction, Tao-ren-cheng-qi-decorction, Ge-gen-qin-lian-decoction, Yin-qiao-jie-du-decoction etc. can notably reduce fever in rats induced by endotoxin with the exception of Bai-hu-decoction that has no obvious effect on fever-reduction.