Clinical Research
Longitudinal Evaluation of the Prevalence of Overweight/Obesity in Children With Congenital Heart Disease

Presented at the European Association of Pediatric Cardiology, Helsinki, Finland, May 21-24, 2014.
https://doi.org/10.1016/j.cjca.2014.08.024Get rights and content

Abstract

Background

Regarding long-term cardiovascular health, obesity may have greater implications for children with congenital heart disease (CHD). We sought to determine trends in anthropometry over time and its association with exercise capacity.

Methods

Medical records of pediatric patients with CHD were randomly sampled. Serial measurements of weight and height were abstracted, body mass index (BMI) was calculated, and measurements were converted to percentiles and z scores. Analyses of trends were performed using regression models adjusted for repeated measures.

Results

Median follow-up after diagnosis for 725 patients was 7.1 years (interquartile range, 1.9-12.8 years). The median initial weight z score was −1.1 (fifth/95th percentile, −3.6/+1.1) and increased over time (+0.103 [0.007] standard deviations [SD]/y; P < 0.001). BMI and height z scores could only be calculated for patients > 2 years old; at that age, the median BMI z score was −0.2 (fifth/95th percentile, −2.6/+1.9) and increased over time (+0.042 [0.007] SD/y; P < 0.001), whereas the median height z score was −0.3 (fifth/95th percentile, −2.7/+1.4) with no change over time (−0.007 [0.006] SD/y; P = 0.18). Using standard BMI percentile cut points to define overweight and obesity, 28% of patients had at least 1 BMI measurement indicating overweight and 17% indicating obesity. Available exercise test results (n = 153) showed that overweight/obese patients had lower percent predicted maximum oxygen consumption (−16 [2]%; P < 0.001), higher peak systolic blood pressure (+11 [4] mm Hg; P = 0.002), and higher systolic blood pressure response (+7 [3] mm Hg; P = 0.01) than normal weight patients.

Conclusions

In conclusion, children with repaired CHD have an important risk of overweight/obesity over time that may increase their cardiovascular risk and impair their exercise capacity.

Résumé

Introduction

Quant à la santé cardiovasculaire à long terme, l’obésité peut avoir des conséquences plus importantes chez les enfants souffrant d’une cardiopathie congénitale (CC). Nous avons cherché à déterminer les tendances temporelles en matière d’anthropométrie et leur association avec l’aptitude à l’effort.

Méthodes

Les dossiers médicaux des patients pédiatriques souffrant de CC ont été sélectionnés de manière aléatoire. Les mesures sérielles du poids et de la taille ont été extraites, l’indice de masse corporelle (IMC) a été calculé, et les mesures ont été converties en percentiles et en écarts réduits. Les analyses sur les tendances ont été réalisées à l’aide des modèles de régression ajustés par mesures répétées.

Résultats

Le suivi médian après le diagnostic de 725 patients était de 7,1 ans (intervalle interquartile, 1,9-12,8 ans). L’écart réduit du poids médian initial était de –1,1 (cinquième/95e percentile, –3,6/+1,1) et augmentait avec le temps (+0,103 [0,007] les écarts types [E]/a; P < 0,001). Les écarts réduits de l’IMC et de la taille pouvaient seulement être calculés chez les patients > 2 ans. À cet âge, l’écart réduit de l’IMC médian était de –0,2 (cinquième/95e percentile, –2,6/+1,9) et augmentait avec le temps (+0,042 [0,007] E/a; P < 0,001), alors que l’écart réduit de la taille médiane était de –0,3 (cinquième/95e percentile, –2,7/+1,4) et ne montrait aucune tendance (–0,007 [0,006] E/a; P = 0,18). Selon les seuils en percentiles de l’IMC définissant la surcharge pondérale et l’obésité, 28 % des patients avaient au moins 1 mesure de l’IMC qui indiquait la surcharge pondérale et 17 % des patients, l’obésité. Les résultats de l’épreuve d’effort (n = 153) montraient que les patients en surcharge pondérale et obèses obtenaient un pourcentage plus faible qui prédisait une consommation maximale d’oxygène (–16 [2]%; P < 0,001), une pression artérielle systolique maximale plus élevée (+11 [4] mm Hg; P = 0,002) et une réponse de la pression artérielle systolique plus élevée (+7 [3] mm Hg; P = 0,01) que les patients ayant un poids normal.

Conclusions

En conclusion, les enfants ayant une CC réparée ont avec le temps un important risque de surcharge pondérale et d’obésité qui peut augmenter leur risque cardiovasculaire et diminuer leur aptitude à l’effort.

Section snippets

Study participants

Patients managed at The Hospital for Sick Children, Toronto, Ontario between 1995 and 2005 were reviewed. Patients were eligible for the study if they had 1 of the following 6 diagnoses: isolated atrial septal defect (ASD), ventricular septal defect (VSD), atrioventricular septal defect (AVSD), tetralogy of Fallot (TOF)/double-outlet right ventricle (DORV), transposition of the great arteries (TGA), or single-ventricle anatomy amenable to a Fontan procedure. Patients were identified from the

Patient characteristics

A total of 725 patients were included in this study (sampled 27% of 2703 patients eligible), and 4153 height and weight measurements were available for analysis (average 6 ± 5 measurements per patient). Median follow-up was 7.1 years (interquartile range, 1.9-12.8 years), and 193 (27%) patients were followed for longer than 10 years. Of included patients, 56% were boys and 14% had Down syndrome. Cardiac diagnosis distribution was ASD, 16%; VSD, 21%; AVSD, 16%; TGA, 19%; TOF/DORV, 18%; and

Discussion

This study demonstrated that patients with CHD had a significant risk of being overweight/obese over time, similar to the general population. Patients who underwent exercise testing as clinically indicated demonstrated that overweight/obese patients had lower exercise capacity and higher blood pressure response, which may contribute an additional cardiovascular risk factor in the future. There are no previous longitudinal large studies that evaluate serial measurements over time for pediatric

Conclusions

This study defines an important prevalence and some of the factors associated with overweight/obesity in this vulnerable population and the adverse consequences of being overweight/obese regarding exercise capacity. Health care providers should balance the benefits and risks of allowing patients with CHD to participate in physical activity according to the current recommendations/guidelines while also minimizing risk.19, 25 Patients with CHD require appropriate evaluation in terms of nutrition,

Funding Sources

Supported in part by the CIBC World Markets Endowed Chair in Child Health Research.

Disclosures

The authors have no conflicts of interest to disclose.

References (25)

  • R.J. Shustak et al.

    Prevalence of obesity among patients with congenital and acquired heart disease

    Pediatr Cardiol

    (2012)
  • R.J. Kuczmarski et al.

    2000 CDC Growth Charts for the United States: methods and development

    Vital Health Stat 11

    (2002)
  • Cited by (61)

    • Physical activity and aerobic fitness in children with inherited cardiac diseases

      2021, Archives of Cardiovascular Diseases
      Citation Excerpt :

      Indeed, repeated physical activity and exercise help to prevent obesity, the prevalence of which has increased dramatically in the young [4]. A sedentary lifestyle and its consequences in the paediatric population currently represent a major public health issue, especially in children with pre-existing cardiac conditions [5–7]. Traditionally, congenital cardiac disorders are divided into three groups: congenital heart disease (CHD) for structural cardiac anomalies; inherited cardiac arrhythmias; and inherited cardiomyopathies.

    • Somatic growth in children with congenital heart disease at 10 years of age: Risk factors and longitudinal growth

      2021, Early Human Development
      Citation Excerpt :

      BMI was comparable to the Swiss population from birth until 10 years of age for the total cohort. Our paper expands the literature on growth in children with CHD [3,15,16] by focusing on longitudinal growth and BMI. At 10 years of age, growth in children with CHD remains impaired.

    View all citing articles on Scopus

    See editorial by St-Pierre and Poirier, pages 109-111 of this issue.

    See page 122 for disclosure information.

    View full text