Abstract
Background/Objectives:
An elevated body mass index (BMI) in childhood is a significant risk factor for cardiovascular disease, and it may pose an additional risk to children and adults with palliated univentricular congenital heart disease. However, little is known about longitudinal development of obesity in this population. The objective of this study is to determine the prevalence of overweight (OW) and obese (OB) habitus at the time of Fontan palliative surgery, to track changes in BMI after surgery, and ultimately to determine whether factors such as gender, ethnicity, preoperative heart defect and ventricular dominance are associated with later development of OW or OB.
Subjects/Methods:
A retrospective chart review of 84 patients undergoing Fontan palliation was performed. Demographic data including gender, ethnicity, preoperative heart defect and ventricular dominance were recorded. Height, weight and BMI were obtained at the time of Fontan and on a yearly basis post surgery.
Results:
At the time of Fontan palliation, 10.7% of patients were OB or OW. During the five years following palliation, the percentage of OB or OW patients trended upward, from 20.3% the year following surgery to 30% at 5 years post Fontan. Repeated measures generalized estimating equation showed a significant association between Hispanic ethnicity and increased BMI Z-scores for the 5 years after Fontan palliation (P<0.001); there was no association between BMI Z-scores and patient sex, lesion or ventricular dominance.
Conclusions:
During the first 5 years after Fontan palliation, there is a trend toward increasing percentages of OB and OW patients. In addition, there is a significant association between Hispanic ethnicity and being OW or OB before and after surgery. Further study is needed to determine whether OW/OB status is associated with worse health outcomes in this patient population.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014; 31: 806–814.
Nadeau KJ, Maahs DM, Daniels SR, Eckel RH . Childhood obesity and cardiovascular disease: links and prevention strategies. Nat Rev Cardiol 2011; 8: 513–525.
Pemberton VL, McCrindle BW, Barkin S, Daniels SR, Barlow SE, Binns HJ et al. Report of the National Heart, Lung, and Blood Institute’s Working Group on obesity and other cardiovascular risk factors in congenital heart disease. Circulation 2010; 121: 1153–1159.
Pinto NM, Marino BS, Wernovsky G, de Ferranti SD, Walsh AZ, Laronde M et al. Obesity is a common co-morbidity in children with congenital and acquired heart disease. Pediatrics 2007; 120: e1157–e1164.
Henaine R, Vergnat M, Bacha EA, Baudet B, Lambert V, Belli E et al. Effects of lack of pulsatility on pulmonary endothelial function in the Fontan circulation. J Thorac Cardiovasc Surg 2013; 146: 522–529.
Barlow SE, and the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120: S164—S192.
Hannan RL, Zabinsky JA, Salvaggio JL, Rossi AF, Khan DM, Alonso FA et al. The Fontan operation: pursuit of associated lesions and cumulative trauma. Pediatr Cardiol 2011; 32: 778–784.
Kelleher DK, Laussen P, Teixeira-Pinto A, Duggan C . Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237–244.
Pollack MM, Ruttimann UE, Wiley JS . Nutritional depletions in critically ill children: associations with physiologic instability and increased quantity of care. J Parenter Enter Nutr 1985; 9: 309–313.
Rhodes J, Curran TJ, Camil L, Rabideau N, Fulton DR, Gauthier NS et al. Sustained effects of cardiac rehabilitation in children with serious congenital heart disease. Pediatrics 2006; 18: e586–e593.
McCrindle BW, Williams RV, Mital S, Clark BJ, Russell JH, Klein G et al. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 2007; 92: 509–514.
Longmuire PE, McCrindle BW . Physical activity restrictions for children after the Fontan operation: disagreement between parent, cardiologist, and medical record reports. Am Heart J 2009; 157: 853–859.
Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 2012; 307: 483–490.
Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM . Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 2010; 303: 242–249.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Wellnitz, K., Harris, I., Sapru, A. et al. Longitudinal development of obesity in the post-Fontan population. Eur J Clin Nutr 69, 1105–1108 (2015). https://doi.org/10.1038/ejcn.2015.68
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2015.68
This article is cited by
-
Sizing Up Fontan Failure: Association with Increasing Weight in Adulthood
Pediatric Cardiology (2021)