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Body composition, energy expenditure and physical activity

Longitudinal development of obesity in the post-Fontan population

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.

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References

  1. 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.

    Article  Google Scholar 

  2. Nadeau KJ, Maahs DM, Daniels SR, Eckel RH . Childhood obesity and cardiovascular disease: links and prevention strategies. Nat Rev Cardiol 2011; 8: 513–525.

    Article  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  CAS  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  CAS  Google Scholar 

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Correspondence to J R Fineman.

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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

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  • DOI: https://doi.org/10.1038/ejcn.2015.68

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