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Nutrition during the early life cycle

Effect of feeding with standard or higher-density formulas on anthropometric measures in children with congenital heart defects after corrective surgery: a randomized clinical trial

Abstract

Objectives

The aim of the present study was to assess the efficacy of feeding a higher-density formula (HDF) in infant with congenital heart disease (CHD).

Methods

In a parallel randomized trial, infants (6 to 12 months) who underwent CHD corrective surgery received either a standard-density formula (SDF, 67 kcal /100 ml) or an HDF (90 kcal/100 ml) after discharge from the intensive care unit for 8 weeks. In addition to the formula, infants could receive breast milk or complementary food. Anthropometry, biochemistry, and formula intake were collected.

Result

Sixty-four infants completed the study (n = 32 in each group). All infants gained weight. The mean ± standard deviation (SD) of weight z score at baseline and week-8 were −2.38 ± 10.04 to −1.38 + 0.97 in the SDF group and −2.69 ± 1.19 to −0.89 ± 0.90 in the HDF group (between-group p = 0.0001). Both groups gained length, but showed a decline in length z-score which was significant in the SDF group but not significant in the HDF group. Mid-upper arm circumference and its z score improved in both groups, with more improvement in the HDF group. Serum albumin level was higher in the HDF than the SDF group at week-8, but no significant between-group differences were observed in hemoglobin, serum ferritin, or iron. Symptoms of gastrointestinal intolerance were not reported, but parents of 4 infants in the HDF group complained of their infants’ constipation.

Conclusion

Feeding infants using a concentrated formula could increase infants’ weight gain and growth, and improve the nutritional status after CHD surgery.

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Fig. 1: CONSORT flowchart.
Fig. 2: Comparison of anthropometric measures over time between the SDF and HDF groups.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Triedman JK, Newburger JW. Trends in congenital heart disease: the next decade. Circulation. 2016;133:2716–33.

    Article  Google Scholar 

  2. Blasquez A, Clouzeau H, Fayon M, Mouton JB, Thambo JB, Enaud R, et al. Evaluation of nutritional status and support in children with congenital heart disease. Eur J Clin Nutr. 2016;70:528–31.

    CAS  Article  Google Scholar 

  3. Hassan BA, Albanna EA, Morsy SM, Siam AG, Al Shafie MM, Elsaadany HF, et al. Nutritional status in children with un-operated congenital heart disease: an Egyptian center experience. Front Pediatr. 2015;3:53.

    Article  Google Scholar 

  4. Shi H, Hu C, Zhang L, Tong M, Li L, Cui Y. Early growth trajectory of infants with simple congenital heart disease and complex congenital heart disease undergoing cardiac repair: a prospective cohort study in China. JPEN J Parenter Enter Nutr. 2021;45:1181–91.

    Article  Google Scholar 

  5. van der Kuip M, Hoos MB, Forget PP, Westerterp KR, Gemke RJ, de Meer K. Energy expenditure in infants with congenital heart disease, including a meta-analysis. Acta Paediatr. 2003;92:921–7.

    Article  Google Scholar 

  6. Nydegger A, Walsh A, Penny DJ, Henning R, Bines JE. Changes in resting energy expenditure in children with congenital heart disease. Eur J Clin Nutr. 2009;63:392–7.

    CAS  Article  Google Scholar 

  7. Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child. 1999;81:49–52.

    CAS  Article  Google Scholar 

  8. Thommessen M, Heiberg A, Kase BF. Feeding problems in children with congenital heart disease: the impact on energy intake and growth outcome. Eur J Clin Nutr. 1992;46:457–64.

    CAS  PubMed  Google Scholar 

  9. Ratanachu-Ek S, Pongdara A. Nutritional status of pediatric patients with congenital heart disease: pre- and post cardiac surgery. J Med Assoc Thai. 2011;94:S133–137.

    PubMed  Google Scholar 

  10. Carmona F, Hatanaka LS, Barbieri MA, Bettiol H, Toffano RB, Monteiro JP, et al. Catch-up growth in children after repair of Tetralogy of Fallot. Cardiol Young-. 2012;22:507–13.

    Article  Google Scholar 

  11. Vaidyanathan B, Radhakrishnan R, Sarala DA, Sundaram KR, Kumar RK. What determines nutritional recovery in malnourished children after correction of congenital heart defects? Pediatrics. 2009;124:e294–299.

    Article  Google Scholar 

  12. Vaidyanathan B, Roth SJ, Gauvreau K, Shivaprakasha K, Rao SG, Kumar RK. Somatic growth after ventricular septal defect in malnourished infants. J Pediatr. 2006;149:205–9.

    Article  Google Scholar 

  13. Argent AC, Balachandran R, Vaidyanathan B, Khan A, Kumar RK. Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries. Cardiol Young-. 2017;27:S22–S30.

    Article  Google Scholar 

  14. Unger R, DeKleermaeker M, Gidding SS, Christoffel KK. Calories count. Improved weight gain with dietary intervention in congenital heart disease. Am J Dis Child. 1992;146:1078–84.

    CAS  Article  Google Scholar 

  15. El-Koofy N, Mahmoud AM, Fattouh AM. Nutritional rehabilitation for children with congenital heart disease with left to right shunt. Turk J Pediatr. 2017;59:442–51.

    Article  Google Scholar 

  16. Benzecry SG, Leite HP, Oliveira FC, Santana EMJF, de Carvalho WB, Silva CM. Interdisciplinary approach improves nutritional status of children with heart diseases. Nutrition. 2008;24:669–74.

    Article  Google Scholar 

  17. Zhang H, Gu Y, Mi Y, Jin Y, Fu W, Latour JM. High-energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial. Nurs Crit Care. 2019;24:97–102.

    Article  Google Scholar 

  18. Pillo-Blocka F, Adatia I, Sharieff W, McCrindle BW, Zlotkin S. Rapid advancement to more concentrated formula in infants after surgery for congenital heart disease reduces duration of hospital stay: a randomized clinical trial. J Pediatr. 2004;145:761–6.

    Article  Google Scholar 

  19. Chen X, Zhang M, Song Y, Luo Y, Wang L, Xu Z, et al. Early high-energy feeding in infants following cardiac surgery: a randomized controlled trial. Transl Pediatr. 2021;10:2439–48.

    Article  Google Scholar 

  20. Clarke SE, Evans S, Macdonald A, Davies P, Booth IW. Randomized comparison of a nutrient-dense formula with an energy-supplemented formula for infants with faltering growth. J Hum Nutr Diet. 2007;20:329–39.

    CAS  Article  Google Scholar 

  21. Taniguchi-Fukatsu A, Matsuoka M, Amagai T. Effect of a high density formula on growth and safety in congenital heart disease infants. e-SPEN, Eur e-J Clin Nutr Metab. 2010;5:e281–e283.

    Article  Google Scholar 

  22. Hopkins D Congenital Heart Disease. In Clinical Paediatric Dietetics. 4th edition. Edited by Shaw V. 2014: 282–307.

  23. Li X, Zhu J, An J, Wang Y, Wu Y, Li X. Growth and development of children under 5 years of age with tetralogy of Fallot in a Chinese population. Sci Rep. 2021;11:14255.

    CAS  Article  Google Scholar 

  24. Becker PJ, Nieman Carney L, Corkins MR, Monczka J, Smith E, Smith SE, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet. 2014;114:1988–2000.

    Article  Google Scholar 

  25. Stephens K, Escobar A, Jennison EN, Vaughn L, Sullivan R, Abdel-Rahman S, et al. Evaluating mid-upper arm circumference Z-score as a determinant of nutrition status. Nutr Clin Pr. 2018;33:124–32.

    Article  Google Scholar 

  26. Tay EL, Peset A, Papaphylactou M, Inuzuka R, Alonso-Gonzalez R, Giannakoulas G, et al. Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome. Int J Cardiol. 2011;151:307–12.

    Article  Google Scholar 

  27. Itiola AY, Animasahun BA, Njokanma OF. Serum iron status of children with cyanotic congenital heart disease in Lagos, Nigeria. Sultan Qaboos Univ Med J. 2019;19:e345–e351.

    Article  Google Scholar 

Download references

Funding

This research is funded by the National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Science, Tehran, Iran.

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Authors and Affiliations

Authors

Contributions

The study was conceptualized by JN, MA, and MM, conducted by MG, MM, and HS and the manuscript were prepared by JN, MA. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Javad Nasrollahzadeh.

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The authors declare no competing interests.

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Aryafar, M., Mahdavi, M., Shahzadi, H. et al. Effect of feeding with standard or higher-density formulas on anthropometric measures in children with congenital heart defects after corrective surgery: a randomized clinical trial. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01186-3

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  • DOI: https://doi.org/10.1038/s41430-022-01186-3

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