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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



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).


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.


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.


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.


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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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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).

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