A Shift from Underweight to Overweight and Obesity in Asian Children and Adolescents with Congenital Heart Disease
Chun-An Chen
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Search for more papers by this authorJou-Kou Wang
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Search for more papers by this authorHung-Chi Lue
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Search for more papers by this authorMei-Hwei Chang
Department of Pediatrics, National Taiwan University Hospital, Taipei
Search for more papers by this authorCorresponding Author
Mei-Hwan Wu
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Mei-Hwan Wu, Division of Pediatric Cardiology, Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail: [email protected]Search for more papers by this authorChun-An Chen
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Search for more papers by this authorJou-Kou Wang
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Search for more papers by this authorHung-Chi Lue
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Search for more papers by this authorMei-Hwei Chang
Department of Pediatrics, National Taiwan University Hospital, Taipei
Search for more papers by this authorCorresponding Author
Mei-Hwan Wu
Department of Pediatrics, National Taiwan University Hospital, Taipei
Cardiac Children's Foundation, Taipei, Taiwan
Mei-Hwan Wu, Division of Pediatric Cardiology, Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail: [email protected]Search for more papers by this authorAbstract
Background: In Western countries, obesity is a common problem in children with congenital heart disease (CHD). However, this problem may have racial difference, and little is known about the shift of this trend as patients grow up. The present study sought to investigate the prevalence and trends of being underweight, overweight and obesity in an Asian CHD cohort using a 5-year citywide school survey database.
Methods: Patient group consisted of 705 first grade elementary school students (children) and 219 first grade senior high school students (adolescents), while 18753 healthy children and 15014 healthy adolescents served as controls. Body mass index (BMI) percentile was calculated to define underweight (BMI < 15th percentile) and overweight (BMI 85th–95th percentile)/obesity (BMI ≥ 95th percentile).
Results: In CHD children, the prevalence of underweight and overweight/obesity was 21.0% (control 16%, P < 0.001) and 14.5% (control 19.8%, P < 0.001), respectively. Children with moderate to severe CHD, especially cyanotic CHD, were more underweight and less overweight/obese than children with non-cyanotic CHD. The prevalence of underweight (23.3%) and overweight/obesity (26.5%) in CHD adolescents became close to that in controls. From childhood to adolescence, different shifts in BMI distribution were noted; controls became more underweight and overweight/obese for males and more underweight and less overweight/obese for females, while CHD patients became more overweight/obese for both genders, including cyanotic CHD.
Conclusions: In this Asian CHD cohort, we demonstrates a shift of BMI distribution from more underweight and less overweight/obese compared with healthy children, to a pattern similar to that in healthy adolescents.
References
- 1 Cabrera AG, Prodhan P, Bhutta AT. Nutritional challenges and outcomes after surgery for congenital heart disease. Current Opinion in Cardiology 2010; 25: 88–94.
- 2 Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Archives of Disease in Childhood 1999; 81: 49–52.
- 3 Ackerman IL, Karn CA, Denne SC, Ensing GJ, Leitch CA. Total but not resting energy expenditure is increased in infants with ventricular septal defects. Pediatrics 1998; 102: 1172–1177.
- 4 Vieira TC, Trigo M, Alonso RR, Ribeiro RH, Cardoso MR, Cardoso AC, et al. Assessment of food intake in infants between 0 and 24 months with congenital heart disease. Arquivos Brasileiros de Cardiologia 2007; 89: 219–224.
- 5 Nydegger A, Walsh A, Penny DJ, Henning R, Bines JE. Changes in resting energy expenditure in children with congenital heart disease. European Journal of Clinical Nutrition 2009; 63: 392–397.
- 6 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–e299.
- 7 Cheung MM, Davis AM, Wilkinson JL, Weintraub RG. Long term somatic growth after repair of tetralogy of Fallot: evidence for restoration of genetic growth potential. Heart 2003; 89: 1340–1343.
- 8 Rhee EK, Evangelista JK, Nigrin DJ, Erickson LC. Impact of anatomic closure on somatic growth among small, asymptomatic children with secundum atrial septal defect. The American Journal of Cardiology 2000; 85: 1472–1475.
- 9 Stefan MA, Hopman WM, Smythe JF. Effect of activity restriction owing to heart disease on obesity. Archives of Pediatrics and Adolescent Medicine 2005; 159: 477–481.
- 10 Rademacher ER, Jacobs DR Jr, Moran A, Steinberger J, Prineas RJ, Sinaiko A. Relation of blood pressure and body mass index during childhood to cardiovascular risk factor levels in young adults. Journal of Hypertension 2009; 27: 1766–1774.
- 11 Srinivasan SR, Myers L, Berenson GS. Changes in metabolic syndrome variables since childhood in prehypertensive and hypertensive subjects: the Bogalusa Heart Study. Hypertension 2006; 48: 33–39.
- 12 Berenson GS, Srinivasan SR. Emergence of obesity and cardiovascular risk for coronary artery disease: the Bogalusa Heart Study. Preventive Cardiology 2001; 4: 116–121.
- 13 Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103: 1175–1182.
- 14 Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. The New England Journal of Medicine 2010; 362: 485–493.
- 15 Pinto NM, Marino BS, Wernovsky G, de Ferranti SD, Walsh AZ, Laronde M, et al. Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 2007; 120: e1157–e1164.
- 16 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.
- 17 Fernandez JR, Allison DB. Understanding racial differences in obesity and metabolic syndrome traits. Nutrition Reviews 2003; 61: 316–319.
- 18 Kimm SY, Barton BA, Obarzanek E, McMahon RP, Sabry ZI, Waclawiw MA, et al. Racial divergence in adiposity during adolescence: the NHLBI Growth and Health Study. Pediatrics 2001; 107: E34.
- 19 Chiu SN, Wang JK, Wu MH, Chang CW, Chen CA, Lin MT, et al. Cardiac conduction disturbance detected in a pediatric population. The Journal of Pediatrics 2008; 152: 85–89.
- 20 Department of Health, Executive Yuan, R.O.C. (Taiwan). Definition and Management of Obesity in Children and Adolescents. 2006. http://www.ctaso.org.tw/news5.htm
- 21 Waterlow JC, Buzina R, Keller W, Lane JM, Nichaman MZ, Tanner JM. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin of the World Health Organization 1977; 55: 489–498.
- 22 Falkner B, Daniels SR. Summary of the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Hypertension 2004; 44: 387–388.
- 23 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 2008; 118: e714–e833.
- 24 Hoffman JI, Kaplan S. The incidence of congenital heart disease. Journal of the American College of Cardiology 2002; 39: 1890–1900.
- 25 Wu MH, Chen HC, Lu CW, Wang JK, Huang SC, Huang SK. Prevalence of congenital heart disease at live birth in Taiwan. The Journal of Pediatrics 2010; 156: 782–785.
- 26 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.
- 27 Deckelbaum RJ, Williams CL. Childhood obesity: the health issue. Obesity Research 2001; 9 (Suppl. 4): 239S–243S.
- 28 Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. The Journal of Pediatrics 2007; 150: 12–17.e12.
- 29 Speiser PW, Rudolf MCJ, Anhalt H, Camacho-Hubner C, Chiarelli F, Eliakim A, et al. Childhood obesity. The Journal of Clinical Endocrinology and Metabolism 2005; 90: 1871–1887.
- 30 Pasquali SK, Marino BS, Pudusseri A, Wernovsky G, Paridon SM, Walker SA, et al. Risk factors and comorbidities associated with obesity in children and adolescents after the arterial switch operation and Ross procedure. American Heart Journal 2009; 158: 473–479.
- 31 Weintraub RG, Menahem S. Early surgical closure of a large ventricular septal defect: influence on long-term growth. Journal of the American College of Cardiology 1991; 18: 552–558.
- 32 Yoshinaga M, Ichiki T, Tanaka Y, Hazeki D, Horigome H, Takahashi H, et al. Prevalence of childhood obesity from 1978 to 2007 in Japan. Pediatrics International 2009; 52: 213–217.
- 33 Wisniewski AB, Chernausek SD. Gender in childhood obesity: family environment, hormones, and genes. Gender Medicine 2009; 6 (Suppl. 1): 76–85.
- 34 Kanaan MN, Afifi RA. Gender differences in determinants of weight-control behaviours among adolescents in Beirut. Public Health Nutrition 2010; 13: 71–81.
- 35 Neumark-Sztainer D, Hannan PJ. Weight-related behaviors among adolescent girls and boys: results from a national survey. Archives of Pediatrics and Adolescent Medicine 2000; 154: 569–577.
- 36 Viner RM, Haines MM, Taylor SJC, Head J, Booy R, Stansfeld S. Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents. International Journal of Obesity 2006; 30: 1514–1521.
