Longitudinal Evaluation of the Prevalence of Overweight/Obesity in Children With Congenital Heart Disease

Background: Regarding long-term cardiovascular health, obesity may have greater implications for children with congenital heart disease (CHD). We sought to determine trends in anthropometry over time and its association with exercise capacity. Methods: Medical records of pediatric patients with CHD were randomly sampled. Serial measurements of weight and height were abstracted, body mass index (BMI) was calculated, and measurements were converted to percentiles and z scores. Analyses of trends were performed using regression models adjusted for repeated measures. Results: Median follow-up after diagnosis for 725 patients was 7.1 years (interquartile range, 1.9-12.8 years). The median initial weight z score was -1.1 (fifth/95th percentile, -3.6/+1.1) and increased over time (+0.103 [0.007] standard deviations [SD]/y; P < 0.001). BMI and height z scores could only be calculated for patients > 2 years old; at that age, the median BMI z score was -0.2 (fifth/95th percentile, -2.6/+1.9) and increased over time (+0.042 [0.007] SD/y; P < 0.001), whereas the median height z score was -0.3 (fifth/95th percentile, -2.7/+1.4) with no change over time (-0.007 [0.006] SD/y; P = 0.18). Using standard BMI percentile cut points to define overweight and obesity, 28% of patients had at least 1 BMI measurement indicating overweight and 17% indicating obesity. Available exercise test results (n = 153) showed that overweight/obese patients had lower percent predicted maximum oxygen consumption (-16[2]%; P < 0.001), higher peak systolic blood pressure (+11 [4] mm Hg; P = 0.002), and higher systolic blood pressure response (+7 [3] mm Hg; P = 0.01) than normal weight patients. Conclusions: In conclusion, children with repaired CHD have an important risk of overweight/obesity over time that may increase their cardiovascular risk and impair their exercise capacity.