Body Mass Index Trajectory and Outcome Post Fontan Procedure

Abstract

Background Patients with a single ventricle who experience early life growth failure suffer high morbidity and mortality in the perisurgical period. However, long‐term implications of poor infant growth, as well as associations between body mass index (BMI) and outcome in adulthood, remain unclear. We aimed to model BMI trajectories of patients with a single ventricle undergoing a Fontan procedure to determine trajectory‐based differences in baseline characteristics and long‐term clinical outcomes. Methods and Results We performed a retrospective analysis of medical records from patients in the Australia and New Zealand Fontan Registry receiving treatment at the Royal Children's Hospital, The Children's Hospital at Westmead, Royal Melbourne Hospital, and Royal Prince Alfred Hospital from 1981 to 2018. BMI trajectories were modeled in 496 patients using latent class growth analysis from 0 to 6 months, 6 to 60 months, and 5 to 16 years. Trajectories were compared regarding long‐term incidence of severe Fontan failure (defined as mortality, heart transplantation, Fontan takedown, or New York Heart Association class III/IV heart failure). Three trajectories were found for male and female subjects at each age group—lower, middle, higher. Subjects in the lower trajectory at 0 to 6 months were more likely to have an atriopulmonary Fontan and experienced increased mortality long term. No association was found between higher BMI trajectory, current BMI, and long‐term outcome. Conclusions Poor growth in early life correlates with increased long‐term severe Fontan failure. Delineation of distinct BMI trajectories can be used in larger and older cohorts to find optimal BMI targets for patient outcome.

Nutritional considerations for people living with a Fontan circulation: a narrative review

“…8 In children with a Fontan circulation, above healthy weight range is associated with protection against adverse clinical outcomes. 9,48,49 In contrast, elevated adiposity is associated with poor clinical outcomes in adults living with a Fontan circulation including risk for Fontan circulatory failure and ventricular dysfunction. 8,9 Assessment of an individual's body composition provides a relative indication of the proportion and distribution of body mass compartments-fat mass and fat-free mass.…”

“…8,20,49,[67][68][69] Research investigating the weight trajectories of people with a Fontan circulation has demonstrated that adolescence is often the period when weight gain occurs. 48 Concerningly, adiposity tends to accumulate in the trunk or abdominal area. 9,53,70 Given this distribution tendency, there may be merit in measuring waist circumference across all ages to aid in monitoring for excess adiposity although this measurement will be confounded in the presence of ascites.…”

“…88 The nutritional efforts (i.e., oral intake, enteral nutrition) for growth catch-up, particularly for weight, may influence body composition leading to an increased accumulation of adiposity rather than lean muscle mass later in life. 48,88 Paediatric growth and age-related development…”

“…Children with a Fontan circulation may have growth and age-related development concerns (i.e., pubertal delays), both of which are known to potentially impact body composition. 20,48,50,53,69,70,89 Over the last decade, the growth deficits experienced by children with a Fontan circulation compared to their peers have been increasingly well characterised. 69,77,[90][91][92][93][94][95] Terms frequently interchangeably utilised to describe growth deficits include growth failure, malnutrition, poor growth, faltering growth, and undernutrition.…”

A 12-week lifestyle intervention: effects on fatigue, fear, and nutritional status in children with a Fontan circulation

“…Compliance was high, with a median training session attendance of 33 (32)(33)(34) out of 36 sessions. In total, 27 patients completed the exercise intervention.…”