Energy Balance-Related Behaviors and Body Mass Index in Asian School-Aged Children With Congenital Heart Disease

Abstract

Background: Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health. Most studies on CCHD have taken place in Western societies, leaving Asian populations understudied, especially children. Objective: We sought (1) to determine body mass index (BMI) distribution among school-aged CCHD in Taiwan; (2) to ascertain whether the BMI of CCHD differs from that of the general population; (3) to describe EBRBs in CCHD; and (4) to identify the associated factors of underweight and overweight/obesity among CCHD.Methods: In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age 9.73 years; 25.8% moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurements were taken in the hospital. Independent variables of EBRBs and health conditions were calculated through logistic regression analysis.Results: Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obesity. Children with moderate-to-severe heart defects were more often underweight. BMI did not differ between CCHD and children in the general population.More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the New York Heart Association Classification Ⅱ-Ⅳ were associated with being overweight/obesity. Conclusions:Sedentary lifestyle is seemingly the only EBRBs correlated with being overweight. Physical activity programs for children may help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries.

Overweight and Obesity in Patients with Congenital Heart Disease: A Systematic Review

“…Twenty-six of the included studies were cross-sectional studies that examined the prevalence of overweight and obesity in patients with CHD [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], and four were cohort studies that investigated the longitudinal change of the prevalence across the lifespan [ 10 , 43 , 44 , 45 ]. The body composition of patients with CHD was compared to a healthy reference cohort in 13 of the included studies [ 20 , 21 , 22 , 23 , 24 , 28 , 29 , 30 , 33 , 35 , 40 , 41 , 45 ], whereas 9 studies merely investigated the prevalence of overweight and obesity in patients with CHD [ 10 , 17 , 18 , 19 , 24 , 32 , 36 ,…”

“…BMI values were converted into age and gender-specific z-Scores in a subset of studies [ 10 , 17 , 18 , 38 , 40 ]. Fourteen studies converted the BMI into percentiles based on various growth charts, classifying patients with BMI ≥85th–<95th percentile as overweight and those with BMI ≥ 95th percentile as obese [ 10 , 19 , 23 , 24 , 32 , 33 , 34 , 36 , 38 , 39 , 40 , 41 , 43 , 45 ].…”

“…Various contributing factors have an impact on weight status and should therefore be considered when investigating the prevalence of overweight and obesity. The included studies in this review controlled for age [ 21 , 24 , 35 , 37 , 39 ], age and lesion severity [ 27 ], age and sex [ 10 , 17 , 18 , 20 , 23 , 28 , 31 , 33 , 36 , 38 , 40 , 41 , 43 , 44 ], race/ethnicity [ 29 , 45 ], family history, parent’s nutritional status [ 19 ], marital status, educational level, and geographic region [ 34 ]. Six studies did not take confounders into account and were therefore rated as “poor” [ 8 , 22 , 25 , 26 , 37 , 42 ].…”

“…In children with CHD, the prevalence of overweight ranged from 9.5% [ 36 ] to 31.5% [ 39 ] and the prevalence of obesity ranged from 9.5% [ 19 ] to 26.2% [ 36 ]. Studies comparing children with CHD to healthy controls reported similar overweight and obesity prevalence in both groups [ 18 , 20 , 21 , 24 , 33 , 35 , 40 , 41 , 45 ], whereby controls were age-matched [ 21 , 35 ], age and sex matched [ 20 ], and age, sex and race/ethnicity matched [ 45 ].…”

“…Part of the included studies examined the association between overweight and obesity and contributing factors. Yang et al reported an association between sedentary behavior and increased overweight and obesity prevalence in CHD children [ 41 ]. BMI has been shown to be negatively associated with exercise duration [ 32 ] and exercise capacity in the CHD population [ 42 ].…”