High Overweight and Obesity in Fontan Patients: A 20-Year History

Abstract

Background: The prevalence of obesity in long-term survivors with complex congenital heart disease may be increasing, and little is known about the timing and onset of weight gain and growth patterns in these high-risk patients. Methods and Results: Prevalence rates of overweight/obesity and longitudinal changes in body mass index (BMI) with age were determined in 606 patients with Fontan circulation seen at a tertiary care cardiology center from 1992 – 2012. The number of clinic encounters (n) was stratified by age group (n=401, 2–5y; n= 333, 6–11y; n=217, 12–19y; and n=129, >20y). Among adults, 39% were overweight/obese at last clinic visit; 22% overweight and 17% obese. Childhood anthropometric data were available for 82 adults; of which 15% (n=12/82) were overweight/obese in childhood. The likelihood of being overweight/ obese as an adult was 3 times higher if there was a BMI ≥ 85th percentile in childhood (CI 2.1–4.5, p <0.01). Overweight/obesity in adulthood was associated with lower heart failure rates (4% vs. 19%, P=0.03). Pediatric rates of overweight/obesity were comparable to national data (NHANES 2011–2012) in every age group: at 2–5y, (25 vs. 23%), 6–11y (26 vs. 34%), and 12–19y (15 vs. 35%). Systolic blood pressure was higher in overweight/obese children as young as 2–5 years of age. Conclusions: Childhood and adult survivors with Fontan circulation have high rates of overweight/obesity. Childhood obesity is a strong predictor of future adiposity and is linked to changes in systolic blood pressure at a very young age.

Prevalence of Hypertension in Children from Public Schools

“…A study carried out in Fortaleza, Brazil, 21 agrees with the results found in this study, by stating that systolic BP rises concomitantly with increasing age. In relation to the nutritional status, there is an association between the systolic and the diastolic BP 22 and between the diastolic BP and weight, 23 in agreement with the findings. Regarding ethnicity/ race, indigenous individuals showed the highest mean systolic BP; a study that analyzed racial differences and childhood SAH identified higher values in nonHispanic blacks.…”

“…30 The fact that obese individuals have a higher prevalence of elevated BP corroborates studies in Brazil and worldwide that reinforce the existence of a definite association between overweight, obesity and SAH. 7,22,34 The chance of an obese individual to also have SAH is 7.53-fold higher than that of an overweight individual. 35 Mavrakanas et al 36 state that obese children have five to six-fold higher BP than non-obese children.…”

High blood pressure in children attending pediatric clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

“…This finding agrees with several previously published studies carried out worldwide. [21202426] Moreover, Mavrakanas et al ., 2009, observed that obese children had a 5–6-fold higher risk of hypertension than normal children. [27] Obese children might also become victims of bullying, which ultimately results in low self-esteem, anxiety, and shyness, and stress,[20] causing such chronic medical conditions as hypertension.…”

Body mass index in adults with congenital heart disease

“…[8][9][10] The most recent data showed that one-quarter of ACHD patients were obese, and ACHD patients are at equal risk as their matched peers to be overweight and obese independently of the severity of the lesion. [8][9][10] The most recent data showed that one-quarter of ACHD patients were obese, and ACHD patients are at equal risk as their matched peers to be overweight and obese independently of the severity of the lesion.…”