No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy

Castleberry, Chesney; Jefferies, John L.; Shi, Lei; Wilkinson, James D.; Towbin, Jeffrey A.; Harrison, Ryan W.; Rossano, Joseph W.; Pahl, Elfriede; Lee, Teresa M.; Addonizio, Linda J.; Everitt, Melanie D.; Godown, Justin; Mahgerefteh, Joseph; Rusconi, Paolo; Canter, Charles E.; Colan, Steven D.; Kantor, Paul F.; Razoky, Hiedy; Lipshultz, Steven E.; Miller, Tracie L.

doi:10.1016/j.jchf.2017.11.015

Cited by 15 publications

(6 citation statements)

References 39 publications

(41 reference statements)

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“…Malnutrition is common in pediatric HF . The etiology of malnutrition in this population is multifactorial, due to a combination of decreased intake caused by fatigue and anorexia coupled with increased nutrient requirements resulting from gastrointestinal losses, inflammation, hypermetabolism, and malabsorption .…”

Section: Introductionmentioning

confidence: 99%

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Hollander

Schultz

Dennis

et al. 2019

Pediatric Transplantation

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Background Malnutrition is common in pediatric heart failure and is associated with mortality. The effect of VAD support on malnutrition in children is unknown. We sought to compare the prevalence and severity of malnutrition at HT in children on VAD support vs OMT to inform decisions regarding support strategies. Methods Retrospective chart review involving all patients <18 years who underwent HT at Stanford between 1/1/2011 and 3/1/2018. Malnutrition diagnosis and severity were defined by ASPEN guidelines using the lowest age‐adjusted z‐score for weight (WAZ), height (HAZ), and BMI (BMIZ) when the patient was euvolemic. Changes in z‐scores from baseline to HT and across groups were analyzed. Results A total of 104 patients (52 in each group) were included. Among all patients, WAZ (−0.9 vs 0.3, P < 0.001) and BMIZ (0 vs 0.6, P < 0.001) improved while HAZ (−0.9 vs −0.9, P = 0.4) did not. Compared to children on OMT, children on VAD experienced greater increases in WAZ (0.8 vs 0.3, P < 0.001) and BMIZ (0.7 vs 0.2, P < 0.003) at HT. The prevalence of moderate‐to‐severe malnutrition decreased in VAD patients (40% to 19%, P < 0.001) and increased in OMT patients (37% to 46%, P < 0.001), leading to a lower prevalence of moderate‐to‐severe malnutrition at HT (19% vs 46%, P = 0.003). Conclusions Malnutrition is common in pediatric HT candidates. Compared to children on OMT, children on VAD support had greater improvement in nutritional status while awaiting HT, and a lower prevalence of malnutrition at HT.

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Section: Introductionmentioning

confidence: 99%

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Hollander

Schultz

Dennis

et al. 2019

Pediatric Transplantation

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“…In studies of pediatric cardiomyopathy from diverse causes other than FRDA, nutritional status, as reflected by BMI, has been associated with survival outcomes. 26 In some children with chronic disease, the adverse effects of very low BMI can be mitigated with nutritional interventions. 24 Although it is plausible that extremely low BMI could lead to worse disease outcomes in children with FRDA, in this observational study with incomplete longitudinal measurements, we were not able to test this.…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index and Height in the Friedreich Ataxia Clinical Outcome Measures Study

et al. 2021

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Background and ObjectivesBody mass index (BMI) and height are important indices of health. We tested the association between these outcomes and clinical characteristics in Friedreich ataxia (FRDA), a progressive neuromuscular disorder.MethodsParticipants (N = 961) were enrolled in a prospective natural history study (Friedreich Ataxia Clinical Outcome Measure Study). Age- and sex-specific BMI and height Z-scores were calculated using CDC 2000 references for participants younger than 18 years. For adults aged 18 years or older, height Z-scores were also calculated, and absolute BMI was reported. Univariate and multivariate linear regression analyses tested the associations between exposures, covariates, and BMI or height measured at the baseline visit. In children, the superimposition by translation and rotation analysis method was used to compare linear growth trajectories between FRDA and a healthy reference cohort, the Bone Mineral Density in Childhood Study (n = 1,535 used for analysis).ResultsMedian age at the baseline was 20 years (IQR, 13–33 years); 49% (n = 475) were women. A substantial proportion of children (17%) were underweight (BMI-Z < fifth percentile), and female sex was associated with lower BMI-Z (β = −0.34, p < 0.05). In adults, older age was associated with higher BMI (β = 0.09, p < 0.05). Regarding height, in children, older age (β −0.06, p < 0.05) and worse modified Friedreich Ataxia Rating Scale (mFARS) scores (β = −1.05 for fourth quartile vs first quartile, p < 0.01) were associated with shorter stature. In girls, the magnitude of the pubertal growth spurt was less, and in boys, the pubertal growth spurt occurred later (p < 0.001 for both) than in a healthy reference cohort. In adults, in unadjusted analyses, both earlier age of FRDA symptom onset (=0.09, p < 0.05) and longer guanine-adenine-adenine repeat length (shorter of the 2 GAA repeats, β = −0.12, p < 0.01) were associated with shorter stature. Both adults and children with higher mFARS scores and/or who were nonambulatory were less likely to have height and weight measurements recorded at clinical visits.DiscussionFRDA affects both weight gain and linear growth. These insights will inform assessments of affected individuals in both research and clinical settings.

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“…What is more, Castleberry et al found that obesity itself was not a risk factor for the pediatric cardiomyopathy population as a whole, including symptomatic and asymptomatic individuals [69]. High circulating lipoprotein levels in obese patients may bind and detoxify lipopolysaccharides that play a role in stimulating the release of inflammatory cytokines, all of which may serve to protect them [70,71].…”

Section: Possible Mechanismsmentioning

confidence: 99%

Total Serum Protein as an Independent Predictor of Heart Failure with Preserved Ejection Fraction in Obese Pediatric Population

Poruban¹,

Banovcinova²,

Vachalcová³

et al. 2021

austinjclincardiolog

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Objectives: We aimed to clarify the prognostic role of Total Serum Protein (TSP) in obese children with HFpEF and its using as an effective and noninvasive approach for screening of target population. Methods: In total, 587 patients who enrolled in our unique program aimed for children’s obesity treatment were referred. Among these patients, we identified and retrospectively studied 64 patients who met our criteria and compared them with 24 lean healthy subjects. Baseline examination, routine blood testing and transthoracic echocardiography were obtained. Results: We revealed that obese patients had higher TSP levels compared to them with normal weight. They also had worse echocardiographic results including a lower Left Ventricular Ejection Fraction (LVEF) and E/A ratio. Positive correlations between TSP and Pulmonary Artery Systolic Pressure (PASP), Left Atrial Volume Index (LAVI), and Interventricular Septal Systolic/Diastolic Dimension (IVSs, IVSd) and negative TSP correlations with LVEF and E/A ratio were found, too. Compared to the commonly used Albumin-to-Globulin Ratio (AGR), the TSP was a better metabolic predictor. There were more significant correlations in obese subgroup with HFpEF than to those without HFpEF. Conclusions: We first indicated that higher TSP levels are positively associated with obesity and HFpEF in children and could be used as a more easily available biomarker which provides a more-accurate HFpEF risk evaluation of obese pediatric population group than other objective indices, possibly allowing early implementation of appropriate intervention in daily practice and leads to better outcomes and early prevention in patients with higher HF risk.

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No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy

Cited by 15 publications

References 39 publications

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Body Mass Index and Height in the Friedreich Ataxia Clinical Outcome Measures Study

Total Serum Protein as an Independent Predictor of Heart Failure with Preserved Ejection Fraction in Obese Pediatric Population

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