Too Fat or Too Thin? Body Habitus Assessment in Children Listed for Heart Transplant and Impact on Outcome

Kaufman, Beth D.; Nagle, Monica; Levine, Selena R.; Vijaynathan, Nirmala; Hanna, Brian D.; Paridon, Stephen M.; Ravishankar, Chitra; Chrisant, Maryanne

doi:10.1016/j.healun.2008.01.026

Cited by 28 publications

(37 citation statements)

References 10 publications

(16 reference statements)

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“…One barrier to an improved understanding of malnutrition in children has been a lack of standardized definitions of malnutrition severity. Previous studies have used several different definitions of malnutrition, including recorded weight, which is often an inaccurate surrogate for nutritional status in the setting of inconsistent fluid states frequently observed in pediatric congestive heart failure . The recent release of standardized definitions of malnutrition by the ASPEN and the MTool, however, now allow for more rigorous study, including comparisons of malnutrition status over time and between patient populations…”

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 contrast, our institution reported that wasting at time of listing for HT had no detectable adverse effect on survival, but obesity at time of listing was a significant risk factor for decreased graft survival. 5 These studies were both limited by small sample sizes. The potential relevance of abnormal body habitus in predicting clinical outcomes in the pediatric HT population requires further study.…”

mentioning

confidence: 99%

Wasting or Obesity at Time of Transplant Does Not Predict Pediatric Heart Transplant Outcomes: Analysis of ISHLT Pediatric Heart Transplant Registry

Kaufman

Chuai

Dobbels

et al. 2009

The Journal of Heart and Lung Transplantation

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“…34,44 Two solid organ transplant studies compared LOS among weight categories. One found significantly longer LOS in obese patients, 33 and the other found no difference in LOS according to weight category. 30 A similar discrepancy existed with the 2 studies of patients with burns 27,39 ; however, only 1 of these adjusted for covariates in the analysis.…”

Section: Resultsmentioning

confidence: 90%

Influence of Obesity on Clinical Outcomes in Hospitalized Children

Bechard¹,

Rothpletz‐Puglia²,

Touger‐Decker³

et al. 2013

JAMA Pediatr

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Importance Obesity is prevalent among hospitalized children. Knowledge of the relationship between obesity and outcomes in hospitalized children will enhance nutrition assessment and provide opportunities for interventions. Objective To systematically review the existing literature concerning the impact of obesity on clinical outcomes in hospitalized children. Evidence Acquisition PubMed, Web of Science, and EMBASE databases were searched for studies of hospitalized children aged 2 to 18 years with identified obesity and at least 1 of the following clinical outcomes: all-cause mortality, incidence of infections, and length of hospital stay. Cohort and case-control studies were included. Cross-sectional studies, studies of healthy children, and those without defined criteria for classifying weight status were excluded. The Newcastle-Ottawa Scale was used to assess study quality. Results Twenty-eight studies (26 retrospective; 24 cohort and 4 case-control) were included. Of the 21 studies that included mortality as an outcome, 10 reported a significant positive relationship between obesity and mortality. The incidence of infections was assessed in 8 of the 28 studies; 2 reported significantly more infections in obese compared with nonobese patients. Of the 11 studies that examined length of stay, 5 reported significantly longer lengths of hospital stay for obese children. Fifteen studies (53%) had a high quality score. Larger studies observed significant relationships between obesity and outcomes. Studies of critically ill, oncologic or stem cell transplant, and solid organ transplant patients showed a relationship between obesity and mortality. Conclusions and Relevance The available literature on the relationship between obesity and clinical outcomes is limited by subject heterogeneity, variations in criteria for defining obesity, and outcomes examined. Childhood obesity may be a risk factor for higher mortality in hospitalized children with critical illness, oncologic diagnoses, or transplants. Further examination of the relationship between obesity and clinical outcomes in this subgroup of hospitalized children is needed.

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Too Fat or Too Thin? Body Habitus Assessment in Children Listed for Heart Transplant and Impact on Outcome

Cited by 28 publications

References 10 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

Wasting or Obesity at Time of Transplant Does Not Predict Pediatric Heart Transplant Outcomes: Analysis of ISHLT Pediatric Heart Transplant Registry

Influence of Obesity on Clinical Outcomes in Hospitalized Children

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