title: Risk factors and comorbidities associated with obesity in children and adolescents after the arterial switch operation and Ross procedure.
abstract: BACKGROUND
  Over 25% of patients with congenital heart disease are obese (OB) or overweight (OW). Unique factors such as activity restriction and early feeding practices may play a role. We evaluated a high-risk cohort predisposed to early coronary artery disease due to past surgery involving coronary artery reimplantation.
  
  
  METHODS
  Patients at our institution who underwent the arterial switch or Ross operation were included. Data collection included chart review and activity and diet questionnaires. The proportion of OB/OW (body mass index > or =85%) was compared to national data. Factors associated with OB/OW were evaluated.
  
  
  RESULTS
  A total of 106 patients were enrolled. Median age was 14.2 years (6.0-19.9 years); 69% were male. Similar to national data, 31% were OB/OW (vs 31%, P = nonsignificant [NS]). There was no difference comparing OB/OW to normal-weight patients in activity restriction (cardiologist documented 27% vs 27%; parent reported 38% vs 42%, P = NS), activity level (9.8 hours/week [1.7-41.2] vs 11.5 [0.8-52.3], P = NS), or early feeding practices (formula vs breastfeeding, caloric fortification, tube feeding). OB/OW patients were more likely to have an OB parent (70% vs 37%, P = .01). Left ventricular mass index was higher in OB/OW patients (48.8 g/m(2.7) [24.4-120.6] vs 37.7 g/m(2.7) [16.5-85.1], P = .01).
  
  
  CONCLUSIONS
  Nearly one third of ASO and Ross patients were OB/OW. Obese/overweight was not found to be related to activity restriction or early feeding practices, but was associated with parental obesity. Obese or OW patients had higher left ventricular mass. Obesity and associated comorbidities may pose additional cardiovascular risk in this unique population who underwent coronary artery reimplantation in childhood.
authors.affiliation: The Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
authors.forename: Anita
authors.initials: A
authors.lastname: Pudusseri
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Paridon
authors.forename: Susan A
authors.initials: SA
authors.lastname: Walker
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D002648:Child; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D012092:Replantation / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult