Longitudinal development of obesity in the post-Fontan population.
OBJECTIVE
An elevated body mass index (BMI) in childhood is a significant risk factor for cardiovascular disease, and it may pose an additional risk to children and adults with palliated univentricular congenital heart disease. However, little is known about longitudinal development of obesity in this population. The objective of this study is to determine the prevalence of overweight (OW) and obese (OB) habitus at the time of Fontan palliative surgery, to track changes in BMI after surgery, and ultimately to determine whether factors such as gender, ethnicity, preoperative heart defect and ventricular dominance are associated with later development of OW or OB.


METHODS
A retrospective chart review of 84 patients undergoing Fontan palliation was performed. Demographic data including gender, ethnicity, preoperative heart defect and ventricular dominance were recorded. Height, weight and BMI were obtained at the time of Fontan and on a yearly basis post surgery.


RESULTS
At the time of Fontan palliation, 10.7% of patients were OB or OW. During the five years following palliation, the percentage of OB or OW patients trended upward, from 20.3% the year following surgery to 30% at 5 years post Fontan. Repeated measures generalized estimating equation showed a significant association between Hispanic ethnicity and increased BMI Z-scores for the 5 years after Fontan palliation (P<0.001); there was no association between BMI Z-scores and patient sex, lesion or ventricular dominance.


CONCLUSIONS
During the first 5 years after Fontan palliation, there is a trend toward increasing percentages of OB and OW patients. In addition, there is a significant association between Hispanic ethnicity and being OW or OB before and after surgery. Further study is needed to determine whether OW/OB status is associated with worse health outcomes in this patient population.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA.
K
K
Wellnitz
Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA.|Cardiovascular Research Institute, University of California, San Francisco, CA, USA.
I S
IS
Harris
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA.
A
A
Sapru
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA.|Cardiovascular Research Institute, University of California, San Francisco, CA, USA.
J R
JR
Fineman
Department of Pediatrics, The Heart Center and the Seattle Children's Hospital, University of Washington, Seattle, WA, USA.|Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
M
M
Radman
D015992:Body Mass Index; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D050177:Overweight / Q000453:epidemiology / Q000209:etiology; D010166:Palliative Care; D011183:Postoperative Complications