title: High Overweight and Obesity in Fontan Patients: A 20-Year History.
abstract: 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. 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 to 2012. The number of clinic encounters (n) was stratified by age group (n = 401, 2-5 years; n = 333, 6-11 years; n = 217, 12-19 years; and n = 129, >20 years). 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 three 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 2-5 years, (25 vs. 23%), 6-11 years (26 vs. 34%), and 12-19 years (15 vs. 35%). Systolic blood pressure was higher in overweight/obese children as young as 2-5 years of age. 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.
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA. chungst@niddk.nih.gov.|National Institute of Diabetes and Digestive Disorders and Kidney Diseases (NIDDK), NIH, 10 Center Dr. Bld 10-CRC, RM 5-5740, MSC 1612, Bethesda, MD, 20892-1612, USA. chungst@niddk.nih.gov.
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Chung
authors.affiliation: Department of Pediatrics, Cardiology, Baylor College of Medicine, Houston, TX, USA.|Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Borah
authors.initials: B
authors.lastname: Hong
authors.affiliation: Department of Pediatrics, Cardiology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Lance
authors.initials: L
authors.lastname: Patterson
authors.affiliation: Department of Pediatrics, Cardiology, Baylor College of Medicine, Houston, TX, USA.|Emory University, Atlanta, GA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA.|Emory University, Atlanta, GA, USA.
authors.forename: J Nina
authors.initials: JN
authors.lastname: Ham
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D050177:Overweight / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Congenital; Fontan procedure; Growth; Heart defect; Obesity; Pediatrics