Obesity is common in children with heart disease, a population already at increased risk of a shortened life expectancy.
More than 25 percent of children with congenital and acquired heart disease are overweight or obese, say researchers from The Children's Hospital of Philadelphia and Children's Hospital Boston in a study released in the current issue of Pediatrics. While this 25 percent prevalence is similar to the rate found in the general population, the researchers stress that health risks from obesity are added to the children's separate risks from their underlying heart disease.
Activity restrictions, whether or not they are recommended by physicians, may play a role in the development of obesity in this patient group, says the research team, adding that doctors may need to counsel families on safe and appropriate exercise routines for their children.
"Children with congenital heart disease may have unique risk factors which may contribute to the development of obesity," said Nelangi M. Pinto, M.D., a pediatric cardiologist and primary investigator of the study. "The long-term impact of superimposed obesity on children with heart disease is unknown but is likely to increase morbidity and mortality as it does in adults with heart disease." Now at the University of Utah, Pinto was at The Children's Hospital of Philadelphia when the research was conducted
The Children's Hospital of Philadelphia clinicians collaborated with researchers from Children's Hospital Boston to review the medical records from a sample of 2,921 patients between ages six and 19 years of age who visited one of the hospitals for cardiology outpatient care in 2004. Of the 2,921 samples, 1,523 children had either acquired or congenital heart disease.
Roughly half of the sample who had no significant heart disease constituted the control group in the study. The rate of overweight and obesity in these control patients was no different from that found in the general population of children, as measured by the Centers for Disease Control and Prevention.
Among the children with heart disease, those with heart transplants, rhythm problems and mild heart disease had a similar prevalence of obesity to the clinic control group. The only subgroup of children with heart disease with a significant lower prevalence of overweight and obesity were those who had undergone the Fontan operation to treat highly complex forms of congenital heart disease.
Those children had a prevalence of 15.9 percent, compared to the over 25 percent rate found in both clinic control group and the heart patients as a whole.
The researchers noted that children who have the Fontan operation often have chronic growth and development problems, but the rate of obesity, nearly one in six, was still very concerning.
The researchers also found that discussions about weight were relatively uncommon during cardiology clinic visits. "Awareness and discussion of weight control, exercise and other lifestyle issues must become an important part of the evaluation of all children with heart disease during cardiology visits," said Meryl S. Cohen, M.D., a pediatric cardiologist at The Children's Hospital of Philadelphia and senior author of the study. "It is also important to note that activity restrictions are not solely determined by cardiologists but may also be initiated by parents or self-imposed by the children themselves."
Drs. Pinto and Cohen's coauthors were Bradley S. Marino, M.D., M.P.P., M.S.C.E.; Gil Wernovsky, M.D.; Kristen Hyland, and Stanley O. Dunn, Jr., all of The Children's Hospital of Philadelphia; and Sarah D. de Ferranti, M.D., M.P.H; Meena Laronde, R.N., and Amy Z. Walsh, R.N., of Children's Hospital Boston.
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