Abstract 18917: High Overweight and Obesity Rates in Fontan Patients: a Twenty-Year History
Background: Elevated body mass index (BMI) is a major independent risk factor for cardiovascular disease. The prevalence of obesity in patients with Fontan physiology is unknown and the added disease burden is unclear. There are no longitudinal studies on weight trends in Fontan patients. Objective: To determine the prevalence of overweight (OW) and obesity (OB) and to track longitudinal changes in BMI in children and adults treated with Fontan palliative surgery at a major tertiary care center. Design and
Methods: We performed a retrospective chart review of all patients who underwent the Fontan operation between 1992 - 2012. Subjects were categorized by age as outlined by the NHANES database (2-5 y, 6-11 y, 12-19 y, adults) and growth records were reviewed. BMI percentiles were calculated for children using the US Centers for Disease Control (CDC) growth charts. CDC definitions of OW and OB were used.
Results: Anthropometric data were available for 701 subjects (n=401, age 2-5 y; n= 333, age 6-11 y; n=217, age 12-19 y; and n=128, adult). Among adults, 38% (n=49) were OW or OB at last clinic visit, with 21.1% (n=27) OW and 17.2% (n=22) OB. Longitudinal data were available for 83 adult subjects. Of this subset, 14.5% (n=12) were OW or OB in childhood, 85.5% (n=71) had BMI < 85th percentile. Forty seven percent of OB adults were OW or OB in childhood (n=9/19). The likelihood of being OW/OB as an adult was 2.5 times higher if there was OW/OB present during childhood (CI 1.8-3.6, p =<0.001). Within children, the total rates of OW and OB in age groups 2-5 y, 6-11 y and 12-19 y were 24.7% (n=99), 26.4% (n=88) and 13.3% (n=29), respectively. Childhood OB rates were 13.4 % (n=54), 12% (n=40), and 4.6% (n=10), respectively, compared to national obesity rates of 10.4%, 19.6%, and 18.1% (NHANES 2007-2008).
Conclusion: In this high-risk population, obesity rates for adults are nearly as high as those reported in national data, and are higher than national rates for children ages 2-5y. Longitudinal data in adult Fontan patients show that increased weight begins in childhood. The impact of early-onset obesity especially in young children with complex congenital heart disease is unknown. Assessment of the additional disease burden of obesity in this population requires additional study.
- © 2012 by American Heart Association, Inc.