A cardiovascular disease risk factor in children with congenital heart disease: unmasking elevated waist circumference - a CHAMPS* study *CHAMPS: Children’s Healthy-Heart Activity Monitoring Program in Saskatchewan

Abstract

Background: Children with congenital heart disease (CHD) have an elevated risk of future cardiovascular disease but the underlying mechanisms are unclear. Abdominal obesity (measured as waist circumference) is a risk factor for adult onset of cardiovascular diseases and is correlated with low physical activity levels, commonly found in children with congenital heart disease. Elevated waist circumference may be a mechanism by which cardiovascular disease risk is elevated in children with CHD. The purpose of this study was to compare waist circumference between children with and without CHD, while considering potential confounders. We hypothesized that children with CHD would have higher measures of waist circumference when controlling for differences in birthweight, lean mass, and physical activity. Methods: Thirty-two children with CHD (10.9 ± 2.6 years; 12 female) from the Children's Healthy-Heart Activity Monitoring Program in Saskatchewan, and 23 healthy controls (11.7 ± 2.5 years; 10 female) were studied. Waist circumference, physical activity (physical activity questionnaire), body composition (lean mass; dual x-ray absorptiometry), and birthweight were assessed. Analysis of covariance, Mann-Whitney U, and independent sample t-tests were used to assess group differences (p < 0.05). Results: Children with CHD had greater waist circumference than controls, controlling for lean mass, physical activity, birthweight, and sex (F (1, 49) = 4.488, p = 0.039). Physical activity, lean mass, and birthweight were not significantly different between groups (p > 0.05). Conclusion: Our findings generate a novel hypothesis-higher waist circumferences in children with CHD compared to age-matched controls, may contribute to an elevated risk of cardiovascular disease.

Overweight and Obesity in Patients with Congenital Heart Disease: A Systematic Review

“…Twenty-six of the included studies were cross-sectional studies that examined the prevalence of overweight and obesity in patients with CHD , and four were cohort studies that investigated the longitudinal change of the prevalence across the lifespan [10,[43][44][45]. The body composition of patients with CHD was compared to a healthy reference cohort in 13 of the included studies [20][21][22][23][24][28][29][30]33,35,40,41,45], whereas 9 studies merely investigated the prevalence of overweight and obesity in patients with…”

“…All included studies assessed overweight and obesity with the body mass index (BMI), while two studies additionally performed dual x-ray absorptiometry [18,20], one study performed impedance measurement [35], and one study assessed waist circumference [20]. Based on the BMI, patients were classified as underweight (<18.5 kg/m 2 ), normal weight (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obese (≥30 kg/m 2 ) and severe obese (≥35 kg/m 2 ).…”

“…Various contributing factors have an impact on weight status and should therefore be considered when investigating the prevalence of overweight and obesity. The included studies in this review controlled for age [21,24,35,37,39], age and lesion severity [27], age and sex [10,17,18,20,23,28,31,33,36,38,40,41,43,44], race/ ethnicity [29,45], family history, parent's nutritional status [19], marital status, educational level, and geographic region [34]. Six studies did not take confounders into account and were therefore rated as "poor" [8,22,25,26,37,42].…”

Physical activity modification in youth with congenital heart disease: a comprehensive narrative review

“…36The method of measurement could explain part of the apparent discrepancies between the studies. Five (22,33,35,37,38,40) out of eight (25,27,30) studies with self-or parent-reported outcomes found significantly lower PA levels in children with CHD. In contrast, five of nine studies with accelerometer-assessed PA found no differences between cases and controls, (26,28,29,31,33) and three found lower PA levels only in subgroups of patients.…”

“…Details of these observational studies and their findings with regard to PA are shown in Supplementary Table 1. Most studies enrolled adolescent patients, four studies enrolled younger school-aged children, (22)(23)(24)(25) and one focused on preschoolers. (26) The number of patients with CHD included in the studies ranged from seven (23) to 316, (27) the double labelled water method (23) were used in one study each.…”