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. 1995 Mar;73(3):277–283. doi: 10.1136/hrt.73.3.277

Nutritional status of children with congenital heart disease.

I M Mitchell 1, R W Logan 1, J C Pollock 1, M P Jamieson 1
PMCID: PMC483812  PMID: 7727190

Abstract

OBJECTIVE--To assess the nutritional status of children with congenital heart disease. DESIGN--Six anthropometric, 24 biochemical, and five haematological markers of nutritional wellbeing were measured in children with congenital heart disease. SETTING--The west of Scotland. PATIENTS--48 children admitted consecutively for surgical correction of congenital heart disease. MAIN OUTCOME MEASURES--Height, weight, and triceps and subscapular skin fold thicknesses were considered abnormal if they were below the third centile compared with standard reference data for age matched British children. Mid-arm circumference and arm muscle circumference were considered abnormal if they fell below the fifth centile compared with standard data. Biochemical and haematological data were compared with age matched and locally validated laboratory normals. RESULTS--A marked degree of undernutrition was evident in all children; 52% had weight less than the third centile, 37% were below the third centile for height, and 12.5% were below the third centile for triceps skin fold thickness and 18.8% for subscapular skin fold thickness. Mid-arm circumference and arm muscle circumference were below the fifth centile in 20.1% and 16.7% of children respectively. Five or more of the 29 biochemical and haematological measurements were abnormal in 83.3% of patients; 10 or more were abnormal in 12.5% of patients. CONCLUSIONS--Children with congenital heart disease are frequently undernourished, irrespective of the nature of cardiac defect and the presence or absence of cyanosis.

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Selected References

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  1. ADAMS F. H., FORSYTH W. B. The effect of surgery on the growth of patients with patent ductus arteriosus. J Pediatr. 1951 Sep;39(3):330–336. doi: 10.1016/s0022-3476(51)80155-0. [DOI] [PubMed] [Google Scholar]
  2. ADAMS F. H., LUND G. W., DISENHOUSE R. B. Observations on the physique and growth of children with congenital heart disease. J Pediatr. 1954 Jun;44(6):674–680. doi: 10.1016/s0022-3476(54)80009-6. [DOI] [PubMed] [Google Scholar]
  3. Abel R. M., Fisch D., Horowitz J., van Gelder H. M., Grossman M. L. Should nutritional status be assessed routinely prior to cardiac operation? J Thorac Cardiovasc Surg. 1983 May;85(5):752–757. [PubMed] [Google Scholar]
  4. Abel R. M., Fischer J. E., Buckley M. J., Barnett G. O., Austen W. G. Malnutrition in cardiac surgical patients. Results of a prospective, randomized evaluation of early postoperative parenteral nutrition. Arch Surg. 1976 Jan;111(1):45–50. doi: 10.1001/archsurg.1976.01360190047008. [DOI] [PubMed] [Google Scholar]
  5. Blackburn G. L., Bistrian B. R., Maini B. S., Schlamm H. T., Smith M. F. Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral Nutr. 1977;1(1):11–22. doi: 10.1177/014860717700100101. [DOI] [PubMed] [Google Scholar]
  6. Blackburn G. L., Gibbons G. W., Bothe A., Benotti P. N., Harken D. E., McEnany T. M. Nutritional support in cardiac cachexia. J Thorac Cardiovasc Surg. 1977 Apr;73(4):489–496. [PubMed] [Google Scholar]
  7. Buzby G. P., Mullen J. L., Matthews D. C., Hobbs C. L., Rosato E. F. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980 Jan;139(1):160–167. doi: 10.1016/0002-9610(80)90246-9. [DOI] [PubMed] [Google Scholar]
  8. Cuthbertson D. P. The disturbance of metabolism produced by bony and non-bony injury, with notes on certain abnormal conditions of bone. Biochem J. 1930;24(4):1244–1263. doi: 10.1042/bj0241244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dickinson D. F., Arnold R., Wilkinson J. L. Congenital heart disease among 160 480 liveborn children in Liverpool 1960 to 1969. Implications for surgical treatment. Br Heart J. 1981 Jul;46(1):55–62. doi: 10.1136/hrt.46.1.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dionigi R., Ariszonta, Dominioni L., Gnes F., Ballabio A. The effects of total parenteral nutrition on immunodepression due to malnutrition. Ann Surg. 1977 Apr;185(4):467–474. doi: 10.1097/00000658-197704000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Dionigi R., Dominioni L., Jemos V., Cremaschi R., Monico R. Diagnosing malnutrition. Gut. 1986 Nov;27 (Suppl 1):5–8. doi: 10.1136/gut.27.suppl_1.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. ENGLE M. A., HOLSWADE G. R., GOLDBERG H. P., GLENN F. Present problems pertaining to patency of the ductus arteriosus. I. Persistence of growth retardation after successful surgery. Pediatrics. 1958 Jan;21(1):70–80. [PubMed] [Google Scholar]
  13. Feldt R. H., Strickler G. B., Weidman W. H. Growth of children with congenital heart disease. Am J Dis Child. 1969 May;117(5):573–579. doi: 10.1001/archpedi.1969.02100030575012. [DOI] [PubMed] [Google Scholar]
  14. Garnett E. S., Barnard D. L., Ford J., Goodbody R. A., Woodehouse M. A. Gross fragmentation of cardiac myofibrils after therapeutic starvation for obesity. Lancet. 1969 May 3;1(7601):914–916. doi: 10.1016/s0140-6736(69)92546-x. [DOI] [PubMed] [Google Scholar]
  15. Golden M. H. Transport proteins as indices of protein status. Am J Clin Nutr. 1982 May;35(5 Suppl):1159–1165. doi: 10.1093/ajcn/35.5.1159. [DOI] [PubMed] [Google Scholar]
  16. Gross R. L., Newberne P. M. Role of nutrition in immunologic function. Physiol Rev. 1980 Jan;60(1):188–302. doi: 10.1152/physrev.1980.60.1.188. [DOI] [PubMed] [Google Scholar]
  17. HIGGINSON J., GILLANDERS A. D., MURRAY J. F. The heart in chronic malnutrition. Br Heart J. 1952 Apr;14(2):213–224. doi: 10.1136/hrt.14.2.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hall J. C., O'Quigley J., Giles G. R., Appleton N., Stocks H. Upper limb anthropometry: the value of measurement variance studies. Am J Clin Nutr. 1980 Aug;33(8):1846–1851. doi: 10.1093/ajcn/33.8.1846. [DOI] [PubMed] [Google Scholar]
  19. Haydock D. A., Hill G. L. Impaired wound healing in surgical patients with varying degrees of malnutrition. JPEN J Parenter Enteral Nutr. 1986 Nov-Dec;10(6):550–554. doi: 10.1177/0148607186010006550. [DOI] [PubMed] [Google Scholar]
  20. Haydock D. A., Hill G. L. Improved wound healing response in surgical patients receiving intravenous nutrition. Br J Surg. 1987 Apr;74(4):320–323. doi: 10.1002/bjs.1800740432. [DOI] [PubMed] [Google Scholar]
  21. Hill G. L. Malnutrition and surgical risk: guidelines for nutritional therapy. Ann R Coll Surg Engl. 1987 Nov;69(6):263–265. [PMC free article] [PubMed] [Google Scholar]
  22. Huse D. M., Feldt R. H., Nelson R. A., Novak L. P. Infants with congenital heart disease. Food intake, body weight, and energy metabolism. Am J Dis Child. 1975 Jan;129(1):65–69. doi: 10.1001/archpedi.1975.02120380043010. [DOI] [PubMed] [Google Scholar]
  23. Johnson D. J., Brooks D. C., Pressler V. M., Hulton N. R., Colpoys M. F., Smith R. J., Wilmore D. W. Hypothermic anesthesia attenuates postoperative proteolysis. Ann Surg. 1986 Oct;204(4):419–429. doi: 10.1097/00000658-198610000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. KROVETZ L. J. WEIGHT GAIN IN CHILDREN WITH PATENT DUCTUS ARTERIOSUS. Dis Chest. 1963 Sep;44:274–283. doi: 10.1378/chest.44.3.274. [DOI] [PubMed] [Google Scholar]
  25. Krieger I. Growth failure and congenital heart disease. Energy and nitrogen balance in infants. Am J Dis Child. 1970 Dec;120(6):497–502. doi: 10.1001/archpedi.1970.02100110045002. [DOI] [PubMed] [Google Scholar]
  26. LEES M. H., BRISTOW J. D., GRISWOLD H. E., OLMSTED R. W. RELATIVE HYPERMETABOLISM IN INFANTS WITH CONGENITAL HEART DISEASE AND UNDERNUTRITION. Pediatrics. 1965 Aug;36:183–191. [PubMed] [Google Scholar]
  27. MEHRIZI A., DRASH A. Growth disturbance in congenital heart disease. J Pediatr. 1962 Sep;61:418–429. doi: 10.1016/s0022-3476(62)80373-4. [DOI] [PubMed] [Google Scholar]
  28. Marks G. C., Habicht J. P., Mueller W. H. Reliability, dependability, and precision of anthropometric measurements. The Second National Health and Nutrition Examination Survey 1976-1980. Am J Epidemiol. 1989 Sep;130(3):578–587. doi: 10.1093/oxfordjournals.aje.a115372. [DOI] [PubMed] [Google Scholar]
  29. McFarlane H., Ogbeide M. I., Reddy S., Adcock K. J., Adeshina H., Gurney J. M., Cooke A., Taylor G. O., Mordie J. A. Biochemical assessment of protein-calorie malnutrition. Lancet. 1969 Feb 22;1(7591):392–394. doi: 10.1016/s0140-6736(69)91357-9. [DOI] [PubMed] [Google Scholar]
  30. Mitchell I. M., Davies P. S., Day J. M., Pollock J. C., Jamieson M. P. Energy expenditure in children with congenital heart disease, before and after cardiac surgery. J Thorac Cardiovasc Surg. 1994 Feb;107(2):374–380. [PubMed] [Google Scholar]
  31. Mullen J. L., Gertner M. H., Buzby G. P., Goodhart G. L., Rosato E. F. Implications of malnutrition in the surgical patient. Arch Surg. 1979 Feb;114(2):121–125. doi: 10.1001/archsurg.1979.01370260011001. [DOI] [PubMed] [Google Scholar]
  32. Neithercut W. D., Smith A. D., McAllister J., La Ferla G. Nutritional survey of patients in a general surgical ward: is there an effective predictor of malnutrition? J Clin Pathol. 1987 Jul;40(7):803–807. doi: 10.1136/jcp.40.7.803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. PITTMAN J. G., COHEN P. THE PATHOGENESIS OF CARDIAC CACHEXIA. N Engl J Med. 1964 Aug 20;271:403–CONTD. doi: 10.1056/NEJM196408202710807. [DOI] [PubMed] [Google Scholar]
  34. Pettigrew R. A., Charlesworth P. M., Farmilo R. W., Hill G. L. Assessment of nutritional depletion and immune competence: a comparison of clinical examination and objective measurements. JPEN J Parenter Enteral Nutr. 1984 Jan-Feb;8(1):21–24. doi: 10.1177/014860718400800121. [DOI] [PubMed] [Google Scholar]
  35. Reeds P. J., Laditan A. A. Serum albumin and transferrin protein-energy malnutrition. Their use in the assessment of marginal undernutrition and the prognosis of severe undernutrition. Br J Nutr. 1976 Sep;36(2):255–263. doi: 10.1079/bjn19760077. [DOI] [PubMed] [Google Scholar]
  36. Report of the New England Regional Infant Cardiac Program. Pediatrics. 1980 Feb;65(2 Pt 2):375–461. [PubMed] [Google Scholar]
  37. Salzer H. R., Haschke F., Wimmer M., Heil M., Schilling R. Growth and nutritional intake of infants with congenital heart disease. Pediatr Cardiol. 1989 Winter;10(1):17–23. doi: 10.1007/BF02328630. [DOI] [PubMed] [Google Scholar]
  38. Schwarz S. M., Gewitz M. H., See C. C., Berezin S., Glassman M. S., Medow C. M., Fish B. C., Newman L. J. Enteral nutrition in infants with congenital heart disease and growth failure. Pediatrics. 1990 Sep;86(3):368–373. [PubMed] [Google Scholar]
  39. Seltzer M. H., Bastidas J. A., Cooper D. M., Engler P., Slocum B., Fletcher H. S. Instant nutritional assessment. JPEN J Parenter Enteral Nutr. 1979 May-Jun;3(3):157–159. doi: 10.1177/014860717900300309. [DOI] [PubMed] [Google Scholar]
  40. Sondheimer J. M., Hamilton J. R. Intestinal function in infants with severe congenital heart disease. J Pediatr. 1978 Apr;92(4):572–578. doi: 10.1016/s0022-3476(78)80290-x. [DOI] [PubMed] [Google Scholar]
  41. Strangway A., Fowler R., Cunningham K., Hamilton J. R. Diet and growth in congenital heart disease. Pediatrics. 1976 Jan;57(1):75–86. [PubMed] [Google Scholar]
  42. Suoninen P. Physical growth of children with congenital heart disease. Pre- and postoperative study of 355 cases. Acta Paediatr Scand Suppl. 1971;225:1–50. [PubMed] [Google Scholar]
  43. Tanner J. M., Whitehouse R. H. Revised standards for triceps and subscapular skinfolds in British children. Arch Dis Child. 1975 Feb;50(2):142–145. doi: 10.1136/adc.50.2.142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Tanner J. M., Whitehouse R. H., Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. I. Arch Dis Child. 1966 Oct;41(219):454–471. doi: 10.1136/adc.41.219.454. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Tanner J. M., Whitehouse R. H., Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II. Arch Dis Child. 1966 Dec;41(220):613–635. doi: 10.1136/adc.41.220.613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. UMANSKY R., HAUCK A. J. Factors in the growth of children with patent ductus arteriousus. Pediatrics. 1962 Oct;30:540–551. [PubMed] [Google Scholar]
  47. Walesby R. K., Goode A. W., Bentall H. H. Nutritional status of patients undergoing valve replacement by open heart surgery. Lancet. 1978 Jan 14;1(8055):76–77. doi: 10.1016/s0140-6736(78)90008-9. [DOI] [PubMed] [Google Scholar]
  48. Walesby R. K., Goode A. W., Spinks T. J., Herring A., Ranicar A. S., Bentall H. H. Nutritional status of patients requiring cardiac surgery. J Thorac Cardiovasc Surg. 1979 Apr;77(4):570–576. [PubMed] [Google Scholar]
  49. Webb J. G., Kiess M. C., Chan-Yan C. C. Malnutrition and the heart. CMAJ. 1986 Oct 1;135(7):753–758. [PMC free article] [PubMed] [Google Scholar]
  50. Wester P. O. Letter: Zinc during diuretic treatment. Lancet. 1975 Mar 8;1(7906):578–578. doi: 10.1016/s0140-6736(75)91602-5. [DOI] [PubMed] [Google Scholar]
  51. Windsor J. A., Hill G. L. Risk factors for postoperative pneumonia. The importance of protein depletion. Ann Surg. 1988 Aug;208(2):209–214. doi: 10.1097/00000658-198808000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Windsor J. A., Hill G. L. Risk factors for postoperative pneumonia. The importance of protein depletion. Ann Surg. 1988 Aug;208(2):209–214. doi: 10.1097/00000658-198808000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Young G. A., Hill G. L. Assessment of protein-calorie malnutrition in surgical patients from plasma proteins and anthropometric measurements. Am J Clin Nutr. 1978 Mar;31(3):429–435. doi: 10.1093/ajcn/31.3.429. [DOI] [PubMed] [Google Scholar]

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