Body mass index stratification in hospitalized Italian adults with congenital heart disease in relation to complexity, diagnosis, sex and age

https://doi.org/10.1016/j.numecd.2019.01.009Get rights and content

Highlights

  • Underweight was higher in our selected population of symptomatic ACHD than in the Italian reference population.

  • Complex cardiac defects had the highest prevalence of underweight and the lowest prevalence of overweight and obesity.

  • Overweight was lower in our symptomatic ACHD patients than in Italians, but obesity level was similar.

  • Overweight and obesity prevalence increased with age in almost all ACHD patients.

Abstract

Background and aims

Adults with congenital heart disease (ACHD) are at risk of overweight and obesity, two major health problems, though underweight can be a negative prognostic factor too. Awareness of the body mass index (BMI) in ACHD is very limited. The present study describes the use and prevalence of BMI in Italian symptomatic hospitalized ACHD patients in relation to complexity by Bethesda system classification, diagnosis, sex and age.

Methods and results

We classified 1388 ACHD patients, aged 18–69 years, on the basis of their BMI, and compared them to the Italian reference population. In our total ACHD population we found a significantly higher prevalence of underweight compared to the Italian reference population (6.34% vs 3.20%). ACHD women were more underweight than men. Underweight decreased with age. Overweight was significantly less frequent in the total ACHD population (26.73% compared to 31.70%) in the Italian reference population. Men were more likely to be overweight than women. In statistical terms obesity was similar in the Italian reference population (10.50%) and our ACHD population (9.58%). Both overweight and obesity increased with age. Results were comparable using a diagnostic anatomical-functional classification and the Bethesda system classification.

Conclusions

In our cohort of ACHD the prevalence of underweight was double that of the Italian reference population. The prevalence of overweight was lower, while obesity was similar. Since BMI does not account for differences in body fat distribution, a future aim will be to quantify the visceral component of the adipose tissue in ACHD patients and examine their body composition in order to reflect their risk of acquired cardiovascular disease better, and either to maintain or achieve an adequate visceral component.

Introduction

The prognosis of children with congenital heart disease (CHD) has changed over the last decades, primarily due to improvements in surgical techniques and interventional catheterization. As a consequence, the population of adults with congenital heart disease (ACHD) has increased [1], [2], [3] and its prevalence is estimated at four per thousand adults [1], [4].

This new population of patients is now exposed to the environmental and behavioral risk factors [5], [6], [7] entailed in chronic diseases - also referred to as non-communicable diseases (NCDs), such as overweight and obesity, which have become two major health problems throughout the world [8], [9], [10]. However, underweight is a risk factor too, and is associated with increased mortality [8], [11]. The body mass index (BMI) is the most widely used measure, defined by the World Health Organization (WHO) to classify weight status, and it correlates with all-causes mortality [8], [12].

In Italy, the latest data from the National Health Institute monitoring system called Passi declared a prevalence of underweight, overweight and obesity in the adult population as respectively 3.2%, 31.7% and 10.5% [13]. Excessive weight and underweight are important health concerns for ACHD patients, since they can both be markers of increased risk and negative prognostic factors [14]. However, data about the weight status of ACHD patients are few and non-homogenous, maybe reflecting national differences [14], [15], [16].

The aim of the present study was to describe, for the first time, the prevalence of underweight, normal weight, overweight and obesity in a wide sample of Italian ACHD patients hospitalized in our Centre, in relation to diagnosis, sex and age.

Section snippets

Methods

We gathered data from the Pediatric and Adult Congenital Heart Centre database and from the Department of Cardiothoracic, Vascular Anesthesia and Intensive Care database at the IRCCS Policlinico San Donato University Hospital (Milan, Italy).

We considered a selected population consisting of patients who were hospitalized for cardiac surgery or for catheterization. Data was obtained at hospital admission before any intervention and comprised information on diagnosis, intervention technique, age,

Results

The study comprised 1388 adult symptomatic patients with congenital heart defects who were hospitalized for cardiac surgery or catheterization. Their mean ± SD age was 41.45 ± 13.18 years. Table 2, Table 3 show all the data analyzed, with the stratification by sex and age that follows two different approaches: defect complexity (in accordance with Bethesda system classification) and diagnostic anatomical-functional classification. There were 776 females (55.91%) and 612 males (44.09%); 467 aged

Discussion

To the best of our knowledge, this is the first retrospective study in Italy focusing on BMI of ACHD hospitalized patients, who represent a selected population of symptomatic ACHD.

This could affect the generalizability to the total ACHD population, which is estimable in Italy in 80.000–100.000 individuals [21].

The main observations on this population are the following:

  • Underweight was double that of the Italian reference population. ACHD women were more underweight than ACHD men. Underweight was

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

The authors declare they have no competing interests to declare.

Acknowledgments

Pistuddi V., Ravasi D.

References (33)

  • Report of the British Cardiac Society Working Party

    Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK

    Heart

    (2002)
  • G.K. Lui et al.

    Management of Cardiovascular Risk Factors in Adults With Congenital Heart Disease

    J Am Heart Assoc

    (2014)
  • P. Moons et al.

    Prevalence of cardiovascular risk factors in adults with congenital heart disease

    Eur J Cardiovasc Prev Rehabil

    (2006)
  • Body-mass index and all-cause mortality: individual-participant- data meta-analysis of 239 prospective studies in four continents

    Lancet

    (2016)
  • Obesity: preventing and managing the global epidemic

    World Health Organ Tech Rep Ser

    (2000)
  • T. Kelly et al.

    Global burden of obesity in 2005 and projections to 2030

    Int J Obes

    (2008)
  • View full text