Moderate and Severe Congenital Heart Diseases Adversely Affect the Growth of Children in Italy: A Retrospective Monocentric Study

Abstract

Children with congenital heart disease (CHD) are at increased risk for undernutrition. The aim of our study was to describe the growth parameters of Italian children with CHD compared to healthy children. We performed a cross-sectional study collecting the anthropometric data of pediatric patients with CHD and healthy controls. WHO and Italian z-scores for weight for age (WZ), length/height for age (HZ), weight for height (WHZ) and body mass index (BMIZ) were collected. A total of 657 patients (566 with CHD and 91 healthy controls) were enrolled: 255 had mild CHD, 223 had moderate CHD and 88 had severe CHD. Compared to CHD patients, healthy children were younger (age: 7.5 ± 5.4 vs. 5.6 ± 4.3 years, p = 0.0009), taller/longer (HZ: 0.14 ± 1.41 vs. 0.62 ± 1.20, p < 0.002) and heavier (WZ: -0,07 ± 1.32 vs. 0.31 ± 1.13, p = 0.009) with no significant differences in BMIZ (-0,14 ± 1.24 vs. -0.07 ± 1.13, p = 0.64) and WHZ (0.05 ± 1.47 vs. 0.43 ± 1.07, p = 0.1187). Moderate and severe CHD patients presented lower z-scores at any age, with a more remarkable difference in children younger than 2 years (WZ) and older than 5 years (HZ, WZ and BMIZ). Stunting and underweight were significantly more present in children affected by CHD (p < 0.01). In conclusion, CHD negatively affects the growth of children based on the severity of the disease, even in a high-income country, resulting in a significant percentage of undernutrition in this population.

Keywords: children; congenital heart diseases; growth failure; malnutrition; obesity; pediatric heart diseases.

Figure 1

Box plots of length/height-for-age z-score (HZ), weight-for-age z-score (WZ), Body-Mass-Index-for-age z-score (BMIZ) and weight-for-height z-score (WHZ), stratified for the different ages and Congenital Heart Disease (CHD) severity groups. (a) Box plot of HZ distribution according to the different age groups and CHD severity groups; (b) Box plot of WZ distribution according to the different age groups and CHD severity groups; (c) Box plot of BMIZ distribution according to CHD severity groups in children older than 2 years of age; (d) Box plot of WHZ distribution according to CHD severity groups in children younger than 2 years of age.

Figure 1

Box plots of length/height-for-age z-score (HZ), weight-for-age z-score (WZ), Body-Mass-Index-for-age z-score (BMIZ) and weight-for-height z-score (WHZ), stratified for the different ages and Congenital Heart Disease (CHD) severity groups. (a) Box plot of HZ distribution according to the different age groups and CHD severity groups; (b) Box plot of WZ distribution according to the different age groups and CHD severity groups; (c) Box plot of BMIZ distribution according to CHD severity groups in children older than 2 years of age; (d) Box plot of WHZ distribution according to CHD severity groups in children younger than 2 years of age.

Figure 2

(a) Graphical distribution of mean length/height-for-age z-score (HZ), weight-for-age z-score (WZ) and Body-Mass-Index-for-age z-score (BMIZ)according to Congenital Heart Disease (CHD) severity in children older than 2 years old, divided into age groups; (b) Graphical distribution of mean weight-for-height z-score (WHZ) according to CHD severity in children younger than 2 years of age.