Preoperative nutritional status and serum insulin-like growth factor of children with cyanotic and acyanotic congenital heart disease

Abstract

Background: Malnutrition is common among children with congenital heart disease (CHD). We compared the anthropometric indices, serum insulin-like growth factor (IGF), and IGF acid-labile subunit (IGFALS) of children with cyanotic and acyanotic CHD before corrective surgery.

Methods: This 82-patient case-control study included 1- to 24-month-old CHD patients referred for corrective surgery. (41 with tetralogy of Fallot [TOF] and 41 with ventricular septal defect [VSD] or atrial septal defect [ASD]). Anthropometric indices represented as Z-scores were used to determine nutritional status. Serum IGF-1 and IGFALS levels were measured.

Results: The median [quartile] age of the acyanotic group was 8 [7,11] months which was lower than the cyanotic group (11 [8,14.5] months). The prevalence of underweight (weight for age Z [WAZ] < -2), wasting (weight for length Z [WLZ] < -2), and thinness (body mass index Z [BMIZ] < -2) was significantly higher in children with acyanotic than cyanotic children with. WAZ, WLZ, and BMIZ were significantly lower in acyanotic children than cyanotic children with CHD (-2.5 ± 1.2 vs -1.0 ± 1.2, p < 0.001 for WAZ, -2.5 ± 1.5 vs -0.8 ± 1.4, p < 0.001 for WLZ, and -2.5 ± 1.5 vs -0.8 ± 1.4, p < 0.001 for BMIZ), but length for age Z was not different between the two groups (-1.2 ± 1.0 vs -0.8 ± 1.1, p = 0.31). A comparison of preoperative serum albumin, IGF-1, and IGFALS showed no differences.

Conclusions: In CHD children without corrective surgery, moderate to severe underweight and wasting were more common in acyanotic CHD (VSD and ASD) than in cyanotic CHD (TOF), but the higher prevalence of malnutrition was not associated with lower IGF-1 and IGFALS levels.

Keywords: Congenital heart disease; IGF-1; IGFALS; Malnutrition; Nutritional status.