Author + information
- Received May 30, 2017
- Revision received November 9, 2017
- Accepted November 11, 2017
- Published online February 26, 2018.
- Chesney D. Castleberry, MDa,∗ (, )
- John L. Jefferies, MD, MPHb,
- Ling Shi, PhDc,
- James D. Wilkinson, MD, MPHd,
- Jeffrey A. Towbin, MDe,
- Ryan W. Harrison, MSc,
- Joseph W. Rossano, MD, MSf,
- Elfriede Pahl, MDg,
- Teresa M. Lee, MDh,
- Linda J. Addonizio, MDh,
- Melanie D. Everitt, MDi,
- Justin Godown, MDj,
- Joseph Mahgerefteh, MDk,
- Paolo Rusconi, MDl,
- Charles E. Canter, MDa,
- Steven D. Colan, MDm,
- Paul F. Kantor, MBBChn,
- Hiedy Razoky, BS, MBAd,
- Steven E. Lipshultz, MDd and
- Tracie L. Miller, MDl
- aDepartment of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- bDepartment of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- cNew England Research Institutes, Watertown, Massachusetts
- dDepartment of Pediatrics, Wayne State University School of Medicine and Children’s Hospital of Michigan, Detroit, Michigan
- eDepartment of Pediatrics, The Heart Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
- fDepartment of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- gDepartment of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- hDepartment of Pediatrics, Columbia University Medical Center, New York, New York
- iDepartment of Pediatrics, Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
- jDepartment of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- kDepartment of Pediatrics, Children’s Hospital at Montefiore, Bronx, New York
- lDepartment of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida
- mDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- nDepartment of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
- ↵∗Address for correspondence:
Dr. Chesney D. Castleberry, Washington University in St. Louis, One Children’s Place, Campus Box 8116-NWT, St. Louis, Missouri 63110.
Objectives This study aimed to examine the role of nutrition in pediatric dilated cardiomyopathy (DCM).
Background In adults with DCM, malnutrition is associated with mortality, whereas obesity is associated with survival.
Methods The National Heart, Lung, and Blood Institute–funded Pediatric Cardiomyopathy Registry was used to identify patients with DCM and categorized by anthropometric measurements: malnourished (MN) (body mass index [BMI] <5% for age ≥2 years or weight-for-length <5% for <2 years), obesity (BMI >95% for age ≥2 years or weight-for-length >95% for <2 years), or normal bodyweight (NB). Of 904 patients with DCM, 23.7% (n = 214) were MN, 13.3% (n=120) were obese, and 63.1% (n=570) were NB.
Results Obese patients were older (9.0 vs. 5.7 years for NB; p < 0.001) and more likely to have a family history of DCM (36.1% vs. 23.5% for NB; p = 0.023). MN patients were younger (2.7 years vs. 5.7 years for NB; p < 0.001) and more likely to have heart failure (79.9% vs. 69.7% for NB; p = 0.012), cardiac dimension z-scores >2, and higher ventricular mass compared with NB. In multivariable analysis, MN was associated with increased risk of death (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.66 to 3.65; p < 0.001); whereas obesity was not (HR: 1.49; 95% CI: 0.72 to 3.08). Competing outcomes analysis demonstrated increased risk of mortality for MN compared with NB (p = 0.03), but no difference in transplant rate (p = 0.159).
Conclusions Malnutrition is associated with increased mortality and other unfavorable echocardiographic and clinical outcomes compared with those of NB. The same effect of obesity on survival was not observed. Further studies are needed investigating the long-term impact of abnormal anthropometric measurements on outcomes in pediatric DCM. (Pediatric Cardiomyopathy Registry; NCT00005391)
Supported by grants from the National Heart, Lung, and Blood Institute (NHLBI; HL 53392) and the Children’s Cardiomyopathy Foundation (CCF). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI or CCF. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 30, 2017.
- Revision received November 9, 2017.
- Accepted November 11, 2017.
- 2018 American College of Cardiology Foundation
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