PM1013: Trends in Obesity in Specific Populations with Congenital Heart Disease

Background: Among children and adolescents, rates of obesity (Body Mass Index (BMI) > 95 percentile) have been steadily increasing. It is known that pediatric obesity is a risk factor for adult obesity as well as multiple cardiovascular morbidities and those with congenital heart disease (CHD) are particularly vulnerable.

This study aims to determine if the rates of obesity have increased significantly over the last 15 years in specific populations of CHD patients with complete repair during infancy: ventricular septal defects (VSD), transposition of the great arteries (d-TGA), coarctation of the aorta (CoA), and Tetralogy of Fallot (TOF).

Methods: A single center retrospective cohort analysis was done to determine if and when a child developed obesity with specific CHD diagnosis. Cohorts were split into era by birth year from 2004-2008 (n= 83), 2009-2012 (n = 78), and 2013-2017 (n = 79). Gestational age ( < 37 weeks = 12.5%), sex at birth (female = 35%), birth weight ( < 2500g = 10.83%), and method of insurance (Medicaid = 46.25%) were recorded. Obesity was defined as BMI > 95th percentile for age. The date at which a patient had a first recorded obese BMI was recorded. A survival curve and time to event hazard curve were constructed and a hazard ratio was calculated to determine significant differences in risk of becoming obesity between birth cohorts. Additionally, the prevalence of obesity within each sample was calculated and compared to a population average from a database using a chi squared analysis.

Results: In the combined CHD cohort population, those born between 2013-2017 have increased risk of developing obesity compared to those born between 2004-2008 (Hazard ratio: 6.048, p = 0.00036). When split into subgroups by diagnosis, populations with coarctation of the aorta (HR: 11.91, p = 0.00971) and those with d-TGA (HR: 12.96, p = 0.024) have increased risk comparing the youngest cohort to the oldest cohort. Cohorts with VSD and tetralogy of Fallot were not shown to be at significantly increased risk of obesity when comparing younger to older birth-year groups. The prevalence of obesity for the entire cohort population is 20.8% and higher compared to the prevalence for the Oregon pediatric population of 13.7% (p = 0.0013). In particular, those with coarctation of the aorta, demonstrated the highest overall prevalence of obesity at 26.2% (p = 0.0044).

Conclusion: While the congenital heart disease population as a whole has experienced an alarming increasing risk of obesity, the risk is not the same between children with different diagnoses. These findings suggest that our youth with CHD may experience significant disease burden in the future in addition to their congenital disease. This could have implications for postoperative recommendations and activity restrictions for children with congenital heart disease.