No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy

Chesney D. Castleberry; John L. Jefferies; Ling Shi; James D. Wilkinson; Jeffrey A. Towbin; Ryan W. Harrison; Joseph W. Rossano; Elfriede Pahl; Teresa M. Lee; Linda J. Addonizio; Melanie D. Everitt; Justin Godown; Joseph Mahgerefteh; Paolo Rusconi; Charles E. Canter; Steven D. Colan; Paul F. Kantor; Hiedy Razoky; Steven E. Lipshultz; Tracie L. Miller

doi:10.1016/j.jchf.2017.11.015

No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy

Chesney D. Castleberry^*, John L. Jefferies, Ling Shi, James D. Wilkinson, Jeffrey A. Towbin, Ryan W. Harrison, Joseph W. Rossano, Elfriede Pahl, Teresa M. Lee, Linda J. Addonizio, Melanie D. Everitt, Justin Godown, Joseph Mahgerefteh, Paolo Rusconi, Charles E. Canter, Steven D. Colan, Paul F. Kantor, Hiedy Razoky, Steven E. Lipshultz, Tracie L. Miller

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	222-230
Number of pages	9
Journal	JACC: Heart Failure
Volume	6
Issue number	3
DOIs	https://doi.org/10.1016/j.jchf.2017.11.015
State	Published - Mar 2018

Funding

The authors thank the participating centers for subject recruitment and follow-up data collection. They also thank the Children’s Cardiomyopathy Foundation for their ongoing support of the Pediatric Cardiomyopathy Registry’s research efforts. 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.

Keywords

dilated cardiomyopathy
heart failure
pediatrics

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jchf.2017.11.015

Cite this

Castleberry, C. D., Jefferies, J. L., Shi, L., Wilkinson, J. D., Towbin, J. A., Harrison, R. W., Rossano, J. W., Pahl, E., Lee, T. M., Addonizio, L. J., Everitt, M. D., Godown, J., Mahgerefteh, J., Rusconi, P., Canter, C. E., Colan, S. D., Kantor, P. F., Razoky, H., Lipshultz, S. E., & Miller, T. L. (2018). No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy. JACC: Heart Failure, 6(3), 222-230. https://doi.org/10.1016/j.jchf.2017.11.015

@article{0dca0a479bbb499d8a8e738e5a8135d2,

title = "No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy",

abstract = "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.",

keywords = "dilated cardiomyopathy, heart failure, pediatrics",

author = "Castleberry, {Chesney D.} and Jefferies, {John L.} and Ling Shi and Wilkinson, {James D.} and Towbin, {Jeffrey A.} and Harrison, {Ryan W.} and Rossano, {Joseph W.} and Elfriede Pahl and Lee, {Teresa M.} and Addonizio, {Linda J.} and Everitt, {Melanie D.} and Justin Godown and Joseph Mahgerefteh and Paolo Rusconi and Canter, {Charles E.} and Colan, {Steven D.} and Kantor, {Paul F.} and Hiedy Razoky and Lipshultz, {Steven E.} and Miller, {Tracie L.}",

note = "Funding Information: The authors thank the participating centers for subject recruitment and follow-up data collection. They also thank the Children{\textquoteright}s Cardiomyopathy Foundation for their ongoing support of the Pediatric Cardiomyopathy Registry{\textquoteright}s research efforts. Funding Information: Supported by grants from the National Heart, Lung, and Blood Institute (NHLBI; HL 53392) and the Children{\textquoteright}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. Publisher Copyright: {\textcopyright} 2018 American College of Cardiology Foundation",

year = "2018",

month = mar,

doi = "10.1016/j.jchf.2017.11.015",

language = "English (US)",

volume = "6",

pages = "222--230",

journal = "JACC: Heart Failure",

issn = "2213-1779",

publisher = "Elsevier Inc.",

number = "3",

}

Castleberry, CD, Jefferies, JL, Shi, L, Wilkinson, JD, Towbin, JA, Harrison, RW, Rossano, JW, Pahl, E, Lee, TM, Addonizio, LJ, Everitt, MD, Godown, J, Mahgerefteh, J, Rusconi, P, Canter, CE, Colan, SD, Kantor, PF, Razoky, H, Lipshultz, SE & Miller, TL 2018, 'No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy', JACC: Heart Failure, vol. 6, no. 3, pp. 222-230. https://doi.org/10.1016/j.jchf.2017.11.015

TY - JOUR

T1 - No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy

AU - Castleberry, Chesney D.

AU - Jefferies, John L.

AU - Shi, Ling

AU - Wilkinson, James D.

AU - Towbin, Jeffrey A.

AU - Harrison, Ryan W.

AU - Rossano, Joseph W.

AU - Pahl, Elfriede

AU - Lee, Teresa M.

AU - Addonizio, Linda J.

AU - Everitt, Melanie D.

AU - Godown, Justin

AU - Mahgerefteh, Joseph

AU - Rusconi, Paolo

AU - Canter, Charles E.

AU - Colan, Steven D.

AU - Kantor, Paul F.

AU - Razoky, Hiedy

AU - Lipshultz, Steven E.

AU - Miller, Tracie L.

N1 - Funding Information: The authors thank the participating centers for subject recruitment and follow-up data collection. They also thank the Children’s Cardiomyopathy Foundation for their ongoing support of the Pediatric Cardiomyopathy Registry’s research efforts. Funding Information: 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. Publisher Copyright: © 2018 American College of Cardiology Foundation

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

KW - dilated cardiomyopathy

KW - heart failure

KW - pediatrics

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No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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