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No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy.

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2018 Mar

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<p><strong>OBJECTIVES: </strong>This study aimed to examine the role of nutrition in pediatric dilated cardiomyopathy (DCM).</p>

<p><strong>BACKGROUND: </strong>In adults with DCM, malnutrition is associated with mortality, whereas obesity is associated with survival.</p>

<p><strong>METHODS: </strong>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]&nbsp;&lt;5% for&nbsp;≥2 years or weight-for-length&nbsp;&lt;5% for&nbsp;&lt;2 years), obesity (BMI &gt;95% for age&nbsp;≥2 years or weight-for-length &gt;95% for&nbsp;&lt;2 years), or normal bodyweight (NB). Of 904 patients with DCM, 23.7% (214) were MN, 13.3% (120) were obese, and 63.1% (570) were NB.</p>

<p><strong>RESULTS: </strong>Obese patients were older (9.0 vs. 5.7 years for NB; p&nbsp;&lt; 0.001) and more likely to have a family history of DCM (36.1% vs. 23.5% for NB; p&nbsp;= 0.023). MN patients were younger (2.7 years vs. 5.7 years for NB; p&nbsp;&lt; 0.001) and more likely to have heart failure (79.9% vs. 69.7% for NB; p&nbsp;= 0.012), cardiac dimension z-scores &gt;2, and higher ventricular mass compared with NB. In multivariable analysis, MN was associated with increased risk of death (hazard&nbsp;ratio [HR]: 2.06; 95% confidence interval [CI]: 1.66 to 3.65; p&nbsp;&lt; 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&nbsp;=&nbsp;0.03), but no difference in transplant rate (p&nbsp;= 0.159).</p>

<p><strong>CONCLUSIONS: </strong>Malnutrition is associated with increased mortality and other unfavorable echocardiographic and clinical&nbsp;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&nbsp;Cardiomyopathy Registry; NCT00005391).</p>



Alternate Title

JACC Heart Fail




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