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

Research output: Contribution to journalArticle

4 Citations (Scopus)

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. (Pediatric Cardiomyopathy Registry; NCT00005391)

Original languageEnglish (US)
Pages (from-to)222-230
Number of pages9
JournalJACC: Heart Failure
Volume6
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Dilated Cardiomyopathy
Obesity
Pediatrics
Cardiomyopathies
Malnutrition
Registries
Mortality
Confidence Intervals
Survival
Body Mass Index
Transplants
Weights and Measures
Lung

Keywords

  • dilated cardiomyopathy
  • heart failure
  • pediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Castleberry, C. D., Jefferies, J. L., Shi, L., Wilkinson, J. D., Towbin, J. A., Harrison, R. W., ... 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

No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy. / Castleberry, Chesney D.; Jefferies, John L.; Shi, Ling; Wilkinson, James D.; Towbin, Jeffrey A.; Harrison, Ryan W.; Rossano, Joseph W.; Pahl, Elfriede; Lee, Teresa M.; Addonizio, Linda J.; Everitt, Melanie D.; Godown, Justin; Mahgerefteh, Joseph; Rusconi, Paolo; Canter, Charles E.; Colan, Steven D.; Kantor, Paul F.; Razoky, Hiedy; Lipshultz, Steven E.; Miller, Tracie L.

In: JACC: Heart Failure, Vol. 6, No. 3, 01.03.2018, p. 222-230.

Research output: Contribution to journalArticle

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
Castleberry CD, Jefferies JL, Shi L, Wilkinson JD, Towbin JA, Harrison RW et al. No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy. JACC: Heart Failure. 2018 Mar 1;6(3):222-230. https://doi.org/10.1016/j.jchf.2017.11.015
Castleberry, Chesney D. ; Jefferies, John L. ; Shi, Ling ; Wilkinson, James D. ; Towbin, Jeffrey A. ; Harrison, Ryan W. ; Rossano, Joseph W. ; Pahl, Elfriede ; Lee, Teresa M. ; Addonizio, Linda J. ; Everitt, Melanie D. ; Godown, Justin ; Mahgerefteh, Joseph ; Rusconi, Paolo ; Canter, Charles E. ; Colan, Steven D. ; Kantor, Paul F. ; Razoky, Hiedy ; Lipshultz, Steven E. ; Miller, Tracie L. / No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy. In: JACC: Heart Failure. 2018 ; Vol. 6, No. 3. pp. 222-230.
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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. (Pediatric Cardiomyopathy Registry; NCT00005391)",
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.}",
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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.

PY - 2018/3/1

Y1 - 2018/3/1

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. (Pediatric Cardiomyopathy Registry; NCT00005391)

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. (Pediatric Cardiomyopathy Registry; NCT00005391)

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