No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy.

Autor:	Castleberry CD; Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri. Electronic address: castleberry_c@kids.wustl.edu., Jefferies JL; Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Shi L; New England Research Institutes, Watertown, Massachusetts., Wilkinson JD; Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, Michigan., Towbin JA; Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, Tennessee., Harrison RW; New England Research Institutes, Watertown, Massachusetts., Rossano JW; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Pahl E; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois., Lee TM; Department of Pediatrics, Columbia University Medical Center, New York, New York., Addonizio LJ; Department of Pediatrics, Columbia University Medical Center, New York, New York., Everitt MD; Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado., Godown J; Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee., Mahgerefteh J; Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York., Rusconi P; Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida., Canter CE; Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri., Colan SD; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts., Kantor PF; Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada., Razoky H; Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, Michigan., Lipshultz SE; Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, Michigan., Miller TL; Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida.
Jazyk:	angličtina
Zdroj:	JACC. Heart failure [JACC Heart Fail] 2018 Mar; Vol. 6 (3), pp. 222-230. Date of Electronic Publication: 2018 Feb 07.
DOI:	10.1016/j.jchf.2017.11.015
Abstrakt:	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). (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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