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Pediatr Cardiol. 2016 Jan;37(1):192-200. doi: 10.1007/s00246-015-1265-7. Epub 2015 Sep 16.

High Overweight and Obesity in Fontan Patients: A 20-Year History.

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Department of Pediatrics, Pediatric Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA.
National Institute of Diabetes and Digestive Disorders and Kidney Diseases (NIDDK), NIH, 10 Center Dr. Bld 10-CRC, RM 5-5740, MSC 1612, Bethesda, MD, 20892-1612, USA.
Department of Pediatrics, Cardiology, Baylor College of Medicine, Houston, TX, USA.
Seattle Children's Hospital, Seattle, WA, USA.
Emory University, Atlanta, GA, USA.
Department of Pediatrics, Pediatric Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA.


The prevalence of obesity in long-term survivors with complex congenital heart disease may be increasing, and little is known about the timing and onset of weight gain and growth patterns in these high-risk patients. Prevalence rates of overweight/obesity and longitudinal changes in body mass index (BMI) with age were determined in 606 patients with Fontan circulation seen at a tertiary care cardiology center from 1992 to 2012. The number of clinic encounters (n) was stratified by age group (n = 401, 2-5 years; n = 333, 6-11 years; n = 217, 12-19 years; and n = 129, >20 years). Among adults, 39% were overweight/obese at last clinic visit; 22% overweight, and 17% obese. Childhood anthropometric data were available for 82 adults, of which 15% (n = 12/82) were overweight/obese in childhood. The likelihood of being overweight/obese as an adult was three times higher if there was a BMI ≥ 85th percentile in childhood (CI 2.1-4.5, P < 0.01). Overweight/obesity in adulthood was associated with lower heart failure rates (4 vs. 19%, P = 0.03). Pediatric rates of overweight/obesity were comparable to national data (NHANES 2011-2012) in every age group: at 2-5 years, (25 vs. 23%), 6-11 years (26 vs. 34%), and 12-19 years (15 vs. 35%). Systolic blood pressure was higher in overweight/obese children as young as 2-5 years of age. Childhood and adult survivors with Fontan circulation have high rates of overweight/obesity. Childhood obesity is a strong predictor of future adiposity and is linked to changes in systolic blood pressure at a very young age.


Congenital; Fontan procedure; Growth; Heart defect; Obesity; Pediatrics

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