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Incidence and impact of malnutrition in patients with Fontan physiology
Ravneet Sekhon1, Rae R Foshaug1, Paul F Kantor2
1Department of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
Insights
Malnutrition affects 6-16% of single-ventricle patients after Fontan surgery and persists long-term. However, this study found no link between nutritional status and transplant-free survival in these patients.
Area of Science:
- Pediatric Cardiology
- Nutritional Science
- Congenital Heart Disease
Background:
- Single-ventricle physiology necessitates staged surgical palliation, culminating in the Fontan procedure.
- Long-term complications are common after Fontan surgery, but the role of nutritional status remains poorly understood.
- Evaluating malnutrition incidence and its impact on outcomes in Fontan patients is critical.
Purpose of the Study:
- To determine the incidence of moderate-to-severe malnutrition in patients who have undergone Fontan surgery.
- To assess the impact of malnutrition on long-term outcomes, including Fontan failure (heart transplant or death).
Main Methods:
- Retrospective cohort study of 69 children undergoing Fontan surgery between 1997 and 2018.
- Collection of anthropometric data (weight, height, BMI) and calculation of z-scores (WAZ, HAZ, BMIZ) at multiple time points.
- Malnutrition categorization using established guidelines; Fontan failure defined as transplant listing or mortality.
Main Results:
- Moderate-to-severe malnutrition was observed in 6-16% of patients at various time points post-Fontan.
- Malnutrition persisted in 6.5-12.9% of patients even 10 years after surgery.
- No statistically significant association was found between pre-Fontan malnutrition severity and Fontan failure.
Conclusions:
- A significant proportion of Fontan patients experience moderate-to-severe malnutrition, which is a persistent condition.
- Current anthropometric parameters and malnutrition status did not correlate with transplant-free survival in this cohort.
- Further prospective, multi-institutional research is warranted to fully elucidate the long-term effects of malnutrition in Fontan survivors.
Background:
Single-ventricle patients require a series of surgeries, with the final stage being the Fontan. This form of circulation results in several long-term complications, but the impact and consequences of nutrition status remain unclear. We sought to evaluate the incidence of malnutrition in Fontan patients and the impact on outcomes.
Methods:
This study was a retrospective cohort study of children who underwent Fontan surgery between 1997 and 2018. Clinical, demographic, and nutrition data were collected, including weight, height, body mass index (BMI), and their respective z scores (z score for weight-for-age [WAZ], z score for height-for-age [HAZ], and z score for BMI-for-age [BMIZ]) pre-Fontan, at discharge, 6 months, and 1, 5, and 10 years post-Fontan. Malnutrition status was categorized using the American Society for Parenteral and Enteral Nutrition guidelines and the Michigan MTool. Fontan failure was defined as listing for heart transplant or death.
Results:
Of the 69 patients, moderate-severe malnutrition occurred at any time point in 11% (n = 8) by WAZ, 16% (n = 11) by HAZ, and 6% (n = 4) by BMIZ. Moderate-severe malnutrition persisted in 6.5%-12.9% at 10 years post-Fontan. Compared with the pre-Fontan period, there was no change in these parameters over time. There was no statistically significant difference in Fontan failure between degrees of pre-Fontan malnutrition.
Conclusion:
There is a 6%-16% incidence of moderate-severe malnutrition in Fontan patients. Malnutrition is a condition that remains present in follow-up. There was no association with anthropometric parameters and transplant-free survival. A prospective multi-institutional study is needed to understand the impact of malnutrition on long-term outcomes.
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