Body Mass Index and Physical Activity Among U.S. Children with Congenital Heart Conditions

Guidelines recommend children maintain a healthy body mass index (BMI) and do physical activity. No population-based estimates exist for elevated BMI or insufficient physical activity among children with congenital heart conditions (CHC). We estimated the national prevalence of elevated BMI and insufficient physical activity among children with and without CHC. We analyzed cross-sectional, nationally representative data on 57,080 children aged 6-17 years from the National Survey of Children's Health, 2021-2022. Among children with (N = 1135) and without (N = 55,945) CHC, we estimated prevalence and 95% confidence intervals (CI) for caregiver-reported elevated BMI (≥ 85th percentile for sex and age) and insufficient physical activity (< 60 min of physical activity < 7 days/week). Using multivariable Cox proportional hazards models adjusted for age, sex, ethnicity/race, federal poverty level, and caregiver education, we approximated adjusted prevalence ratios (aPR) and CI for each outcome by CHC status and, separately, by demographics among children with CHC. Children with CHC had a similar prevalence of elevated BMI (31.5%, aPR = 0.97, CI 0.82-1.14) and a slightly higher prevalence of insufficient physical activity (84.0%, aPR = 1.05, CI 1.00-1.09) compared to children without CHC. Among children with CHC, elevated BMI was 1.5-1.6 times higher for Hispanic compared to non-Hispanic White children, those with lower compared to higher household incomes, and those with caregivers with ≤ high school compared to ≥ college education; there were no demographic differences in insufficient physical activity. Pediatricians and cardiologists can support patients with CHC in meeting BMI and physical activity recommendations to improve their long-term cardiovascular outcomes.