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Impact of Adiposity on Cardiopulmonary Fitness in Children and Adolescents with Ventricular Septal Defects: a
I-Hsiu Liou1,2, Guan-Bo Chen3, Shu-Fen Sun2,4
1Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan (R.O.C.).
Insights
Children with ventricular septal defect (VSD) have lower cardiopulmonary fitness (CPF). Obesity and underweight are more common in VSD patients, with higher BMI significantly reducing CPF, underscoring the need for weight management.
Area of Science:
- Pediatric Cardiology
- Exercise Physiology
- Congenital Heart Disease Research
Background:
- Ventricular septal defect (VSD) is the most common pediatric congenital heart defect.
- Emerging evidence suggests VSD impacts long-term cardiopulmonary fitness (CPF).
- Rising childhood obesity rates may exacerbate CPF impairments in children with VSD.
Purpose of the Study:
- To investigate the relationship between adiposity and CPF in children with VSD.
- To compare CPF between children with VSD and healthy controls.
- To analyze the impact of varying BMI categories on CPF in pediatric VSD patients.
Main Methods:
- Retrospective analysis of 349 children/adolescents with VSD and 349 matched healthy controls.
- Symptom-limited treadmill cardiopulmonary exercise testing (CPET) was performed.
- VSD group stratified by BMI (underweight, normal, overweight, obese); CPET parameters like anaerobic threshold (AT MET) and peak MET analyzed.
Main Results:
- Children with VSD showed higher prevalence of underweight (15.5% vs. 4.3%) and obesity (14.6% vs. 9.7%) compared to controls.
- Within the VSD group, AT MET and peak MET decreased progressively with increasing BMI (p < 0.001).
- Children with VSD had significantly lower AT MET (6.56 vs. 6.97) and peak MET (9.32 vs. 10.17) than controls (p < 0.001).
Conclusions:
- Children with VSD exhibit reduced CPF compared to healthy peers, irrespective of surgical history.
- Undernutrition and obesity are more prevalent in children with VSD.
- Obesity is strongly linked to impaired CPF in pediatric VSD patients, necessitating early interventions and weight management.
Abstract:
Background: Ventricular septal defect (VSD) is the most common congenital heart defect in children. While previously considered benign, recent studies suggest long-term impacts on cardiopulmonary fitness (CPF). Overweight and obesity, increasingly prevalent among children, may further impair CPF in this population. This study aimed to evaluate the relationship between adiposity and CPF in children with VSD using cardiopulmonary exercise testing (CPET). Methods: This retrospective study included 349 children and adolescents with VSD and 349 age-, sex-, and body mass index (BMI)-matched healthy controls. Participants underwent symptom-limited treadmill CPET. Children with VSD were stratified into BMI categories (underweight, normal, overweight, obesity) based on national standards. Multiple CPET parameters were analyzed, including anaerobic threshold metabolic equivalents (AT MET) and peak metabolic equivalents (peak MET). Results: Children with VSD had significantly higher rates of both underweight (15.5% vs. 4.3%) and obesity (14.6% vs. 9.7%) compared to controls (p < 0.001). Within the VSD group, AT MET and peak MET declined progressively with increasing BMI. [AT MET: 7.41 ± 1.57 (underweight), 6.86 ± 1.38 (normal), 6.01 ± 1.23 (overweight), 5.62 ± 1.23 (obese), p < 0.001; Peak MET: 10.37 ± 2.22 (underweight), 9.58 ± 1.94 (normal), 8.56 ± 1.70 (overweight), 7.81 ± 1.60 (obese), p < 0.001]. Compared to controls, children with VSD showed lower AT MET (6.56 ± 1.51 vs. 6.97 ± 1.47, p < 0.001) and peak MET (9.32 ± 2.03 vs. 10.17 ± 1.95, p < 0.001), along with reduced peak heart rate and heart rate at AT. Conclusion: Children with VSD, regardless of surgical status, exhibit diminished CPF compared to healthy peers. Moreover, both undernutrition and excessive adiposity are more prevalent in the VSD group. Obesity was associated with significantly impaired cardiopulmonary fitness, highlighting the need for early identification and lifestyle interventions. Routine CPET and weight management strategies should be incorporated into long-term care for pediatric VSD patients.
