BACKGROUND
Children and adolescents with congenital heart disease (CHD) are at a higher risk
of being overweight or obese. Lifestyle risk behaviours are prevalent in this population
and limited information is known about how the clustering of unhealthy lifestyle behaviours
impact patients’ weight status. Objective: To determine the association between unhealthy
lifestyle behaviours and risk of being overweight or obese in pediatric patients with
CHD.
METHODS AND RESULTS
We performed a cross-sectional analysis of children and adolescents (ages 8-17 years)
referred from outpatient cardiology clinics who successfully enrolled in the Exercise
Medicine (EM) Program at the Hospital for Sick Children between January 2018 – February
2020. Patients’ demographic characteristics, medical history, anthropometry, and lifestyle
behaviour data were retrospectively collected. CHD severity status was classified
as simple, moderate, and severe based on the Bethesda Classification. The exposure
variable was clustering of lifestyle risk behaviours (physical inactivity, excessive
screen time, unhealthy dietary intake, and poor sleep hygiene). Participants were
categorized into two groups: lesser clustering (one or two lifestyle risk behaviours)
or greater clustering (three or four lifestyle risk behaviours). The outcome variable
was body mass index z-score (zBMI) and patients were categorized into either normal
body weight (-2 < zBMI < 2) or overweight/obese (>2 zBMI). Final multivariable logistic
model was adjusted for age, sex, and CHD severity. There were 53 CHD patients included
in the analysis. The mean age was 13±3 years, 27 (49%) were male, 19 (36%) were taking
cardiac medication, and 30 (57%) had documented comorbidities. The proportion of simple,
moderate, and severe CHD was 15%, 42%, and 43%, respectively. The proportion of patients
with normal body weight was 72%, while 28% were overweight/obese. Of the 53 patients,
21 (53%) had greater clustering of unhealthy lifestyle patterns while 25 (48%) had
lesser clustering. In our final multivariable logistic model, participants with greater
clustering of lifestyle risk behaviours had 7.4 times the odds of being overweight/obese
(95% CI 1.5, 54.4, P=0.025) than those participants with lesser clustering of lifestyle
risk behaviours (Table 1). Age, sex, and CHD severity were not associated with weight
status.
CONCLUSION
Clustering of multiple unhealthy lifestyle behaviour patterns are prevalent among
children with CHD and this is associated with increased risk of being overweight/obese.
Timely identification of lifestyle risk behaviours and targeted intervention through
personalized lifestyle counseling and physical activity promotion may be an effective
strategy to optimize body weight.
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© 2021 Published by Elsevier Inc.