Evaluation of certain biochemical results and nutritional status regarding patients with biventricular and univentricular congenital heart disease

Congenital heart disease is a chronic disease that causes growth retardation in children. Especially in children who have undergone univentricular Fontan operation, changes in body composition, pubertal delay, abnormalities in endocrine growth factors, inadequate food intake and decrease in physical activity are observed. Despite these risk factors, existing pediatric literature indicating how nutritional deficiency affects anthropometric measurements is insufficient. It is critical to recognize the disease-specific nutritional status regarding these children and provide them with nutritional support in the pre- and post-operative period. This study included 50 children aged 4 - 17 (23 girls and 27 boys) with biventricular and univentricular congenital heart disease. They were called for post-operative control between September 2018 and October 2020 at Hacettepe University İhsan Doğramacı Children's Hospital, Department of Cardiovascular Surgery to detect and predict such requirements. 45.8% of 24 children with univentricular congenital heart disease were girls, and 54.2% were boys. 46.2% of those with biventricular congenital heart disease were girls, and 53.8% were boys. The children and adolescents with univentricular and biventricular congenital heart disease were asked to fill out a questionnaire form and provide general information, socio-demographic characteristics of their families, their nutritional habits, physical activity levels, and 3-day food consumption records. Mediterranean Diet Quality Index (KIDMED) questionnaire and STAMP (Screening Tool for the Assessment) malnutrition scale were applied to the patients to obtain their anthropometric measurements. Body composition analysis was performed by a bioelectrical impedance device (BIA) of Tanita brand. Biochemical results in the patient files were reviewed. WAZ scores (Weight for Age Z scores) revealed that 28.6% of the male and 14.2% of the female univentricular patients, and 37.1% of the male and 50% of the female biventricular patients were wasted (˂-2SD). On the other hand, HAZ scores (Height for Age Z scores) showed that %23.1 of the male and %27.3 of the female univentricular patients, and %37.5 of the male and %33.3 of the female biventricular patients were too short (˂-2SD). Based on the BMI (Body Mass Index) Z scores evaluated, it was found that 23.1% of the male and 27.3% of the female univentricular patients, and 50% of the male and 42.9% of the female biventricular patients were wasted (˂-2SD). BIA (Bioelecrrical İmpedance Analysis) measurements showed that 37.5% of the univentricular and 42.3% of the biventricular patients had low levels of body fat, and 33.3% of the univentricular and 23.1% of the biventricular patients had low levels of fat-free mass. Children's fat-free mass (FFMI) was significantly lower in patients with a HAZ score of ≤-2SD than those with a HAZ score of >-2SD (p=0.004). According to the STAMP malnutrition scale; as the diagnosis of the disease is taken into account, the high risk level was 67.5% in univentricular patients and 46.2% in biventricular patients (p>0.005). A moderate, negative correlation was found between the STAMP score and fat-free mass (r=-0.472, p=0.001). Concerning the physical activity levels, no children were active among univentricular patients; instead, 50% of the children in this group were sedentary, and 50% were lightly active. 7.7% of the biventricular patients were moderately active, 73.1% were lightly active, and 19.2% were sedentary (p=0.041). Biochemical results revealed that 50% of the univentricular patients had low albumin levels, while the other 50% had normal albumin levels. On the other hand, 15.4% of the biventricular patients had low albumin levels, while 84.6% had normal albumin levels. The univentricular patients had a KIDMED score of 4.29±2.77 (moderate), while biventricular patients of 4.80±2.48 (moderate). The percentage of intake the energy requirement in univentricular boys was 87.13±21.47%, and 90.91±23.95% in girls, and 89±21.37% in biventricular boys and 81.76±17.26% in girls. The ratio of energy from protein is 14.54±1.56% in univentricular male patients, 15.45±2.65% in female patients, 15.36±1.64% in biventricular male patients, and 15.17±1.99% in female patients. Fat supplied 37.54±7.97% and 38.08±3.70% of the energy in univentricular boys and girls, and 38.93±3.22% and 38.50±4.40% of the energy in biventricular boys and girls, respectively. This study showed that children with heart disease, especially who have undergone univentricular Fontan operation, it was found that it is necessary to evaluate the nutritional status in the postoperative period and to monitor the patients at regular intervals in order to maintain their lean body mass, to meet their increasing energy and nutrient needs, to ensure their ideal growth. Data for nutritional support for children with CHD should be tailored to specific needs. Requirements should be identified, and protocols be created accordingly.