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Improved Weight Gain With Dietary Intervention in Congenital Heart Disease

Rebecca Unger, MD; Monique DeKleermaeker, RD; Samuel S. Gidding, MD; Katherine Kaufer Christoffel, MD, MPH

Am J Dis Child. 1992;146(9):1078-1084.

Abstract
• Objectives.
—We assessed the nutritional status of patients with congenital heart disease (CHD) to evaluate the role of dietary intake in impaired weight for patient length. Underweight patients with CHD underwent nutritional counseling to evaluate the role of this intervention in improvement of weight for length.

Research Design.
—We prospectively evaluated a clinical protocol for nutritional assessment and counseling in patients with CHD. Eligible patients were enrolled from a cardiology clinic during a 13-month period. Initial anthropometric measurements and measurements of dietary intake of underweight and normal-weight patients were compared. Initial and follow-up measurements of underweight patients who received nutritional counseling were compared.

Patients.
—Nineteen underweight patients with CHD and 16 normal-weight patients with CHD, aged 1 month to 2 years, were studied. Exclusion criteria included noncardiac factors that could affect growth (eg, low birth weight, Down syndrome, gastrointestinal deficit, and any severe abnormality of the central nervous system). Seventeen of the 19 underweight patients underwent nutritional counseling in the presence of a parent every 2 months for 6 months. Caloric and protein intakes were maximized using high-calorie formulas.

Measurements and Results.
—Baseline dietary intake was lower in underweight patients than in normal-weight patients (mean percentage of the recommended daily allowance of calories, 89% vs 108%). Follow-up evaluation in normal-weight patients showed no change in percentage of ideal body weight for length. Follow-up evaluation in underweight patients showed improvement in mean dietary intake (from 90% to 104% of the recommended daily allowance of calories) and in mean percentage of ideal body weight for length after intervention (from 83.1% to 88.3%).

Conclusion.
—Nutritional evaluation of patients with CHD demonstrated that underweight children had inadequate diets. Underweight patients with CHD who received nutritional counseling showed increased dietary intake and improved anthropometric measurements on follow-up.

(AJDC. 1992;146:1078-1084)

Author Affiliations
From the Department of Pediatrics, Northwestern University Medical School, and Children's Memorial Hospital, Chicago, Ill.

Footnotes
Accepted for publication May 11, 1992.

Reprint requests to Division of General and Emergency Pediatrics, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614 (Dr Unger).

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