Calories count. Improved weight gain with dietary intervention in congenital heart disease
R. Unger, M. DeKleermaeker, S. S. Gidding and K. K. Christoffel
Department of Pediatrics, Northwestern University Medical School, Chicago, Ill.
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.
