Frequency and risk factors associated with malnutrition among children with congenital heart disease in a cardiology hospital.

Objectives. To assess the frequency and risk factors of malnutrition among children with congenital heart disease (CHID). Material and methods. Between August 1997 and May 1998, a cross-sectional survey was conducted among 244 children, at the congenital heart disease ward of the Cardiology Hospital, National Medical Center "Siglo XXI", Mexican Institute of Social Security, in Mexico City. Study subjects were male and female children younger than 17 years, diagnosed with CHID and without any other congenital malformation. Weight/Age (W/A), Height/Age (H/A) and Weight/Height (W/H) were used to measure nutritional status; Z scores greater than -2 was the case definition of malnutrition. Risk factors investigated were age, sex, perinatal history, dietary factors and nutritional supplementation, socioeconomic status, and family composition and functionality. Four CHID groups were studied: acyanotic with and without pulmonary hypertension (APH, AWPH) and, cyanotic with and without pulmonary hypertension (CPH, CWPH). Statistical analysis consisted of the chi-squared, Mann Whitney's U, and Kruskal-Wallis tests. Confounding variables were controlled for with a logistic regression model; odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Results. APH was the most frequent CHID (62.7%), followed by CWPH (15.6%), AWPH (11.5%), and CPH (10.2%). Malnutrition was identified in 40.9% children with the W/A index, in 24.6% with the H/A index; and in 31.1% with the W/H index. Infants and the CPH group had the worst nutritional status Risk factors associated with malnutrition were: having a cyanotic CHID (OR 2.54; 95%CI, 0.98-6.58), lack of nutritional supplementation (OR 2.38; 95%CI, 1.06-5.34), and a greater number of family members (OR, 1.42; 95%CI, 0.99-2.05). Older children were more likely to be well-nourished (OR 0.92; 95%CI, 0.89-0.96). Conclusions. Malnutrition is frequent among children with CHD; it is more common in younger children and in those with cyanotic CHID. Educational programs directed to the families of these children are needed to prevent and decrease the frequency of malnutrition. The English version of this paper is available at: http://www.insp.mx/salud/index.html.