Lean mass deficits, vitamin D status and exercise capacity in children and young adults after Fontan palliation.

TitleLean mass deficits, vitamin D status and exercise capacity in children and young adults after Fontan palliation.
Publication TypeJournal Article
Year of Publication2014
AuthorsAvitabile CM, Leonard MB, Zemel BS, Brodsky JL, Lee D, Dodds K, Hayden-Rush C, Whitehead KK, Goldmuntz E, Paridon SM, Rychik J, Goldberg DJ
JournalHeart
Volume100
Issue21
Pagination1702-7
Date Published2014 Nov
ISSN1468-201X
KeywordsAbsorptiometry, Photon, Adolescent, Adult, Body Composition, Child, Child, Preschool, Cross-Sectional Studies, Exercise Tolerance, Female, Follow-Up Studies, Fontan Procedure, Heart Defects, Congenital, Humans, Incidence, Leg, Male, Oxygen Consumption, Postoperative Period, Prospective Studies, Thinness, Time Factors, United States, Vitamin D, Young Adult
Abstract

OBJECTIVE: We sought to evaluate body composition in children and young adults with Fontan physiology. Leg lean mass (LM) deficits correlate with diminished exercise capacity in other populations and may contribute to exercise limitations in this cohort.

METHODS: This cross-sectional study included whole body dual energy X-ray absorptiometry scans in 50 Fontan participants ≥5 years, and measures of peak oxygen consumption (VO2) in 28. Whole body and leg LM (a measure of skeletal muscle) were converted to sex- and race-specific Z-scores, relative to age and stature, based on 992 healthy reference participants.

RESULTS: Median age was 11.5 (range 5.1-33.5) years at 9.3 (1.1-26.7) years from Fontan. Height Z-scores were lower in Fontan compared with reference participants (-0.47±1.08 vs 0.25±0.93, p<0.0001). Body mass index Z-scores were similar (0.15±0.98 vs 0.35±1.02, p=0.18). LM Z-scores were lower in Fontan compared with reference participants (whole body LM -0.33±0.77 vs 0.00±0.74, p=0.003; leg LM -0.89±0.91 vs 0.00±0.89, p<0.0001). LM Z-scores were not associated with age or Fontan characteristics. Leg LM Z-scores were lower in vitamin D deficient versus sufficient Fontan participants (-1.47±0.63 vs -0.71±0.92, p=0.01). Median per cent predicted peak VO2 was 81% (range 13%-113%) and was associated with leg LM Z-scores (r=0.54, p=0.003).

CONCLUSIONS: Following Fontan, children and young adults are shorter than their peers and have significant LM deficits. Skeletal muscle deficits were associated with vitamin D deficiency and reduced exercise capacity. Future studies should examine the progression of these deficits to further understand the contribution of peripheral musculature to Fontan exercise capacity.

DOI10.1136/heartjnl-2014-305723
Alternate JournalHeart
PubMed ID24973081
PubMed Central IDPMC4386691
Grant ListK23 HL089647 / HL / NHLBI NIH HHS / United States
R01 HL098252 / HL / NHLBI NIH HHS / United States
R01 HL098252-01 / HL / NHLBI NIH HHS / United States
T32 HL007915 / HL / NHLBI NIH HHS / United States
UL1 TR000003 / TR / NCATS NIH HHS / United States
K24 DK0768084 / DK / NIDDK NIH HHS / United States
K24 DK076808 / DK / NIDDK NIH HHS / United States
UL1 RR024134 / RR / NCRR NIH HHS / United States