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Advances in Pediatric Cardiology Nutrition
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Advances in Pediatric Cardiology Nutrition

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (20 January 2023) | Viewed by 18347

Special Issue Editors

Prof. Dr. Marcello Lanari

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Guest Editor
Pediatric Emergency Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St.Orsola, University of Bologna, 40138 Bologna, Italy
Interests: children; infectious diseases; respiratory infectious diseases; respiratory syncytial virus; child abuse; pediatric emergency care; kawasaki disease
Dr. Marianna Fabi

E-Mail Website
Guest Editor
Pediatric Emergency Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St.Orsola, University of Bologna, 40138 Bologna, Italy
Interests: pediatric; cardiovascular disease; hypertension
Dr. Laura Andreozzi

E-Mail Website
Guest Editor
Pediatric Emergency Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St.Orsola, University of Bologna, 40138 Bologna, Italy
Interests: Kawasaki disease; pediatric; cardiovascular disease

Special Issue Information

Dear Colleagues,

The scope of this Special Issue is to amplify the current understanding on the complex relationship between nutrition and pediatric cardiovascular diseases.  Nutrition is a crucial aspect in pediatric patients with both acute and chronic cardiovascular conditions, from a preventive, therapeutic and prognostic point of view.  Even though great advancements have been achieved in pediatric cardiology, several nutritional considerations on this topic are in progress.  Only a few decades ago were the problems concerning obesity, metabolic syndrome and cardiovascular outcomes considered to be an adult issue. The global change in dietary habits and lifestyles, leading to the dramatic increase in pediatric obesity and the risk of metabolic syndrome early in pediatric age, has triggered research on the typical endocrine (dyslipidemia) and cardiovascular alterations that usually affect adults.  Similarly, the advancements in congenital heart disease care are leading to better outcomes and higher survival rates, raising a question about nutritional claims before and after surgery. Indeed, failure to thrive is one of the most important issues in children with congenital heart diseases, conditioning the timing and the success of the surgical intervention. Moreover, the long-term outcome of pediatric patients with congenital or acquired heart diseases (i.e., Kawasaki disease with coronary involvement) could be positively influenced by specific dietary claims. Eventually, nutritional deficiencies due to organic or psychiatric diseases (including anorexia and other eating disorders) may affect cardiovascular health.  These are only a few aspects of the complex relationship between nutrition and cardiovascular diseases in children and adolescents.  Therefore, research focused on novel nutritional considerations in pediatric cardiology is welcome, including original research papers, reviews, short communications and comprehensive case reports.

Prof. Dr. Marcello Lanari
Dr. Marianna Fabi
Dr. Laura Andreozzi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric heart diseases
  • congenital heart diseases
  • hypertension
  • vasculitis
  • malnutrition
  • obesity
  • dyslipidemia
  • diet
  • nutritional status
  • growth failure
  • atherosclerosis
  • eating disorders
  • metabolic syndrome

Published Papers (7 papers)

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Editorial

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3 pages, 179 KiB  
Editorial
Advances in Pediatric Cardiology Nutrition
by Marcello Lanari, Laura Andreozzi and Marianna Fabi
Nutrients 2023, 15(12), 2653; https://doi.org/10.3390/nu15122653 - 7 Jun 2023
Viewed by 1194
Abstract
The relationship between nutrition and cardiovascular diseases is powerful and complex [...] Full article
(This article belongs to the Special Issue Advances in Pediatric Cardiology Nutrition)

Research

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13 pages, 1514 KiB  
Article
Body Mass Index (BMI) Is the Strongest Predictor of Systemic Hypertension and Cardiac Mass in a Cohort of Children
by Marianna Fabi, Matteo Meli, Davide Leardini, Laura Andreozzi, Giulio Maltoni, Maria Bitelli, Luca Pierantoni, Chiara Zarbo, Arianna Dondi, Cristina Bertulli, Luca Bernardini, Andrea Pession and Marcello Lanari
Nutrients 2023, 15(24), 5079; https://doi.org/10.3390/nu15245079 - 12 Dec 2023
Cited by 1 | Viewed by 1089
Abstract
Background: Hypertension (HTN) is a well-established cardiovascular (CV) risk factor in adults. The presence of HTN in children appears to predict its persistence into adulthood. Early diagnosis of HTN is crucial to reduce CV morbidity before the onset of organ damage. Aim: The [...] Read more.
Background: Hypertension (HTN) is a well-established cardiovascular (CV) risk factor in adults. The presence of HTN in children appears to predict its persistence into adulthood. Early diagnosis of HTN is crucial to reduce CV morbidity before the onset of organ damage. Aim: The aim of this study is to investigate cardiac damage in HTN, its risk factors (RFs), and evolution. Methods: We conducted a prospective/retrospective study involving children referred to the Childhood Hypertension Outpatient Clinic. This study included clinical and echocardiographic assessments of cardiac morphology and function at three time points: enrollment (T0) and follow-up (T1 and T2). Results: Ninety-two patients (mean age 11.4 ± 3 years) were enrolled. Cardiac eccentric and concentric hypertrophy were present in 17.9% and 9%, respectively, with remodeling in 10.5%. Overweight/obese subjects exhibited significantly higher systolic blood pressure (SBP), frequency of HTN, and body mass index (BMI) at T0 compared with patients with chronic kidney disease (CKD). SBP and BMI persisted more during follow-up. Normal-weight vs. overweight/obese patients were significantly more likely to have normal geometry. Positive correlations were found between BMI and left ventricular (LV) mass at T0, BMI and SBP at T0 and T1. Gender, BMI, SBP, and diastolic blood pressure (DBP) significantly predicted LV mass index (LVMI), but only BMI added significance to the prediction. During follow-up, the variation of BMI positively correlated with the variation of SBP, but not with LVMI. Conclusions: In our cohort, body weight is strongly associated with HTN and cardiac mass. Importantly, the variation in body weight has a more significant impact on the consensual variation of cardiac mass than blood pressure (BP) values. A strict intervention on weight control through diet and a healthy lifestyle from early ages might reduce the burden of CV morbidity in later years. Full article
(This article belongs to the Special Issue Advances in Pediatric Cardiology Nutrition)
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11 pages, 1120 KiB  
Article
Moderate and Severe Congenital Heart Diseases Adversely Affect the Growth of Children in Italy: A Retrospective Monocentric Study
by Daniela Palleri, Ylenia Bartolacelli, Anna Balducci, Simone Bonetti, Rossana Zanoni, Cristina Ciuca, Valentina Gesuete, Ambra Bulgarelli, Tammam Hasan, Luca Ragni, Emanuela Angeli, Gaetano Domenico Gargiulo and Andrea Donti
Nutrients 2023, 15(3), 484; https://doi.org/10.3390/nu15030484 - 17 Jan 2023
Cited by 4 | Viewed by 1986
Abstract
Children with congenital heart disease (CHD) are at increased risk for undernutrition. The aim of our study was to describe the growth parameters of Italian children with CHD compared to healthy children. We performed a cross-sectional study collecting the anthropometric data of pediatric [...] Read more.
Children with congenital heart disease (CHD) are at increased risk for undernutrition. The aim of our study was to describe the growth parameters of Italian children with CHD compared to healthy children. We performed a cross-sectional study collecting the anthropometric data of pediatric patients with CHD and healthy controls. WHO and Italian z-scores for weight for age (WZ), length/height for age (HZ), weight for height (WHZ) and body mass index (BMIZ) were collected. A total of 657 patients (566 with CHD and 91 healthy controls) were enrolled: 255 had mild CHD, 223 had moderate CHD and 88 had severe CHD. Compared to CHD patients, healthy children were younger (age: 7.5 ± 5.4 vs. 5.6 ± 4.3 years, p = 0.0009), taller/longer (HZ: 0.14 ± 1.41 vs. 0.62 ± 1.20, p < 0.002) and heavier (WZ: −0,07 ± 1.32 vs. 0.31 ± 1.13, p = 0.009) with no significant differences in BMIZ (−0,14 ± 1.24 vs. –0.07 ± 1.13, p = 0.64) and WHZ (0.05 ± 1.47 vs. 0.43 ± 1.07, p = 0.1187). Moderate and severe CHD patients presented lower z-scores at any age, with a more remarkable difference in children younger than 2 years (WZ) and older than 5 years (HZ, WZ and BMIZ). Stunting and underweight were significantly more present in children affected by CHD (p < 0.01). In conclusion, CHD negatively affects the growth of children based on the severity of the disease, even in a high-income country, resulting in a significant percentage of undernutrition in this population. Full article
(This article belongs to the Special Issue Advances in Pediatric Cardiology Nutrition)
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Review

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17 pages, 835 KiB  
Review
Nutritional Management of Patients with Fontan Circulation: A Potential for Improved Outcomes from Birth to Adulthood
by Letizia Baldini, Katia Librandi, Chiara D’Eusebio and Antonella Lezo
Nutrients 2022, 14(19), 4055; https://doi.org/10.3390/nu14194055 - 29 Sep 2022
Cited by 9 | Viewed by 2586
Abstract
Fontan circulation (FC) is a surgically achieved palliation state offered to patients affected by a wide variety of congenital heart defects (CHDs) that are grouped under the name of univentricular heart. The procedure includes three different surgical stages. Malnutrition is a matter of [...] Read more.
Fontan circulation (FC) is a surgically achieved palliation state offered to patients affected by a wide variety of congenital heart defects (CHDs) that are grouped under the name of univentricular heart. The procedure includes three different surgical stages. Malnutrition is a matter of concern in any phase of life for these children, often leading to longer hospital stays, higher mortality rates, and a higher risk of adverse neurodevelopmental and growth outcomes. Notwithstanding the relevance of proper nutrition for this subset of patients, specific guidelines on the matter are lacking. In this review, we aim to analyze the role of an adequate form of nutritional support in patients with FC throughout the different stages of their lives, in order to provide a practical approach to appropriate nutritional management. Firstly, the burden of faltering growth in patients with univentricular heart is analyzed, focusing on the pathogenesis of malnutrition, its detection and evaluation. Secondly, we summarize the nutritional issues of each life phase of a Fontan patient from birth to adulthood. Finally, we highlight the challenges of nutritional management in patients with failing Fontan. Full article
(This article belongs to the Special Issue Advances in Pediatric Cardiology Nutrition)
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Graphical abstract

20 pages, 672 KiB  
Review
The Role of Nutrition in Primary and Secondary Prevention of Cardiovascular Damage in Childhood Cancer Survivors
by Fiorentina Guida, Riccardo Masetti, Laura Andreozzi, Daniele Zama, Marianna Fabi, Matteo Meli, Arcangelo Prete and Marcello Lanari
Nutrients 2022, 14(16), 3279; https://doi.org/10.3390/nu14163279 - 11 Aug 2022
Cited by 5 | Viewed by 2757
Abstract
Innovative therapeutic strategies in childhood cancer led to a significant reduction in cancer-related mortality. Cancer survivors are a growing fragile population, at risk of long-term side effects of cancer treatments, thus requiring customized clinical attention. Antineoplastic drugs have a wide toxicity profile that [...] Read more.
Innovative therapeutic strategies in childhood cancer led to a significant reduction in cancer-related mortality. Cancer survivors are a growing fragile population, at risk of long-term side effects of cancer treatments, thus requiring customized clinical attention. Antineoplastic drugs have a wide toxicity profile that can limit their clinical usage and spoil patients’ life, even years after the end of treatment. The cardiovascular system is a well-known target of antineoplastic treatments, including anthracyclines, chest radiotherapy and new molecules, such as tyrosine kinase inhibitors. We investigated nutritional changes in children with cancer from the diagnosis to the end of treatment and dietary habits in cancer survivors. At diagnosis, children with cancer may present variable degrees of malnutrition, potentially affecting drug tolerability and prognosis. During cancer treatment, the usage of corticosteroids can lead to rapid weight gain, exposing children to overweight and obesity. Moreover, dietary habits and lifestyle often dramatically change in cancer survivors, who acquire sedentary behavior and weak adherence to dietary guidelines. Furthermore, we speculated on the role of nutrition in the primary prevention of cardiac damage, investigating the potential cardioprotective role of diet-derived compounds with antioxidative properties. Finally, we summarized practical advice to improve the dietary habits of cancer survivors and their families. Full article
(This article belongs to the Special Issue Advances in Pediatric Cardiology Nutrition)
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10 pages, 280 KiB  
Review
Postoperative Chylothorax in Neonates and Infants after Congenital Heart Disease Surgery—Current Aspects in Diagnosis and Treatment
by Georgios Samanidis, Georgios Kourelis, Stavroula Bounta and Meletios Kanakis
Nutrients 2022, 14(9), 1803; https://doi.org/10.3390/nu14091803 - 26 Apr 2022
Cited by 7 | Viewed by 3911
Abstract
Postoperative chylothorax is a rare complication following cardiac surgery for congenital heart disease (CHD) in the pediatric population, including neonates and infants. Multiple mechanisms are involved in the development of postoperative chylous effusions, mainly the traumatic injury of lymphatic vessels, systemic venous obstruction [...] Read more.
Postoperative chylothorax is a rare complication following cardiac surgery for congenital heart disease (CHD) in the pediatric population, including neonates and infants. Multiple mechanisms are involved in the development of postoperative chylous effusions, mainly the traumatic injury of lymphatic vessels, systemic venous obstruction and dysfunction of the right ventricle. In this review, we focus on the existing evidence regarding the definition and diagnosis of postoperative chylothorax in children with CHD, as well as current therapeutic approaches, both nutritional and interventional, for the management of these patients. As part of nutritional management, we specifically comment on the use of defatted human milk and its effect on both chylothorax resolution and patient growth. A consensus with regard to several key aspects of this potentially significant complication is warranted given its impact on the cost, morbidity and mortality of children with CHD. Full article
(This article belongs to the Special Issue Advances in Pediatric Cardiology Nutrition)

Other

17 pages, 1409 KiB  
Brief Report
The Healthy Eating Assessment Tool (HEAT): A Simplified 10-Point Assessment of CHILD-2 Dietary Compliance for Children and Adolescents with Dyslipidemia
by Sara DiLauro, Jonathan P. Wong, Tanveer Collins, Nita Chahal and Brian W. McCrindle
Nutrients 2023, 15(4), 1062; https://doi.org/10.3390/nu15041062 - 20 Feb 2023
Cited by 1 | Viewed by 3695
Abstract
Traditional dietary assessment tools used to determine achievement of cholesterol-lowering dietary targets, defined in the Cardiovascular Health Integrated Lifestyle Diet (CHILD-2), are time intensive. We sought to determine the utility of the Healthy Eating Assessment Tool (HEAT), a simplified 10-point dietary assessment tool, [...] Read more.
Traditional dietary assessment tools used to determine achievement of cholesterol-lowering dietary targets, defined in the Cardiovascular Health Integrated Lifestyle Diet (CHILD-2), are time intensive. We sought to determine the utility of the Healthy Eating Assessment Tool (HEAT), a simplified 10-point dietary assessment tool, in relation to meeting dietary cut points of the CHILD-2, as well as its association with markers of adiposity and lipid variables. We performed a 2-year single-center, prospective cross-sectional study of pediatric patients with dyslipidemia. HEAT score associations with meeting CHILD-2 fat targets were modest. Only patients with the highest HEAT scores (good 43%, excellent 64%) met the CHILD-2 cut point of <25% total fat calories (p = 0.03), with a non-significant trend for limiting the percentage of daily saturated fat to <8% (excellent 64%), and no association with cholesterol intake. There were more consistent associations with markers of adiposity (body mass index z-score r = −0.31, p = <0.01 and waist-to-height ratio r = −0.31, p = <0.01), and there was no independent association with lipid levels. While fat-restricted diets are safe, they are not particularly effective for treatment of dyslipidemia or for weight management alone. The HEAT may be a more useful and simplified way of assessing and tracking broader dietary goals in clinical practice. Full article
(This article belongs to the Special Issue Advances in Pediatric Cardiology Nutrition)
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