A Shift from Underweight to Overweight and Obesity in Asian Children and Adolescents with Congenital Heart Disease Chun-An Chen, a,b Jou-Kou Wang, a,b Hung-Chi Lue, a,b Yu-Chuan Hua, b Mei-Hwei Chang, a Mei-Hwan Wu a,b a Department of Pediatrics, National Taiwan University Hospital, Taipei, and b Cardiac Children’s Foundation, Taipei, Taiwan Abstract Background: In Western countries, obesity is a common problem in children with congenital heart disease (CHD). However, this problem may have racial difference, and little is known about the shift of this trend as patients grow up. The present study sought to investigate the prevalence and trends of being underweight, overweight and obesity in an Asian CHD cohort using a 5-year citywide school survey database. Methods: Patient group consisted of 705 first grade elementary school students (children) and 219 first grade senior high school students (adolescents), while 18753 healthy children and 15014 healthy adolescents served as controls. Body mass index (BMI) percentile was calculated to define underweight (BMI < 15 th percentile) and overweight (BMI 85 th –95 th percentile)/obesity (BMI  95 th percentile). Results: In CHD children, the prevalence of underweight and overweight/obesity was 21.0% (control 16%, P < 0.001) and 14.5% (control 19.8%, P < 0.001), respectively. Children with moderate to severe CHD, especially cyanotic CHD, were more underweight and less overweight/obese than children with non-cyanotic CHD. The prevalence of underweight (23.3%) and overweight/obesity (26.5%) in CHD adolescents became close to that in controls. From childhood to adolescence, different shifts in BMI distribution were noted; controls became more underweight and overweight/obese for males and more underweight and less overweight/obese for females, while CHD patients became more overweight/obese for both genders, including cyanotic CHD. Conclusions: In this Asian CHD cohort, we demonstrates a shift of BMI distribution from more underweight and less overweight/obese compared with healthy children, to a pattern similar to that in healthy adolescents. Keywords: body mass index, congenital heart disease, children, adolescents. Patients with congenital heart disease (CHD) are at risk for failure to thrive during early childhood, 1–3 sometimes requiring high calorie formula and tube feeding to increase body weight gain. 4 Early corrective cardiac interventions also help normalise somatic growth. 5–8 These measures might promote nutritional recovery and mitigate the negative effect of underly- ing cardiac disease on body weight gain in children with CHD. Schools frequently caution children with CHD entering schools against participating in sport activi- ties. The restriction in formal activity may cause sig- nificant increase in body mass index (BMI), 9 resulting in childhood obesity, associated with many cardiovas- cular diseases and premature death in adults. 10–14 Based on a hospital-based study in the US, obesity has also reported to be a common problem in children with CHD, 15 and recommendations on the prevention and management of obesity in these children has recently been published. 16 As racial differences distin- guish obesity, 17,18 it is unclear whether or not Asian CHD patients have similar obesity problems. More- over, research has little information about the trend shift in BMI as patients grow up. Therefore, based on the database of a city-wide school survey program for cardiac disease, this work investigates the patterns and trends of BMI change in children and adolescents with CHD. Methods Selection of patients and controls The Cardiac Children’s Foundation, Taiwan, under the support of the Taipei City Government conducted a Correspondence: Mei-Hwan Wu, Division of Pediatric Cardiology, Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail: wumh@ntu.edu.tw 336 doi: 10.1111/j.1365-3016.2012.01293.x © 2012 Blackwell Publishing Ltd Paediatric and Perinatal Epidemiology, 2012, 26, 336–343