{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T02:04:11Z","timestamp":1780538651897,"version":"3.54.1"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,12,20]]},"abstract":"\n Background<\/jats:title>\n \n Peak oxygen consumption (peak\n \n \n \n \n V<\/mml:mi>\n \u0307<\/mml:mo>\n <\/mml:mover>\n \n O<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msub>\n <\/mml:mrow>\n $$ \\dot{\\mathrm{V}}{\\mathrm{O}}_2 $$<\/mml:annotation>\n <\/mml:semantics>\n <\/mml:math>\n ) is traditionally divided (\u201cratio\u2010scaled\u201d) by body mass (BM) for clinical interpretation. Yet, it is unknown whether ratio\u2010scaling to BM can produce a valid size\u2010independent expression of peak\n \n \n \n \n V<\/mml:mi>\n \u0307<\/mml:mo>\n <\/mml:mover>\n \n O<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msub>\n <\/mml:mrow>\n $$ \\dot{\\mathrm{V}}{\\mathrm{O}}_2 $$<\/mml:annotation>\n <\/mml:semantics>\n <\/mml:math>\n in people with a Fontan circulation. Furthermore, people with a Fontan circulation have deficits in lean mass, and it is unexplored whether using different measures of body composition may improve scaling validity. The objective was to assess the validity of different scaling denominators (BM, stature, body surface area, fat\u2010free mass, lean mass, and appendicular lean mass using ratio and allometric scaling).\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Eighty\u2010nine participants (age: 23.3\u00b16.7\u2009years; 53% female) with a Fontan circulation had their cardiorespiratory fitness and body composition measured by cardiopulmonary exercise testing and dual\u2010energy x\u2010ray absorptiometry. Ratio and allometric (log\u2010linear regression) scaling was performed and Pearson correlations assessed scaling validity. Scaling denominators BM (\n r<\/jats:italic>\n =\u22120.25,\n P<\/jats:italic>\n =0.02), stature (\n r<\/jats:italic>\n =0.46,\n P<\/jats:italic>\n <0.001), and body surface area (0.23,\n P<\/jats:italic>\n =0.03) were significantly correlated with their respective ratio\u2010scaled expressions of peak\n \n \n \n \n V<\/mml:mi>\n \u0307<\/mml:mo>\n <\/mml:mover>\n \n O<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msub>\n <\/mml:mrow>\n $$ \\dot{\\mathrm{V}}{\\mathrm{O}}_2 $$<\/mml:annotation>\n <\/mml:semantics>\n <\/mml:math>\n , but fat\u2010free mass, lean mass, or appendicular lean mass were not (\n r<\/jats:italic>\n \u22640.11;\n R<\/jats:italic>\n 2<\/jats:sup>\n =1%). Allometrically expressed peak\n \n \n \n \n V<\/mml:mi>\n \u0307<\/mml:mo>\n <\/mml:mover>\n \n O<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msub>\n <\/mml:mrow>\n $$ \\dot{\\mathrm{V}}{\\mathrm{O}}_2 $$<\/mml:annotation>\n <\/mml:semantics>\n <\/mml:math>\n resulted in no significant correlation with any scaling denominator (\n r<\/jats:italic>\n =\u22640.23;\n R<\/jats:italic>\n 2<\/jats:sup>\n =\u22644%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The traditional and accepted method of ratio\u2010scaling to BM is invalid because it fails to create a size\u2010independent expression of peak\n \n \n \n \n V<\/mml:mi>\n \u0307<\/mml:mo>\n <\/mml:mover>\n \n O<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msub>\n <\/mml:mrow>\n $$ \\dot{\\mathrm{V}}{\\mathrm{O}}_2 $$<\/mml:annotation>\n <\/mml:semantics>\n <\/mml:math>\n in people with a Fontan circulation. However, ratio\u2010scaling to measures of body composition (fat\u2010free mass, lean mass, and appendicular lean mass) and allometric techniques can produce size\u2010independent expressions of peak\n \n \n \n \n V<\/mml:mi>\n \u0307<\/mml:mo>\n <\/mml:mover>\n \n O<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msub>\n <\/mml:mrow>\n $$ \\dot{\\mathrm{V}}{\\mathrm{O}}_2 $$<\/mml:annotation>\n <\/mml:semantics>\n <\/mml:math>\n in people with a Fontan circulation.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.122.026181","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T11:38:29Z","timestamp":1671017909000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Scaling Peak Oxygen Consumption for Body Size and Composition in People With a Fontan Circulation"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3275-7975","authenticated-orcid":false,"given":"Curtis A.","family":"Wadey","sequence":"first","affiliation":[{"name":"Children\u2019s Health & Exercise Research Centre (CHERC) Public Health and Sport Science, Faculty of Health and Life Sciences, University of Exeter Exeter United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8610-5417","authenticated-orcid":false,"given":"Alan R.","family":"Barker","sequence":"additional","affiliation":[{"name":"Children\u2019s Health & Exercise Research Centre (CHERC) Public Health and Sport Science, Faculty of Health and Life Sciences, University of Exeter Exeter United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2789-2216","authenticated-orcid":false,"given":"Graham","family":"Stuart","sequence":"additional","affiliation":[{"name":"Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust Bristol United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3274-363X","authenticated-orcid":false,"given":"Derek L.","family":"Tran","sequence":"additional","affiliation":[{"name":"Central Clinical School, The University of Sydney Camperdown New South Wales"},{"name":"Department of Cardiology Royal Prince Alfred Hospital Camperdown New South Wales"},{"name":"Heart Research Institute, Charles Perkins Centre, The University of Sydney Camperdown New South 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