{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T15:47:08Z","timestamp":1786549628483,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The global burden of malnutrition in children with congenital heart disease (CHD) is substantial, yet whether surveillance modality\u2014the clinical pathway of initial CHD detection\u2014influences nutritional status remains unexplored. We aim to compare nutritional status and complex CHD between children with CHD detected through active versus passive surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study included 9,355 children aged 0\u201318\u202fyears with confirmed CHD admitted to Fuwai Yunnan Hospital (China) between September 2017 and June 2025. Active surveillance was defined as detection through systematic screening (prenatal echocardiography, newborn pulse oximetry, routine health check-ups, or school-based echocardiography), while passive surveillance included symptom-driven diagnoses. Undernutrition was assessed using the WHO growth standards. Complex CHD was classified per the AHA anatomic criteria. Multivariable logistic regression examined associations of surveillance type with undernutrition and complex CHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 9,355 children (63.4% active, 36.6% passive), the admission undernutrition prevalence was 31.8%. Marked heterogeneity emerged across active surveillance subtypes (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001): prenatal screening showed the highest undernutrition (45.3%) and complex CHD proportion (26.4%), whereas school-based screening had the lowest (27.3 and 2.2%, respectively). Compared with passive surveillance, prenatal screening was associated with higher odds of undernutrition (adjusted OR\u202f=\u202f1.48, 95% CI:1.19\u20131.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and complex CHD (OR\u202f=\u202f2.89, 95% CI:2.19\u20133.81,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), whereas school-based screening was associated with lower odds (OR\u202f=\u202f0.81, 95% CI:0.72\u20130.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001 and OR\u202f=\u202f0.27, 95% CI:0.20\u20130.36,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Biochemical parameters independently associated with undernutrition included lower hemoglobin (OR\u202f=\u202f0.99, 95% CI:0.98\u20130.99), lower albumin (OR\u202f=\u202f0.94, 95% CI:0.92\u20130.96), higher blood urea nitrogen (OR\u202f=\u202f1.11, 95% CI:1.07\u20131.15), lower creatinine (OR\u202f=\u202f0.94, 95% CI:0.93\u20130.95), higher uric acid (OR\u202f=\u202f1.01, 95% CI:1.00\u20131.02), and higher triglycerides (OR\u202f=\u202f1.24, 95% CI:1.15\u20131.34) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CHD detection pathways are independently associated with nutritional status. Prenatally detected children may benefit from proactive nutritional surveillance from birth, while the expansion of school-based screening should be prioritized in underserved areas. These findings advocate for a stratified, pathway-aware malnutrition surveillance framework to optimize outcomes across the full CHD spectrum in settings with comparable screening infrastructures. While healthcare systems vary across Global South regions, this study provides a novel perspective that may inform policy discussions and guide future research in other middle-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1919015","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:51:51Z","timestamp":1786546311000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Screening modality matters: heterogeneous nutritional status, disease complexity in children with congenital heart disease detected through active versus passive surveillance"],"prefix":"10.3389","volume":"13","author":[{"given":"Kai","family":"Bai","sequence":"first","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]},{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Gao","sequence":"additional","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wang","sequence":"additional","affiliation":[{"name":"Yunnan Population and Family Planning Research Institute","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Xia","sequence":"additional","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Luo","sequence":"additional","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijun","family":"Li","sequence":"additional","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuling","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Duo","sequence":"additional","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teng","family":"Wang","sequence":"additional","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"He","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Lu","sequence":"additional","affiliation":[{"name":"Fuwai Yunnan Hospital, Chinese Academy of Medical Science, Affiliated Cardiovascular Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"1990","journal-title":"J Am Coll Cardiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"101249","DOI":"10.1016\/j.eclinm.2021.101249","article-title":"Global, regional, and national time trends in mortality for congenital heart disease, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study","volume":"43","author":"Su","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e94","DOI":"10.1016\/j.pedhc.2025.10.011","article-title":"The prevalence of malnutrition in children with congenital heart disease: a Meta-analysis","volume":"40","author":"Lee","year":"2026","journal-title":"J Pediatric Health Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1186\/s12967-024-05952-8","article-title":"Prevalence of undernutrition and associated factors among children with congenital heart disease in Africa: a systemic review and meta-analysis","volume":"23","author":"Akele","year":"2025","journal-title":"J Transl Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1258725","DOI":"10.3389\/fped.2024.1258725","article-title":"Risk factors of malnutrition in children with congenital heart disease: a meta-analysis","volume":"12","author":"Zhang","year":"2024","journal-title":"Front Pediatr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"101002","DOI":"10.1016\/j.lanwpc.2023.101002","article-title":"Failure to thrive in pediatric patients with congenital heart disease: a cross-sectional study of 13,256 patients","volume":"44","author":"He","year":"2024","journal-title":"Lancet Regional Health Western Pacific"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"520","DOI":"10.6133\/apjcn.202209_31(3).0019","article-title":"Assessment of dietary nutrient intake and its relationship to the nutritional status of children with congenital heart disease in Guangdong province of China","volume":"31","author":"Zheng","year":"2022","journal-title":"Asia Pac J Clin Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1097\/HCO.0b013e32835dd005","article-title":"Nutrition and growth in congenital heart disease: a challenge in children","volume":"28","author":"Medoff-Cooper","year":"2013","journal-title":"Curr Opin Cardiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/s0022-3476(98)70146-5","article-title":"Increased energy expenditure in infants with cyanotic congenital heart disease","volume":"133","author":"Leitch","year":"1998","journal-title":"J Pediatr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1186\/s12887-020-02124-7","article-title":"Risk factors of malnutrition in Chinese children with congenital heart defect","volume":"20","author":"Zhang","year":"2020","journal-title":"BMC Pediatr"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e032662","DOI":"10.1161\/jaha.123.032662","article-title":"Preoperative malnutrition increases risk of in-hospital mortality, major infection, and longer intensive care unit stay after ventricular septal defect closure","volume":"13","author":"Wittenberg","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"25738","DOI":"10.1038\/s41598-025-96374-z","article-title":"Preoperative nutrition status in children with congenital heart disease and its impact on postoperative outcomes: a systematic review and meta-analysis","volume":"15","author":"Abbas","year":"2025","journal-title":"Sci Rep"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.ahj.2020.03.012","article-title":"Associations between anthropometric indices and outcomes of congenital heart operations in infants and young children: an analysis of data from the Society of Thoracic Surgeons database","volume":"224","author":"Ross","year":"2020","journal-title":"Am Heart J"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1572805","DOI":"10.3389\/fnut.2025.1572805","article-title":"Efficiency analysis of nutritional screening tools for children with congenital heart disease: a retrospective observational study","volume":"12","author":"Xu","year":"2025","journal-title":"Front Nutr"},{"key":"ref15","volume-title":"WHO Child Growth Standards Based on Length\/Height, Weight and Age","year":"2006"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"660","DOI":"10.2471\/blt.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"de Onis","year":"2007","journal-title":"Bull World Health Organ"},{"key":"ref17","volume-title":"Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children","year":"2013"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/s0140-6736(13)60937-x","article-title":"Maternal and child undernutrition and overweight in low-income and middle-income countries","volume":"382","author":"Black","year":"2013","journal-title":"Lancet"},{"key":"ref19","first-page":"8","article-title":"ICD-10-cm","volume":"13","author":"Parman","year":"2004","journal-title":"J Oncol Manag"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e698","DOI":"10.1161\/cir.0000000000000603","article-title":"2018 AHA\/ACC guideline for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"139","author":"Stout","year":"2019","journal-title":"Circulation"},{"key":"ref21","volume-title":"WHO AnthroPlus for Personal Computers Manual: Software for Assessing Growth of the World's Children and Adolescents","author":"Blossner","year":"2009"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1161\/CIRCULATIONAHA.115.020864","article-title":"Does first-trimester screening modify the natural history of congenital heart disease? Analysis of outcome of regional cardiac screening at 2 different time periods","volume":"135","author":"Jicinska","year":"2017","journal-title":"Circulation"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/s0140-6736(11)60753-8","article-title":"Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study","volume":"378","author":"Ewer","year":"2011","journal-title":"Lancet"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1161\/circulationaha.121.056455","article-title":"High prevalence of unrecognized congenital heart disease in school-age children in rural China: a population-based echocardiographic screening study","volume":"144","author":"Zhao","year":"2021","journal-title":"Circulation"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1778716","DOI":"10.3389\/fpubh.2026.1778716","article-title":"Post-treatment status and unmet treatment needs after congenital heart defect screening policy in school-aged children: a multi-ethnic screening of 1.02 million in China","volume":"14","author":"Bai","year":"2026","journal-title":"Front Public Health"},{"key":"ref26","volume-title":"Notice on Issuing the Work Plan for Free Screening and Intervention for Congenital Heart Disease in Children in Yunnan Province Yunnan Provincial Health and Family Planning Commission Yunnan Provincial Health and Family Planning Commission","year":"2017"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12887-017-0779-y","article-title":"Wasting, underweight and stunting among children with congenital heart disease presenting at Mulago hospital, Uganda","volume":"17","author":"Batte","year":"2017","journal-title":"BMC Pediatr"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1919015\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:51:53Z","timestamp":1786546313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1919015\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":27,"alternative-id":["10.3389\/fnut.2026.1919015"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1919015","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"1919015"}}