{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T18:50:11Z","timestamp":1780599011839,"version":"3.54.1"},"reference-count":40,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T00:00:00Z","timestamp":1729296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003094","name":"F\u00f6rdergemeinschaft Deutsche Kinderherzzentren","doi-asserted-by":"publisher","award":["W-B-009\/2020"],"award-info":[{"award-number":["W-B-009\/2020"]}],"id":[{"id":"10.13039\/501100003094","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003094","name":"F\u00f6rdergemeinschaft Deutsche Kinderherzzentren","doi-asserted-by":"publisher","award":["01GI0601"],"award-info":[{"award-number":["01GI0601"]}],"id":[{"id":"10.13039\/501100003094","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003094","name":"F\u00f6rdergemeinschaft Deutsche Kinderherzzentren","doi-asserted-by":"publisher","award":["01KX2140"],"award-info":[{"award-number":["01KX2140"]}],"id":[{"id":"10.13039\/501100003094","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Competence Network for Congenital Heart Defects","award":["W-B-009\/2020"],"award-info":[{"award-number":["W-B-009\/2020"]}]},{"name":"Competence Network for Congenital Heart Defects","award":["01GI0601"],"award-info":[{"award-number":["01GI0601"]}]},{"name":"Competence Network for Congenital Heart Defects","award":["01KX2140"],"award-info":[{"award-number":["01KX2140"]}]},{"name":"National Register for Congenital Heart Defects","award":["W-B-009\/2020"],"award-info":[{"award-number":["W-B-009\/2020"]}]},{"name":"National Register for Congenital Heart Defects","award":["01GI0601"],"award-info":[{"award-number":["01GI0601"]}]},{"name":"National Register for Congenital Heart Defects","award":["01KX2140"],"award-info":[{"award-number":["01KX2140"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Malnutrition and poor weight gain has been reported in infants with congenital heart defects (CHDs); however data in older children with CHDs are limited. In order to obtain representative data on the nutritional status, dietary behavior, and potential influencing factors in school-aged children with CHDs, we performed a nationwide online survey. Methods: Patients aged 6 to 17 years registered in the German National Register for CHDs were asked to participate in this study by completing the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) eating study questionnaire in order to assess their self-reported dietary habits. The use of the same questionnaire enabled a comparison with a representative subset of 4569 participants of the KiGGS study. Results: A total of 894 patients (mean age 12.5 \u00b1 3.0 years; 47.2% female) were enrolled. Patients were allocated according to anatomic complexity into simple (23.8%), moderate (37.8%), and complex CHDs (38.4%). The consumption of sugar-containing food (p &lt; 0.001) and fast food (p &lt; 0.05) was significantly lower among the CHD patients than in the healthy children. Children with CHDs showed significantly lower body mass index (BMI) percentiles (p &lt; 0.001) compared with their healthy peers, while children with complex and moderate CHDs had the lowest BMI. While in CHD patients, the BMI percentiles were not related to unhealthy food, there was a strong correlation with the CHD severity and number of previous interventions (p &lt; 0.01). Conclusions: According to this nationwide survey, school-aged children with complex CHD are at risk of undernutrition, which is not due to dietary habits but to CHD severity and repeated surgery.<\/jats:p>","DOI":"10.3390\/children11101264","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T03:57:09Z","timestamp":1729483029000},"page":"1264","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Trends in Nutritional Status and Dietary Behavior in School-Aged Children with Congenital Heart Defects"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6473-7743","authenticated-orcid":false,"given":"Dominik","family":"Tobias","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, University Children Hospital, 89075 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Christian","family":"Helm","sequence":"additional","affiliation":[{"name":"National Register for Congenital Heart Defects, Competence Network for Congenital Heart Defects, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike Maria Margarethe","family":"Bauer","sequence":"additional","affiliation":[{"name":"National Register for Congenital Heart Defects, Competence Network for Congenital Heart Defects, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2094-0836","authenticated-orcid":false,"given":"Claudia","family":"Niessner","sequence":"additional","affiliation":[{"name":"Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Hahn","sequence":"additional","affiliation":[{"name":"Oecothrophology and Nutritional Science, University of Applied Sciences, 92224 Fulda, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jannos","family":"Siaplaouras","sequence":"additional","affiliation":[{"name":"Pediatrics and Interprofessional Care, University of Applied Sciences, 92224 Fulda, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Apitz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University Children Hospital, 89075 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1093\/nutrit\/nuac089","article-title":"Nutrition in school-age children: A rationale for revisiting priorities","volume":"81","author":"Saavedra","year":"2023","journal-title":"Nutr. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1007\/s00103-007-0254-2","article-title":"EsKiMo\u2014The nutrition module in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)","volume":"50","author":"Mensink","year":"2007","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/obr.12334","article-title":"Predicting adult obesity from childhood obesity: A systematic review and meta-analysis","volume":"17","author":"Simmonds","year":"2016","journal-title":"Obes. Rev."},{"key":"ref_4","first-page":"15","article-title":"Overweight and obesity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends","volume":"3","author":"Schienkiewitz","year":"2018","journal-title":"J. Health Monit."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s11883-014-0443-z","article-title":"Role of childhood food patterns on adult cardiovascular disease risk","volume":"16","author":"Kaikkonen","year":"2014","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s00392-011-0355-7","article-title":"Frequency and spectrum of congenital heart defects among live births in Germany: A study of the Competence Network for Congenital Heart Defects","volume":"100","author":"Schwedler","year":"2011","journal-title":"Clin. Res. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.clp.2015.11.009","article-title":"Nutrition in the cardiac newborns. Evidence-based Nutrition Guidelines for Cardiac Newborns","volume":"43","author":"Karpen","year":"2016","journal-title":"Clin. Perinatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e236","DOI":"10.1542\/peds.2012-1157","article-title":"Growth in children with congenital heart disease","volume":"131","author":"Daymont","year":"2013","journal-title":"Pediatrics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/HCO.0b013e32835dd005","article-title":"Nutrition and growth in congenital heart disease: A challenge in children","volume":"28","author":"Ravishankar","year":"2013","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e12302","DOI":"10.1111\/mcn.12302","article-title":"\u201cI was so worried about every drop of milk\u201d\u2014Feeding problems at home are a significant concern for parents after major heart surgery in infancy","volume":"13","author":"Tregay","year":"2017","journal-title":"Matern. Child. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/PCC.0000000000000402","article-title":"Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease","volume":"16","author":"Mitting","year":"2015","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1017\/S1047951115001778","article-title":"A cross-sectional audit of the prevalence of stunting in children attending a regional paediatric cardiology service","volume":"26","author":"Marino","year":"2016","journal-title":"Cardiol. Young"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/chd.12064","article-title":"Perioperative nutritional support and malnutrition in infants and children with congenital heart disease","volume":"9","author":"Toole","year":"2014","journal-title":"Congenit. Heart Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1016\/j.clnu.2017.06.020","article-title":"Bioimpedance spectroscopy measurements of phase angle and height for age are predictive of outcome in children following surgery for congenital heart disease","volume":"37","author":"Marino","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1038\/ejcn.2015.209","article-title":"Evaluation of nutritional status and support in children with congenital heart disease","volume":"70","author":"Blasquez","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1001\/archpedi.1995.02170230052007","article-title":"Malnutrition in hospitalized children with congenital heart disease","volume":"149","author":"Cameron","year":"1995","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/2150135118765881","article-title":"Nutrition Considerations in the Pediatric Cardiac Intensive Care Unit Patient","volume":"9","author":"Justice","year":"2018","journal-title":"World J. Pediatr. Congenit. Heart Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.nut.2005.06.008","article-title":"Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure","volume":"22","author":"Kelleher","year":"2006","journal-title":"Nutrition"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"397.e1","DOI":"10.1016\/j.jtcvs.2009.02.033","article-title":"Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle","volume":"138","author":"Anderson","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.nut.2010.06.001","article-title":"Malnutrition in pediatric hospital patients: Current issues","volume":"27","author":"Joosten","year":"2011","journal-title":"Nutrition"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1210\/jc.2012-3595","article-title":"Childhood stunting and mortality between 36 and 64 years: The British 1946 Birth Cohort Study. (1945\u20137197 (Electronic))","volume":"98","author":"Ong","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jpeds.2012.07.048","article-title":"Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology: A report from the pediatric heart network infant single ventricle trial","volume":"162","author":"Ravishankar","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_23","first-page":"3","article-title":"Sports and dietary behaviour among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends","volume":"3","author":"Krug","year":"2018","journal-title":"J. Health Monit."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/s001120170107","article-title":"Perzentile f\u00fcr den Body-mass-Index f\u00fcr das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben","volume":"149","author":"Wabitsch","year":"2001","journal-title":"Monatsschrift Kinderheilkd."},{"key":"ref_25","first-page":"123","article-title":"Referenzwerte f\u00fcr den Body-Mass-Index f\u00fcr Kinder, Jugendliche und Erwachsene in Deutschland: Anpassung der AGA-BMI_Referenz im Altersbereich von 15 bis 18 Jahren","volume":"9","author":"Moss","year":"2015","journal-title":"Adipositas"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e143","DOI":"10.1016\/j.jacc.2008.10.001","article-title":"ACC\/AHA 2008 guidelines for the management of adults with congenital heart disease","volume":"52","author":"Warnes","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e012030","DOI":"10.1161\/JAHA.119.012030","article-title":"Congenital heart disease and risk of cardiovascular disease: A meta-analysis of cohort studies","volume":"8","author":"Wang","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s00246-017-1750-2","article-title":"Prevalence of coronary artery disease risk factors and metabolic syndrome in children with heart disease","volume":"39","author":"Ware","year":"2018","journal-title":"Pediatr. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/01.hjr.0000224483.72726.1a","article-title":"Atherosclerosis lifestyle risk factors in children with congenital heart disease","volume":"14","author":"Massin","year":"2007","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/j.cjca.2018.09.012","article-title":"Carotid Intima-Media Thickness in Children and Adolescents With Congenital Heart Disease","volume":"34","author":"Reiner","year":"2018","journal-title":"Can. J. Cardiol."},{"key":"ref_31","first-page":"e698","article-title":"AHA\/ACC guideline for the management of adults with congenital heart disease","volume":"139","author":"Stout","year":"2019","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Siaplaouras, J., Niessner, C., Helm, P.C., Jahn, A., Flemming, M., Urschitz, M.S., Sticker, E., Abdul-Khaliq, H., Bauer, U.M., and Apitz, C. (2020). Physical Activity Among Children With Congenital Heart Defects in Germany: A Nationwide Survey. Front. Pediatr., 8.","DOI":"10.3389\/fped.2020.00170"},{"key":"ref_33","first-page":"373","article-title":"Nutrition in congenital heart disease: Consensus document","volume":"98","author":"Tejero","year":"2023","journal-title":"An. Pediatr. (Engl. Ed.)"},{"key":"ref_34","first-page":"3","article-title":"Fast food consumption among 12- to 17-year-olds in Germany\u2014Results of EsKiMo II","volume":"5","author":"Moosburger","year":"2020","journal-title":"J. Health Monit."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4295","DOI":"10.1007\/s00394-021-02586-0","article-title":"Dietary patterns are associated with central adiposity and carotid intima-media thickness in children and adolescents with congenital heart disease","volume":"60","author":"Honicky","year":"2021","journal-title":"Eur. J. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/0148607113479972","article-title":"Defining pediatric malnutrition: A paradigm shift toward etiology-related definitions","volume":"37","author":"Mehta","year":"2013","journal-title":"J. Parenter. Enteral Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Lv, S., and Ru, S. (2021). The prevalence of malnutrition and its effects on the all-cause mortality among patients with heart failure: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.37766\/inplasy2021.6.0063"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"179","DOI":"10.5114\/ait.2023.130632","article-title":"Malnutrition risk in elective surgery patients and effectiveness of preoperative nutritional interventions at a pre-anaesthetic clinic: A 4-year apart, single-centre, observational study","volume":"55","author":"Kutnik","year":"2023","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1159\/000493938","article-title":"Prenatal Growth in Fetuses with Isolated Cyanotic and Non-Cyanotic Congenital Heart Defects","volume":"47","author":"Inversetti","year":"2020","journal-title":"Fetal Diagn. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1002\/pd.5770","article-title":"Adverse perinatal outcome and placental abnormalities in pregnancies with major fetal congenital heart defects: A retrospective case-control study","volume":"40","author":"Giorgione","year":"2020","journal-title":"Prenat. Diagn."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/10\/1264\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:16:33Z","timestamp":1760112993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/10\/1264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,19]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["children11101264"],"URL":"https:\/\/doi.org\/10.3390\/children11101264","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,19]]}}}