Association of nutritional status and laboratory parameters with heart failure among children with congenital heart disease

Herlina Dimiati* -  Faculty of Medicine, Syiah Kuala University. Pediatric Cardiology Division, Dr. Zainoel Abidin Regional General Hospital, Banda Aceh, Aceh, Indonesia
Zaki Akbar -  Pediatric Cardiology Division, Dr. Zainoel Abidin Regional General Hospital, Banda Aceh, Aceh, Indonesia
DOI : 10.30867/action.v10i4.2731

Congenital Heart Disease (CHD) is a structural and functional abnormality of the heart that occurs at birth. If left untreated, CHD can lead to heart failure, respiratory infection, and malnutrition. Data on nutritional status, anemia, leukocyte count, and serum 25-hydroxy vitamin D [25(OH)D] levels in pediatric CHD patients with heart failure remain limited.  This study aimed to analyze the correlation between nutritional status, anemia, leukocyte count, and serum 25-Hydroxy vitamin D levels, and heart failure in children with CHD. A cross-sectional study was conducted at three hospitals in Banda Aceh from August 1, 2022, to July 31, 2023. Pediatric patients with CHD underwent anthropometric, echocardiographic, and laboratory examinations. The exclusion criteria included renal, urinary, endocrine, and hematologic-oncological disorders. Data were analyzed using SPSS version 26.0, and the Mann–Whitney U test was applied for nonparametric variables. Results: Of the 128 patients with CHD (46.1% men), 78.9% had heart failure. Poor nutritional status was found in 49.2% of patients, and anemia in 51.6%, with many showing abnormal leukocyte counts and low serum 25(OH)D levels. Low serum 25(OH)D levels (p=0.010; OR=6.7) and abnormal leukocyte counts (p=0.000; OR=55.6) were significantly associated with heart failure. In conclusion, low serum 25(OH)D levels and abnormal leukocyte counts significantly increase the risk of heart failure in children with CHD.

Keywords : Congenital heart disease, heart failure, anemia, leukocytes, vitamin D, nutritional status, children

  1. Al Rahmad, A. H. (2023). Scoping review: The role of micronutrients (Fe, Zn, iodine, retinol, folate) during pregnancy. Jurnal Kesehatan Manarang, 9(1), 1–13. https://doi.org/10.33490/jkm.v9i1.812
  2. Algharyani, H., El-Latef, A. A., & Anany, H. G. (2021). Nutritional status in children with operated congenital heart diseases in Zagazig University Hospitals. Zagazig University Medical Journal, 27(3), 390–399. https://doi.org/10.21608/zumj.2019.10636.1184
  3. Alverina, C., Utamayasa, I. K. A., & Sembiring, Y. E. (2022). Characteristics of cyanotic congenital heart disease at Dr. Soetomo General Hospital Surabaya. Journal of the Indonesian Medical Association, 72(1), 4–10. https://doi.org/10.47830/jinma-vol.72.1-2022-762
  4. Amdani, S., Conway, J., George, K. M., Martinez, H. R., Asante-Korang, A., Goldberg, C. S., Davies, R. R., Miyamoto, S. D., & Hsu, D. T. (2024). Evaluation and management of chronic heart failure in children and adolescents with congenital heart disease: A scientific statement from the American Heart Association. Circulation, 150(2). https://doi.org/10.1161/CIR.0000000000001245
  5. Amelia, P., Adriansyah, R., Lubis, B., & Akil, M. (2020). The association between cyanotic and acyanotic congenital heart disease with nutritional status. Open Access Macedonian Journal of Medical Sciences, 8(B), 245–248. https://doi.org/10.3889/oamjms.2020.3978
  6. Billingsley, H. E., Hummel, S. L., & Carbone, S. (2020). The role of diet and nutrition in heart failure: A state-of-the-art narrative review. Progress in Cardiovascular Diseases, 63(5), 538–551. https://doi.org/10.1016/j.pcad.2020.08.004
  7. Blasquez, A., Clouzeau, H., Fayon, M., Mouton, J.-B., Thambo, J.-B., Enaud, R., & Lamireau, T. (2016). Evaluation of nutritional status and support in children with congenital heart disease. European Journal of Clinical Nutrition, 70(4), 528–531. https://doi.org/10.1038/ejcn.2015.209
  8. Chang, W.-S., Kim, E., Lim, Y., Yoon, D., Son, J.-Y., Park, J., Hong, S., Cho, S., & Lee, J.-S. (2016). Age-related changes in immunological factors and their relevance in allergic disease development during childhood. Allergy, Asthma & Immunology Research, 8(4), 338–345. https://doi.org/10.4168/aair.2016.8.4.338
  9. Doğru, M., & Seren, L. P. (2017). Serum 25-hydroxyvitamin D levels in children with recurrent wheezing and relation to the phenotypes and frequency of wheezing. European Annals of Allergy and Clinical Immunology, 49(6), 257–264. https://doi.org/10.23822/eurannaci.1764-1489.14
  10. Düğeroğlu, H., & Kaya, Y. (2022). The frequency of vitamin D deficiency in Ordu and its relationship with chronic diseases. Anatolian Current Medical Journal, 4(1), 8–12. https://doi.org/10.38053/acmj.1002370
  11. Fedora, K., Utamayasa, I. K. A., & Purwaningsih, S. (2019). Profile of acyanotic congenital heart defect in children at Dr. Soetomo General Hospital Surabaya period of January–December 2016. Juxta Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga, 10(2), 79–83. https://doi.org/10.20473/juxta.v10i22019.79-83
  12. Gilljam, T., Mandalenakis, Z., Dellborg, M., Lappas, G., Eriksson, P. S., Skoglund, K., & Rosengren, A. (2019). Development of heart failure in young patients with congenital heart disease: A nationwide cohort study. Open Heart, 6(1), e000858. https://doi.org/10.1136/openhrt-2018-000858
  13. Gökalp, S., Tunaoglu, F. S., Canbeyli, F., Terlemez, S., Atasayan, V., Aral, L. A., Kula, S., & Oğuz, A. D. (2022). Effect of vitamin D on myocardial remodeling and inflammatory status in children with congenital heart disease. Turkish Journal of Medical Sciences, 52(6), 1900–1905. https://doi.org/10.55730/1300-0144.5537
  14. Hao, Y., & Chen, Y. (2019). Vitamin D levels and vitamin D receptor variants are associated with chronic heart failure in Chinese patients. Journal of Clinical Laboratory Analysis, 33(4), e22847. https://doi.org/10.1002/jcla.22847
  15. Izumi, G., Inai, K., Shimada, E., & Nakanishi, T. (2016). Vitamin D kinetics and parathyroid gland function in patients with congenital heart disease. Congenital Heart Disease, 11(6), 700–706. https://doi.org/10.1111/chd.12389
  16. Kato, T., Yaku, H., Morimoto, T., Inuzuka, Y., Tamaki, Y., Yamamoto, E., Yoshikawa, Y., Kitai, T., Taniguchi, R., Iguchi, M., Kato, M., Takahashi, M., Jinnai, T., Ikeda, T., Nagao, K., Kawai, T., Komasa, A., Nishikawa, R., Kawase, Y., … Kimura, T. (2020). Association with controlling nutritional status (CONUT) score and in-hospital mortality and infection in acute heart failure. Scientific Reports, 10(1), 1–10. https://doi.org/10.1038/s41598-020-60404-9
  17. Marino, L. V., Johnson, M. J., Davies, N. J., Kidd, C., Fienberg, J., Richens, T., Bharucha, T., Beattie, R. M., & Darlington, A. (2020). Improving growth of infants with congenital heart disease using a consensus-based nutritional pathway. Clinical Nutrition, 39(8), 2455–2462. https://doi.org/10.1016/j.clnu.2019.10.031
  18. Mignot, M., Huguet, H., Cambonie, G., Guillaumont, S., Vincenti, M., Blanc, J., Ovaert, C., Picot, M., Karsenty, C., Amédro, P., Kollen, L., & Gavotto, A. (2023). Risk factors for early occurrence of malnutrition in infants with severe congenital heart disease. European Journal of Pediatrics, 182(3), 1261–1269. https://doi.org/10.1007/s00431-023-04812-9
  19. Mir, A. B., Shah, J. A., Mushtaq, S., & Jan, M. (2019). Prevalence and profile of malnutrition and iron deficiency anemia in children with cyanotic congenital heart defects. International Journal of Contemporary Pediatrics, 6(3), 1303. https://doi.org/10.18203/2349-3291.ijcp20192033
  20. Oktaria, V., Putri, D. A. D., Ihyauddin, Z., Julia, M., Sulistyoningrum, D. C., Koon, P. B., Danchin, M., & Murni, I. K. (2022). Vitamin D deficiency in South-East Asian children: A systematic review. Archives of Disease in Childhood, 107(11), 980–987. https://doi.org/10.1136/archdischild-2021-323765
  21. Oyarzún, I., Clavería, C., Larios, G., & Roy, C. L. (2018). Recuperación nutricional post cirugía cardiaca en niños con cardiopatía congénita. Revista Chilena de Pediatría, 89(1), 24–31. https://doi.org/10.4067/S0370-41062018000100024
  22. Rastegar, M., Teshnizi, S. H., Khaleghinia, M., Seddighi, N., & Rajaei, S. (2024). Vitamin D and zinc deficiency in children with congenital heart defects. Journal of Comprehensive Pediatrics, 15(3), Article e145841. https://doi.org/10.5812/jcp-145841
  23. Roffe-Vazquez, D. N., Delgado, A. S. H., Castillo, E. C., Villarreal-Calderón, J. R., González-Gil, A. M., Enriquez, C., García-Rivas, G., & Elizondo-Montemayor, L. (2019). Correlation of vitamin D with inflammatory cytokines, atherosclerotic parameters, and lifestyle factors in heart failure: A 12-month follow-up study. International Journal of Molecular Sciences, 20(22), 5811. https://doi.org/10.3390/ijms20225811
  24. Salehi, F., Zangouei, A., Zia, Z., Taheribojd, F., Salehi, S., Khosravi Bizhaem, S., & Zangoue, M. (2020). Investigating vitamin D serum levels in children with congenital heart disease compared with healthy controls. Journal of Pediatric Perspectives, 8(3), 11077–11085. https://doi.org/10.22038/ijp.2019.42886.3600
  25. Salwaa, S. F., Hidayat, T., & Suryawan, I. G. R. (2022). Association between breastfeeding and nutritional status in children with congenital heart disease at Dr. Soetomo General Hospital. Syntax Literate: Jurnal Ilmiah Indonesia, 7(1), 345–352. https://doi.org/10.36418/syntax-literate.v7i1.5741
  26. Sunaga, A., Hikoso, S., Yamada, T., Yasumura, Y., Tamaki, S., Yano, M., Hayashi, T., Nakagawa, Y., Nakagawa, A., Seo, M., Kurakami, H., Yamada, T., Kitamura, T., Sato, T., Oeun, B., Kida, H., Sotomi, Y., Dohi, T., Okada, K., … Sakata, Y. (2022). Change in nutritional status during hospitalization and prognosis in patients with heart failure with preserved ejection fraction. Nutrients, 14(20), 4345. https://doi.org/10.3390/nu14204345
  27. Yousafzai, Z. A., Ilyas, S., Nawab, Z. M., & Abdullah. (2024). Impact of malnutrition on pediatric heart failure: Analyzing z-scores at presentation. Biological and Clinical Sciences Research Journal, 2024(1), 767. https://doi.org/10.54112/bcsrj.v2024i1.767
  28. Zhang, J., & Lü, N. (2021). The association between childhood conditions and heart disease among middle-aged and older population in China: A life course perspective. BMC Geriatrics, 21(1), Article 2134. https://doi.org/10.1186/s12877-021-02134-9
  29. Zhang, X., Zhang, J., Liu, F., Li, W., Zhang, T., Fang, B., Zhang, Z., Xie, Q., Yang, Y., & Li, X. (2023). Prognostic nutritional index as a predictor in patients with metabolic syndrome and heart failure. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 16, 2503–2514. https://doi.org/10.2147/DMSO.S420924
  30. Zhou, H., & Qian, H. (2018). Relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with heart failure. Clinical Interventions in Aging, 13, 397–401. https://doi.org/10.2147/CIA.S157507

Open Access Copyright (c) 2025 Herlina Dimiati, Zaki Akbar
Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

AcTion: Aceh Nutrition Journal
Published by: Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health.
Soekarno-Hatta Street, No. 168. Health Polytechnic of Aceh, Aceh Besar, 23352. Telp/Fax: 0651 46126 / 0651 46121.
Website: https://gizipoltekkesaceh.ac.id/
E-mail: jurnal6121@gmail.com

e-issn: 2548-5741, p-issn: 2527-3310

All content is licensed under a: Creative Commons Attribution ShareAlike 4.0 International License

View My Stats

Get a feed by atom here, RRS2 here and OAI Links here