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Daelman, B., Van Bulck, L., Luyckx, K., Kovacs, A. H., Van De Bruaene, A., Ladouceur, M., . . . Wijayarathne, P. M. (2024). Frailty and cognitive function in middle-aged and older adults with congenital heart disease. Journal of the American College of Cardiology, 83(12), 1149-1159
Open this publication in new window or tab >>Frailty and cognitive function in middle-aged and older adults with congenital heart disease
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2024 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 83, no 12, p. 1149-1159Article in journal (Refereed) Published
Abstract [en]

Background: Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.

Objectives: The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.

Methods: Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.

Results: In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.

Conclusions: Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
aging, cognition, congenital heart defects, frailty, frailty phenotype
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-222575 (URN)10.1016/j.jacc.2024.01.021 (DOI)38508848 (PubMedID)2-s2.0-85187024075 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20190525
Available from: 2024-04-08 Created: 2024-04-08 Last updated: 2024-04-08Bibliographically approved
Wikner, A., Johansson, K., Enocson, E., Sthen Bergdahl, M., Hansson, L., Rydberg, A. & Sandberg, C. (2024). Lower bone strength in young patients with Fontan circulation compared to controls. Cardiology in the Young
Open this publication in new window or tab >>Lower bone strength in young patients with Fontan circulation compared to controls
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2024 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: Previous reports indicate bone deficits in patients with Fontan circulation. However, the consequences of these deficits on bone strength and when these changes occur are unclear.

Aim: To compare the tibial bone strength-strain index between young patients (6-19 years) with Fontan circulation and age- and sex-matched controls, and to determine strength-strain-index in subgroups of children (6-12 years) and adolescents (13-19 years) versus controls.

Method: The tibia was examined with peripheral quantitative CT. Based on the assessed data, bone strength-strain index was calculated in the lateral and anterior-posterior directions.

Results: Twenty patients with Fontan and twenty controls (mean age 13.0 ± 4.4 years; 50% females) were examined. Patients had a lower strength-strain index in the lateral direction compared to controls (808.4 ± 416.8mm3 versus 1162.5 ± 552.1mm3, p = 0.043). Subgroup analyses showed no differences regarding strength-strain index in children (6-12 years) with Fontan circulation compared to controls. However, the adolescents (13-19 years) with Fontan circulation had lower strength-strain indexes in both the lateral and anterior-posterior directions compared to controls (1041.4 ± 299.8mm3 versus 1596.4 ± 239.6mm3, p < 0.001, and 771.7 ± 192.4mm3 versus 1084.9 ± 215.0mm3, p = 0.004). When adjusted for height, there were differences between patients (6-19 years) and controls in strength-strain indexes in both the lateral and anterior-posterior directions. In subgroup analyses, the results remained robust.

Conclusion: Young patients (6-19 years) with Fontan circulation have a lower strength-strain index in the tibia compared to controls. Subgroup analyses show that this deficit is mainly driven by the differences in adolescents (13-19 years), which might suggest that bone strength decreases with age.

Place, publisher, year, edition, pages
Cambridge University Press, 2024
Keywords
adolescents, bone mineral content, bone mineral density, CHD, children, Strength-strain index, total cavo-pulmonary connection
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-222429 (URN)10.1017/S1047951124000404 (DOI)38450512 (PubMedID)2-s2.0-85187115758 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160496
Available from: 2024-03-19 Created: 2024-03-19 Last updated: 2024-03-19
Ekblom-Bak, E., Börjesson, M., Ekblom, Ö., Angerås, O., Bergman, F., Berntsson, C., . . . Jernberg, T. (2023). Accelerometer derived physical activity and subclinical coronary and carotid atherosclerosis: cross-sectional analyses in 22 703 middle-aged men and women in the SCAPIS study. BMJ Open, 13(11), Article ID e073380.
Open this publication in new window or tab >>Accelerometer derived physical activity and subclinical coronary and carotid atherosclerosis: cross-sectional analyses in 22 703 middle-aged men and women in the SCAPIS study
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 11, article id e073380Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim included investigation of the associations between sedentary (SED), low-intensity physical activity (LIPA), moderate-to-vigorous intensity PA (MVPA) and the prevalence of subclinical atherosclerosis in both coronaries and carotids and the estimated difference in prevalence by theoretical reallocation of time in different PA behaviours.

Design: Cross-sectional.

Setting: Multisite study at university hospitals.

Participants: A total of 22 670 participants without cardiovascular disease (51% women, 57.4 years, SD 4.3) from the population-based Swedish CArdioPulmonary bioImage study were included. SED, LIPA and MVPA were assessed by hip-worn accelerometer.

Primary and secondary outcomes: Any and significant subclinical coronary atherosclerosis (CA), Coronary Artery Calcium Score (CACS) and carotid atherosclerosis (CarA) were derived from imaging data from coronary CT angiography and carotid ultrasound.

Results: High daily SED (>70% ≈10.5 hours/day) associated with a higher OR 1.44 (95% CI 1.09 to 1.91), for significant CA, and with lower OR 0.77 (95% CI 0.63 to 0.95), for significant CarA. High LIPA (>55% ≈8 hours/day) associated with lower OR for significant CA 0.70 (95% CI 0.51 to 0.96), and CACS, 0.71 (95% CI 0.51 to 0.97), but with higher OR for CarA 1.41 (95% CI 1.12 to 1.76). MVPA above reference level, >2% ≈20 min/day, associated with lower OR for significant CA (OR range 0.61-0.67), CACS (OR range 0.71-0.75) and CarA (OR range 0.72-0.79). Theoretical replacement of 30 min of SED into an equal amount of MVPA associated with lower OR for significant CA, especially in participants with high SED 0.84 (95% CI 0.76 to 0.96) or low MVPA 0.51 (0.36 to 0.73).

Conclusions: MVPA was associated with a lower risk for significant atherosclerosis in both coronaries and carotids, while the association varied in strength and direction for SED and LIPA, respectively. If causal, clinical implications include avoiding high levels of daily SED and low levels of MVPA to reduce the risk of developing significant subclinical atherosclerosis.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
cardiovascular imaging, epidemiology, public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-217547 (URN)10.1136/bmjopen-2023-073380 (DOI)37996228 (PubMedID)2-s2.0-85177801853 (Scopus ID)
Funder
Swedish Heart Lung FoundationKnut and Alice Wallenberg FoundationSwedish Research CouncilVinnovaUniversity of GothenburgKarolinska InstituteRegion StockholmLinköpings universitetLund UniversityUmeå UniversityUppsala UniversityRegion Västra Götaland, ALFGBG- 720691Swedish Heart Lung Foundation, 20180379
Available from: 2023-12-11 Created: 2023-12-11 Last updated: 2023-12-11Bibliographically approved
Wikner, A., Sandström, A., Rinnström, D., Wiklund, U., Christersson, C., Dellborg, M., . . . Sandberg, C. (2023). Impaired exercise capacity and mortality risk in adults with congenital heart disease. JACC: Advances, 2(5), 100422-100422, Article ID 100422.
Open this publication in new window or tab >>Impaired exercise capacity and mortality risk in adults with congenital heart disease
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2023 (English)In: JACC: Advances, ISSN 2772-963X, Vol. 2, no 5, p. 100422-100422, article id 100422Article in journal (Refereed) Published
Abstract [en]

Background: An association between impaired exercise capacity and risk of mortality has been reported among adults with congenital heart disease (CHD). Over the years, treatment methods have improved and may influence outcome. Hence, we report data from a national cohort reflecting a contemporary population.

Objectives: The purpose of this study was to investigate the association between exercise capacity (workload) and mortality in a large registry-based cohort.

Methods: Data on exercise capacity using cycle ergometer were retrieved from the national registry of CHD. The association between predicted exercise capacity (%ECpred) and mortality was analyzed using Cox regression.

Results: In total, 3,721 adults (>18 years, 44.6% women) with CHD were included. The median age was 27.0 years (IQR: 20.8-41.0 years) and mean %ECpred was 77% ± 20%. Over a mean follow-up of 9.4 ± 6.0 years, there were 214 (5.8%) deaths. The Multivariable Cox regression model showed that moderately and severely impaired exercise capacity (50-<70 %ECpred: HR: 2.1, 95% CI: 1.4-3.2, P < 0.001, and <50 %ECpred: HR: 3.5, 95% CI: 2.1-6.0, P < 0.001) and CHD complexity were associated with higher mortality (moderate complexity: HR: 1.9 95% CI: 1.2-3.0, P = 0.003, great complexity: HR: 2.3 95% CI: 1.3-4.2, P = 0.008) when adjusted for New York Heart Association class, physical activity, cardiovascular medication, sex, impaired systemic ventricular function, and age.

Conclusions: Impaired exercise capacity and CHD complexity are independently associated with all-cause mortality in patients with CHD. Exercise capacity is an easily accessible variable that may be a useful tool for risk assessment in adult patients with CHD, but this needs confirmation in prospective studies.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
aerobic exercise capacity, congenital heart disease, exercise test, mortality, outcome
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-215208 (URN)10.1016/j.jacadv.2023.100422 (DOI)2-s2.0-85179944904 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20200493Swedish Heart Lung Foundation, 20190525Swedish Heart Lung Foundation, 20170483Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, 20100355Umeå UniversityRegion VästerbottenVisare Norr
Available from: 2023-10-11 Created: 2023-10-11 Last updated: 2024-01-12Bibliographically approved
Sthen Bergdahl, M., Crenshaw, A. G., Rylander Hedlund, E., Sjöberg, G., Rydberg, A. & Sandberg, C. (2022). Calf Muscle Oxygenation is Impaired and May Decline with Age in Young Patients with Total Cavopulmonary Connection. Pediatric Cardiology, 43(2), 449-456
Open this publication in new window or tab >>Calf Muscle Oxygenation is Impaired and May Decline with Age in Young Patients with Total Cavopulmonary Connection
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2022 (English)In: Pediatric Cardiology, ISSN 0172-0643, E-ISSN 1432-1971, Vol. 43, no 2, p. 449-456Article in journal (Refereed) Published
Abstract [en]

Patients palliated with Total Cavopulmonary Connection have a lower muscle mass and a lower exercise capacity. We assessed calf muscle oxidative metabolism during and after heel raise exercise to exhaustion in young patients with TCPC compared to healthy peers. Near-infrared spectroscopy was used for measuring oxygen metabolism in the medial portion of the gastrocnemius muscle. Forty-three patients with TCPC, aged 6–18 years, were compared with 43 age and sex-matched healthy control subjects. Subgroups were formed to include children (6–12 years) and adolescents (13–18 years) to determine if these age groups influenced the results. During exercise, for the patients compared to controls there was a lower increase in deoxygenated hemoglobin (oxygen extraction) (5.13 ± 2.99au vs. 7.75 ± 4.15au, p = 0.001) and a slower rate of change in total hemoglobin (blood volume) (0.004 ± 0.015au vs 0.016 ± 0.01au, p = 0.001). Following exercise, patients exhibited a slower initial increase in tissue oxygenation saturation index (0.144 ± 0.11au vs 0.249 ± 0.226au, p = 0.007) and a longer half-time to maximum hyperemia (23.7 ± 11.4 s vs 16.8 ± 7.5 s, p = 0.001). On the subgroup level, the adolescents differed compared to healthy peers, whereas the children did not. Young patients with TCPC had impaired oxidative metabolism during exercise and required a longer time to recover. In that the differences were seen in the adolescent group and not in the children group may indicate a declining function with age.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Exercise, Fontan, Near-infrared spectroscopy, NIRS, TCPC, Total cavopulmonary connection
National Category
Pediatrics Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-191382 (URN)10.1007/s00246-021-02743-6 (DOI)000705716400001 ()34623455 (PubMedID)2-s2.0-85116846174 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160496
Available from: 2022-01-14 Created: 2022-01-14 Last updated: 2024-04-10Bibliographically approved
Michelsen, H. Ö., Sjölin, I., Bäck, M., Gonzalez, M., Olsson, A., Sandberg, C., . . . Leósdóttir, M. (2022). Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial. Journal of Medical Internet Research, 24(3), Article ID e25224.
Open this publication in new window or tab >>Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial
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2022 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 3, article id e25224Article in journal (Refereed) Published
Abstract [en]

Background: Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care.

Objective: This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care).

Methods: All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables.

Results: There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic −27.7 vs −16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic −25.3 vs −16.4 mm Hg; P=.02, and diastolic −13.4 vs −9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25.

Conclusions: Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation.

Place, publisher, year, edition, pages
JMIR publications, 2022
Keywords
cardiac rehabilitation, cardiovascular, eHealth, mobile device app, mobile phone, risk factors, web-based application
National Category
Physiotherapy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-194274 (URN)10.2196/25224 (DOI)000789335500002 ()35357316 (PubMedID)2-s2.0-85127738629 (Scopus ID)
Available from: 2022-04-29 Created: 2022-04-29 Last updated: 2024-01-17Bibliographically approved
Ternrud, L., Hlebowicz, J., Sandberg, C., Johansson, B. & Sparv, D. (2022). Prevalence of fatigue in adults with congenital heart disease. Cardiology in the Young, 32, 1432-1439
Open this publication in new window or tab >>Prevalence of fatigue in adults with congenital heart disease
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2022 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 32, p. 1432-1439Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of this cross-sectional study was to examine the prevalence of the multidimensional phenomenon of fatigue in adults with congenital heart disease.

Background: Adults with congenital heart disease are a growing population, and patient-reported outcomes can provide valuable information about the patient's experience of living with CHD. Fatigue is a multidimensional phenomenon that can be described as an overwhelming feeling of exhaustion with a reduced capacity of mental and physical work. Fatigue can be observed clinically in adults with congenital heart disease, but the actual prevalence is unknown.

Methods: Fatigue was assessed by the Multidimensional Fatigue Inventory which enables the respondent to report the presence of fatigue according to five dimensions: "general fatigue,""physical fatigue,""mental fatigue,""reduced motivation,"and "reduced activity."The questionnaire was sent to 463 patients in Lund and Umeå. Four groups with complex CHD and two groups with moderately complex CHD were included. The reliability (internal consistency) of the Multidimensional Fatigue Inventory was tested for all dimensions and groups of diagnosis.

Results: The response rate was 56.6% (n= 262). In patients with complex CHD, 40.0-59.4% reported severe to very severe general fatigue, and patients with a single ventricle reported the highest prevalence (59.4%). Among patients with complex CHD, 29.2-40.0% reported severe to very severe mental fatigue. The Multidimensional Fatigue Inventory had a high reliability measured with Cronbach's alpha.

Conclusions: The study findings show a relatively high prevalence of fatigue in adults with congenital heart disease, and general fatigue was the most prevalent. Further studies are needed regarding fatigue and its causes and consequences in adults with congenital heart disease.

Relevance to clinical practice: The Multidimensional Fatigue Inventory proved to be an instrument with high reliability and low internal loss, which suggests that the instrument may be suitable to use as a patient-reported outcome in the care of adults with congenital heart disease, preferably at repeated occasions.

Place, publisher, year, edition, pages
Cambridge University Press, 2022
Keywords
Adult congenital heart disease, experience, fatigue, multidimensional fatigue inventory-20, patient-reported outcome
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-189592 (URN)10.1017/S1047951121004297 (DOI)000752690000001 ()2-s2.0-85118605652 (Scopus ID)
Funder
Swedish Heart Lung Foundation
Available from: 2021-11-16 Created: 2021-11-16 Last updated: 2022-11-30Bibliographically approved
Van Bulck, L., Kovacs, A. H., Goossens, E., Luyckx, K., Zaidi, A., Wang, J.-K., . . . Moons, P. (2022). Rationale, design and methodology of APPROACH-IS II: International study of patient-reported outcomes and frailty phenotyping in adults with congenital heart disease. International Journal of Cardiology, 363, 30-39
Open this publication in new window or tab >>Rationale, design and methodology of APPROACH-IS II: International study of patient-reported outcomes and frailty phenotyping in adults with congenital heart disease
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2022 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 363, p. 30-39Article in journal (Refereed) Published
Abstract [en]

Background: In recent years, patient-reported outcomes (PROs) have received increasing prominence in cardiovascular research and clinical care. An understanding of the variability and global experience of PROs in adults with congenital heart disease (CHD), however, is still lacking. Moreover, information on epidemiological characteristics and the frailty phenotype of older adults with CHD is minimal. The APPROACH-IS II study was established to address these knowledge gaps. This paper presents the design and methodology of APPROACH-IS II.

Methods/design: APPROACH-IS II is a cross-sectional global multicentric study that includes Part 1 (assessing PROs) and Part 2 (investigating the frailty phenotype of older adults). With 53 participating centers, located in 32 countries across six continents, the aim is to enroll 8000 patients with CHD. In Part 1, self-report surveys are used to collect data on PROs (e.g., quality of life, perceived health, depressive symptoms, autonomy support), and explanatory variables (e.g., social support, stigma, illness identity, empowerment). In Part 2, the cognitive functioning and frailty phenotype of older adults are measured using validated assessments.

Discussion: APPROACH-IS II will generate a rich dataset representing the international experience of individuals in adult CHD care. The results of this project will provide a global view of PROs and the frailty phenotype of adults with CHD and will thereby address important knowledge gaps. Undoubtedly, the project will contribute to the overarching aim of improving optimal living and care provision for adults with CHD.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Congenital heart disease, Frailty phenotype, Patient-reported outcomes
National Category
Cardiac and Cardiovascular Systems
Research subject
Clinical Physiology
Identifiers
urn:nbn:se:umu:diva-198232 (URN)10.1016/j.ijcard.2022.06.064 (DOI)000836120500006 ()35780933 (PubMedID)2-s2.0-85133759448 (Scopus ID)
Available from: 2022-07-21 Created: 2022-07-21 Last updated: 2023-06-08Bibliographically approved
Hansson, L., Sandberg, C., Öhlund, I., Lind, T., Sthen Bergdahl, M., Wiklund, U., . . . Rydberg, A. (2022). Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation. Cardiology in the Young, 32(6), 861-868
Open this publication in new window or tab >>Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation
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2022 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 32, no 6, p. 861-868Article in journal (Refereed) Published
Abstract [en]

Introduction/aim: Young patients with Fontan circulation may have low serum 25-hydroxyvitamin D levels, an affected liver, and unhealthy body compositions. This study aimed to explore the association between vitamin D intake/levels, liver biomarkers, and body composition in young Fontan patients.

Method: We collected prospective data in 2017 to 2018, obtained with food-frequency questionnaires, biochemical analyses of liver biomarkers, and dual-energy X-ray absorptiometry scans in 44 children with Fontan circulation. Body compositions were compared to matched controls (n = 38). Linear regression analyses were used to investigate associations of biomarkers, leg pain, and lean mass on serum levels of 25-hydroxyvitamin D. Biomarkers were converted to z scores and differences were evaluated within the Fontan patients.

Results: Our Fontan patients had a daily mean vitamin D intake of 9.9 µg and a mean serum 25-hydroxyvitamin D of 56 nmol/L. These factors were not associated with fat or lean mass, leg pain, or biomarkers of liver status. The Fontan patients had significantly less lean mass, but higher fat mass than controls. Male adolescents with Fontan circulation had a greater mean abdominal fat mass than male controls and higher cholesterol levels than females with Fontan circulation.

Conclusion: Vitamin D intake and serum levels were not associated with body composition or liver biomarkers in the Fontan group, but the Fontan group had lower lean mass and higher fat mass than controls. The more pronounced abdominal fat mass in male adolescents with Fontan circulation might increase metabolic risks later in life.

Place, publisher, year, edition, pages
Cambridge University Press, 2022
Keywords
CHD, Fontan circulation, vitamin D, micronutrient intake, body composition
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-176573 (URN)10.1017/S1047951121003115 (DOI)000752691600001 ()34338624 (PubMedID)2-s2.0-85112065396 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160496
Note

Originally included in thesis in manuscript form.

Available from: 2020-11-09 Created: 2020-11-09 Last updated: 2022-11-29Bibliographically approved
Sandberg, C., Crenshaw, A. G., Christersson, C., Hlebowicz, J., Thilén, U. & Johansson, B. (2021). Despite reductions in muscle mass and muscle strength in adults with CHD, the muscle strength per muscle mass relationship does not differ from controls. Cardiology in the Young, 31(5), 792-798
Open this publication in new window or tab >>Despite reductions in muscle mass and muscle strength in adults with CHD, the muscle strength per muscle mass relationship does not differ from controls
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2021 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 31, no 5, p. 792-798Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with CHD exhibit reduced isometric muscle strength and muscle mass; however, little is known how these parameters relate. Therefore, the aim was to investigate the relation between isometric limb muscle strength and muscle mass for patients in comparison to age- and sex-matched control subjects.

METHODS: Seventy-four patients (35.6 ± 14.3 years, women n = 22) and 74 matched controls were included. Isometric muscle strength in elbow flexion, knee extension, and hand grip was assessed using dynamometers. Lean mass, reflecting skeletal muscle mass, in the arms and legs was assessed with dual-energy x-ray absorptiometry.

RESULTS: Compared to controls, patients had lower muscle strength in elbow flexion, knee extension, and hand grip, and lower muscle mass in the arms (6.6 ± 1.8 kg versus 5.8 ± 1.7 kg, p < 0.001) and legs (18.4 ± 3.5 kg versus 15.9 ± 3.2 kg, p < 0.001). There was no difference in achieved muscle force per unit muscle mass in patients compared to controls (elbow flexion 0.03 ± 0.004 versus 0.03 ± 0.005 N/g, p = 0.5; grip strength 0.008 ± 0.001 versus 0.008 ± 0.001 N/g, p = 0.7; knee extension 0.027 ± 0.06 versus 0.028 ± 0.06 N/g, p = 0.5). For both groups, muscle mass in the arms correlated strongly with muscle strength in elbow flexion (patients r = 0.86, controls, r = 0.89), hand grip (patients, r = 0.84, controls, r = 0.81), and muscle mass in the leg to knee extension (patients r = 0.64, controls r = 0.68).

CONCLUSION: The relationship between isometric muscle strength and limb muscle mass in adults with CHD indicates that the skeletal muscles have the same efficiency as in healthy controls.

Place, publisher, year, edition, pages
Cambridge University Press, 2021
Keywords
CHD, body composition, isometric muscle strength, lean mass, muscle mass, skeletal muscle
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-180955 (URN)10.1017/S1047951120004709 (DOI)000652194500013 ()33455600 (PubMedID)2-s2.0-85099574010 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20100355, 20130472, 20170483Region Västerbotten, VLL-574081Visare Norr
Available from: 2021-03-03 Created: 2021-03-03 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4043-7130

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