Key result
Malnutrition was associated with a higher risk of death or heart transplant in univariate analysis (HR 3.7; 95% CI 1.3 to 10.7; p=0.01), but this was not significant after adjustment (p=0.81).
Why the study?
Malnutrition is a relevant prognostic factor in cardiovascular disease, but had not been studied in adults with CHD and Fontan circulation.
Does malnutrition predict death or heart transplant in adults with Fontan circulation?
Cohort (n=93)
No
Does malnutrition predict death or heart transplant in adults with Fontan circulation?
Malnutrition is common in adults with Fontan circulation and is associated with worse functional capacity and unadjusted risk of death or heart transplant, though it loses significance when adjusted for other clinical factors.
Answers are grounded in this paper and cite their sources.
Malnutrition screening may aid risk stratification in Fontan adults; leaves open whether interventions improve outcomes.
Background: Malnutrition is a relevant prognostic factor in cardiovascular disease. However, it has not been studied in adults with CHD and Fontan circulation. Methods: Retrospective, single-centre cohort study including all consecutive adults with Fontan circulation. Objectives: 1. To evaluate the prevalence of malnutrition, defined according to Controlling Nutritional Status score, which includes albumin, lymphocytes, and cholesterol and 2. To assess its utility as a prognostic marker. Results: We included 93 patients (55.9% male) with a mean age of 32.7 ± 8.3 years. After a median follow-up of 5.5 years (interquartile range 2.2 – 10.6), 14 patients met the combined primary outcome of death or heart transplant (15.1%). Moderate or severe malnutrition (Controlling Nutritional Status score ≥ 5) was detected in 18.3%. Overweight was found in 21.5% of patients, obesity in 4.3%, and low weight in 8.6%, with no significant differences in malnutrition parameters across weight categories. Patients with malnutrition had worse functional capacity (58.8% in New York Heart Association—NYHA-class III–IV, vs. 33.3% in patients without malnutrition, p = 0.05). In univariate analysis, malnutrition was associated with a worse prognosis (death or heart transplant) with a hazard ratio of 3.7 (95% confidence interval 1.3 to 10.7, p = 0.01). In the adjusted model including cyanosis, functional class, and protein-losing enteropathy, malnutrition did not reach statistical significance (p = 0.81). Conclusion: Malnutrition as defined by Controlling Nutritional Status score is common in adults with Fontan circulation and represents a strong prognostic marker. Controlling Nutritional Status scale could be used in Fontan patients as a simple tool to identify a high-risk population.
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Merás et al. (2025) conducted a cohort in Adults with Fontan circulation (n=93). Malnutrition vs. No malnutrition was evaluated on Death or heart transplant (HR 3.7, 95% CI 1.3 to 10.7, p=0.01). Malnutrition was associated with a higher risk of death or heart transplant in univariate analysis (HR 3.7; 95% CI 1.3 to 10.7; p=0.01), but this was not significant after adjustment (p=0.81).
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