Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease.

OBJECTIVE: To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes. METHODS: Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior. RESULTS: The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90). CONCLUSIONS: Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease / Mudanças nos comportamentos de estilo de vida durante a pandemia COVID-19 em crianças e adolescentes com cardiopatia congênita

Abstract Objective: To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes. Methods: Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior. Results: The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90). Conclusions: Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

Resumo Objetivo: Descrever as mudanças nos estilos de vida durante a pandemia em crianças e adolescentes com cardiopatia congênita e investigar a associação da complexidade da cardiopatia congênita com as mudanças de estilo de vida. Métodos: Estudo transversal com 127 crianças e adolescentes com cardiopatia congênita, que realizaram procedimento cardíaco (tempo médio de pós-operatório: 10,11 (3,13) anos), realizado entre dezembro de 2020 e janeiro de 2021. O estilo de vida (alimentação, atividade física, comportamento sedentário e sono) foi avaliado por entrevista telefônica, com base em questionários validados. Padrões alimentares foram identificados por meio da análise de componentes principais. Frequência de combinações gerais e específicas de mudanças de estilo de vida saudável e não saudável foram avaliadas. Regressões logísticas multinominais foram utilizadas para testar associações. Resultados: Os principais comportamentos de estilo de vida adquiridos durante a pandemia foram: 83,5% reduziram a atividade física, 37,0% aumentaram o comportamento sedentário, 26,0% dormiram mais e 23,6% mudaram para um padrão alimentar menos saudável. Quase metade (41,8%) dos participantes teve pelo menos uma mudança não saudável no estilo de vida. Cardiopatias congênitas complexas foram associadas ao aumento do comportamento sedentário durante a pandemia (odds ratio 3,49, IC95% 1,23-9,90). Conclusões: Crianças e adolescentes com cardiopatia congênita apresentaram estilo de vida não saudável durante a pandemia, principalmente na forma de redução da atividade física e aumento do comportamento sedentário.

Dietary patterns are associated with central adiposity and carotid intima-media thickness in children and adolescents with congenital heart disease.

PURPOSE: Unhealthy dietary patterns (DP) in childhood are associated with cardiovascular disease in adulthood. DP in children and adolescents with congenital heart disease (CHD) are unknown. The aims of this study were to describe DPs of children and adolescents with CHD and to evaluate their associations with central adiposity, high-sensitivity C-reactive protein (hs-CRP) and carotid intima-media thickness (cIMT). METHODS: A cross-sectional study including 232 children and adolescents with CHD. Dietary data were based on three 24-h dietary recalls. Central adiposity was evaluated by waist circumference. hs-CRPs were determined by nephelometry. The cIMT was measured using ultrasound. DPs were identified using principal component analysis. Data were examined using logistic and linear regressions. RESULTS: Six DPs were identified. In multivariable-adjusted analysis, unhealthy DP (high intake of poultry, red meat, cold cuts and processed meats, soft drinks and sweetened beverages) and healthy DP (high intake of fish, eggs, bread, beans, tubers and roots, fruit and fruit juice) were associated with increased and decreased odds of central adiposity, respectively (Odds ratio (OR): 2.10; 95% confidence interval (95% CI) 1.09; 4.02; OR: 0.48 95% CI 0.24; 0.93). Besides, low-fat dairy DP (high intake of low-fat milk and dairy, mixed dishes, ultra-processed breads, candy and chocolate) was inversely associated with cIMT (ß: - 0.024; 95% CI - 0.04; - 0.01). CONCLUSION: Unhealthy DP seems to increase the risk of central adiposity, while the healthy DP seems to decrease the risk of central adiposity. Still, low-fat dairy DP was inversely associated with cIMT. These findings may be helpful to develop nutrition recommendations for early cardiovascular disease prevention in children and adolescents with CHD.