Weight Trajectories Are Associated With Exercise Capacity Among Children With Complex Congenital Heart Defects
Bibliographic record
Abstract
Children with complex congenital heart defects (CHD) are often short/lightweight relative to peers, and may require supplementary feeding to meet energy demands. It was hypothesized that CHD patients with limited growth would also have decreased energy for exercise. PURPOSE: To investigate the impact of chronic energy deficit, as evidenced by negative growth trajectory, on submaximal exercise capacity. METHODS: Retrospective chart review of Bruce treadmill exercise test results, weight/height at each visit for 5 years prior to the exercise test, age at exercise test, sex and CHD diagnosis among CHD patients 8 to 14 years of age. Submaximal energy consumption (VO2150 = estimated ml O2/kg/min at heart rate of 150 bpm) and growth trajectory (slope of the body weight z-score over 5 years) were calculated per child. A linear regression model examined energy consumption by growth trajectory, adjusting for age, sex, CHD severity and initial body weight z-score. RESULTS: Participants were 90 children with CHD (34 females (38%)), mean age 10.5 (SD=2.3) years. CHD diagnoses were simple (n=19, 21.1%), moderate (n=33, 36.7%) or complex (n=38, 42.4%). Mean VO2 @ 150bpm was 28.7 (SD=7.4). Initial height (median 0.36, IQR: -0.65, 1.04) and weight (median 0.21, IQR: -0.69, 1.12) z-scores indicated most participants were taller/heavier than expected for age. Submaximal energy consumption was significantly higher (model R2 = 0.29) with lower initial weight z-score (b=-1.4 [0.2, 2.5] per 1 unit increase, p = .02), a decreasing slope of the weight z-score (b = 7.9 [1.8,, 14.0], p = .01), male sex (b = 3.8 [1.2, 6.3], p = .004) and severe CHD (b = 4.0 [0.7. 7.4], p = .02), but not by age (b = 0.4, p = 0.15). CONCLUSIONS: Children with CHD who were underweight or had a negative growth trajectory had significantly higher energy consumption during submaximal exercise. The relationship between a negative growth trajectory and daily physical activity should be examined to assess whether the higher energy demands for submaximal exercise are also associated with an inactive lifestyle, and therefore the known increase in risk for sedentary lifestyle morbidities. Prospective studies are required to understand the mechanisms linking growth limitations to reduced exercise capacity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".