O2048: Physical inactivity, overweight, and obesity among children and adolescents with congenital heart conditions, National Survey of Children’s Health 2021 & 2022

Background: Federal guidelines recommend that children and adolescents get 60 minutes of physical activity daily and maintain a healthy body weight. While these outcomes are tracked for children and adolescents overall, no national, population-based information exists on the prevalence of physical inactivity, overweight, and obesity in US children and adolescents born with heart conditions—a group with increased risk of accelerated atherosclerotic disease. Experts agree that most children and adolescents with congenital heart conditions can meet the same physical activity recommendations as the general population. Therefore, our objective was to estimate the population-based prevalence of physical inactivity, overweight, and obesity in 6-17-year-olds with congenital heart conditions.

Methods: We analyzed cross-sectional, nationally-representative data on 57,080 6-17-year-olds from the caregiver-reported 2021 and 2022 National Survey on Children’s Health. We compared the prevalence of not meeting physical activity guidelines (not engaging in 60 minutes of physical activity 7 days/week), overweight, and obesity (BMI 85th-94th and ≥ 95th percentile for sex and age, respectively) among 6-17-year-olds with and without a caregiver reported congenital heart condition using chi-square tests. We used multivariable models to approximate adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) by heart condition status. Models were adjusted for race/ethnicity and caregiver education level. Analyses accounted for complex sample design and used sampling weights to estimate population prevalence.

Results: Overall, an estimated 1.8% (95% CI: 1.6-2.0) of children and adolescents had a congenital heart condition. A high prevalence of children and adolescents with congenital heart conditions (84.0%, [95% CI: 80.4-87.5]) and those without (80.0%, [95% CI: 79.3-80.6]) did not meet physical activity guidelines (p=0.05; Figure 1). The prevalence of having overweight or obesity was similar between children and adolescents with (31.5% [95% CI: 26.0-36.9]) and without (33.7% [95% CI: 32.9-34.6]) congenital heart conditions (p=0.4; Figure 2). After adjusting for potential confounders, children and adolescents with congenital heart conditions were slightly more likely not to meet physical activity guidelines (aPR=1.05; 95% CI: 1.01-1.10) and as likely to have overweight/obesity (aPR= 0.97; 95% CI: 0.82-1.14) as children and adolescents without congenital heart conditions.

Conclusion: Over 8 in 10 US children and adolescents with congenital heart conditions do not meet national physical activity guidelines, based on nationally-representative data. Additionally, almost a third of children and adolescents with congenital heart conditions have overweight or obesity. These results can inform general pediatric and pediatric cardiology guidelines and confirm the importance of public health efforts to increase physical activity, reduce obesity, and slow the potential development of atherosclerotic disease among this population.