ArticlePediatric cardiology2026
High BMI Associated with Lower Child Opportunity Index Negatively Impacts Exercise Capacity in Fontan Patients.
Article in Pediatric cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Cardiopulmonary exercise testing (CPET) is a valuable prognostic tool in patients with Fontan physiology, yet the impact of social determinants of health – such as the Childhood Opportunity Index (COI) – on exercise capacity (VO2/kg) remains unclear. We evaluate the relationship between COI and predicted VO2/kg in a pediatric Fontan cohort. We performed a retrospective review of 158 Fontan patients who completed a clinically indicated CPET. CPET parameters were expressed as a percent of predicted value using standardized equations. COI quintile (1 = lowest opportunity, 5 = highest) was assigned based on home address (diversitydatakids.org). The association between COI and VO2/kg was assessed using a Spearman rank correlation(ρ). Group comparisons were performed for lower performers (VO2/kg < 60% predicted) vs. higher performers (VO2/kg ≥ 60% predicted). Patients in COI groups were compared using univariate and multivariate analysis to explore the independent predictors of exercise capacity. Patients in higher opportunity groups (COI 4–5, n = 51) had higher VO2/kg compared to the lowest opportunity group (COI 1, n = 54) (57.7 ± 2.0 vs. 51.5 ± 1.5, p = 0.01). Across COI quintiles, there was an association with VO2/kg (Spearman ρ = 0.191, p = 0.016; bootstrap 95% CI 0.041–0.335). Lower performers (VO2/kg < 60% predicted) were older (14.7 vs. 13.0 years, p = < 0.001) and had higher BMI (22.4 vs. 17.8, p < 0.001). BMI had a inverse relationship with COI (Spearman ρ=−0.319, p < 0.001; bootstrap 95% CI − 0.45 to − 0.18). In multivariate analysis BMI > 20 (OR 6.5; 2.1–19.7) along with systemic right ventricle morphology (OR = 1.8, 1.1–2.9) were both independent predictors of low VO2/kg. In this single center cohort of 158 patients with Fontan physiology, higher BMI and systemic right ventricular morphology both independently predicted lower VO2/kg. Lower neighborhood opportunity, as measured by lower COI, was associated with reduced VO2/kg and higher BMI but was not an independent predictor after adjustment, suggesting an indirect effect of SDOH on VO2/kg possibly through BMI.
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