"I don't like that!" Parents know what's coming. When their children push fruit, vegetables, salad, fish, etc. – in short, everything rich in vitamins and nutrients – to  the side of their plate with astonishing precision, it becomes exhausting. In the hustle and bustle of everyday life, there is often little time to prepare meals together using carefully selected seasonal ingredients. And the supermarket is full of readily available alternatives to tempt us.

The Underestimated Health Risk

Nutrition expert Professor Sigrid Hahn from Fulda University of Applied Sciences emphasises that it is particularly important during the growth phase that the body receives sufficient vitamins, minerals and trace elements. "These nutrients are important not only for bone and muscle development, but also for mental and social-emotional development and for strengthening the immune system". This is precisely where the problem lies: "Most ready-made and industrial foods contain a too high energy content and too little of these essential nutrients to provide an adequate supply".

The Heavy Toll of Affluence-related Diseases

Too sweet, too salty, too fatty, and simply too much. This has consequences. More and more children and young people are too fat. According to the KiGGS study, 15.4 per cent of all children and adolescents between the ages of 6 and 17 in Germany are overweight – around  2 million people. Around 800,000 of them are obese. "Their percentage of body fat is so high that it poses a permanent health risk," explains Professor Sigrid Hahn. "There are many reasons for this. However, Western eating habits are a key factor".

This alarming trend is costing us all dearly: in addition to the significant health risks, there are also social disadvantages. The World Obesity Federation currently estimates that the economic cost of related health and social care expenditure in Germany alone will be 127.2 billion US dollars by 2030. This is equivalent to around 114.5 billion euros or 2.66 per cent of Germany's gross domestic product in 2024. By 2060, the international expert organisation expects the costs to raise up to 250.7 billion US dollars for Germany - around 3.5 per cent of gross domestic product.

How Badly are Children and Adolescents with Congenital Heart Defects Affected?

Experts in congenital heart defects have been deeply concerned about this development for some time. "There is an urgent need for action," says Professor Jannos Siaplaouras, a paediatric cardiologist and adult heart specialist who treats patients of all ages with his cardiology team in Wölfersheim, Hesse. "Many of our young patients are overweight. They don't get enough exercise and often eat the wrong foods. In addition, modern dietary trends are confusing many parents and their children. The paediatric cardiologist sees the consequences of this unhealthy development every day in his practice.

"A lack of physical activity and malnutrition can significantly increase the risk of life-threatening complications and further interventions for children and adolescents with congenital heart defects. These consequences can have a profound impact on quality of life ," warns Professor Christian Apitz, Head of Paediatric Cardiology at the University Hospital in Ulm, Germany.

First Representative Study on Dietary Habits in CHD

Christian Apitz, Sigrid Hahn, Jannos Siaplaouras and Paul Helm, a certified psychologist from the National Register for Congenital Heart Defects, have now presented the results of their joint study on the dietary habits of children and adolescents with congenital heart defects (CHD). The nationwide E-BAHn study is the world's largest representative survey on this topic.

One of the main reasons for this is that research relies on enough reliable data. Individual clinics and centres do not have access to this amount of data, as the spectrum of congenital heart defects is too broad. "That is why we rely on the National Registry, which collects data from many clinics, centres and doctors' practices and processes it for scientific purposes", says Professor Christian Apitz. "Creating such a research base doesn't happen overnight. The National Registry has been painstakingly building it up for more than twenty years".

What Data Was Used in the Study?

The researchers were able to analyse the medical data, including the body mass index (BMI) and survey results of 976 participants in the National Register, aged six to 17 years, and compare them with data from their peers from the KiGGS study. According to Warnes, 23.8 % of the study participants have a mild, 37.8 % have a moderate and 38.4 % have a complex heart defect. Around half of the children and adolescents included in the study, 422 (47.2 per cent ), are female.

What's for Dinner?

The researchers were pleasantly surprised by some of the results. "A surprising number of them showed healthy eating habits. Fast food and sugary foods are significantly less common in the diets of children and adolescents with congenital heart defects compared to the KiGGS group with heart-healthy peers," says Paul Helm.

More Children with Mild Congenital Heart Defects are Overweight

This also seems to be reflected in the BMI data. Almost 30 percent of children and adolescents with congenital heart defects are not of normal weight. This remains an alarming finding," says Jannos Siaplaouras. Children and adolescents with mild heart defects are more likely to be overweight than their healthy peers. 

"This is particularly risky in the case of congenital heart defects," warns Christian Apitz. "Being overweight as a child promotes lipid metabolism disorders and atherosclerosis. With increasing age, serious metabolic diseases, strokes, and organ damage become apparent".

Noticeably High Number of Children with Complex CHD are Underweight

The researchers are also concerned about the strikingly high number of underweight and severely underweight children and adolescents with congenital heart defects. Adolescents with complex congenital heart defects had the lowest BMI. "Malnutrition leads to higher complication rates in severe congenital heart defects even in early childhood," says Christian Apitz. Based on their findings, the researchers conclude that much more attention needs to be paid to the BMI and dietary habits of each individual with  congenital heart defects.

Modern Trends with Pitfalls

Vegetarian, vegan, gluten-free, low-lactose, paleo diet, raw food: with a total of 120 participants, around one in seven of all children and young people with congenital heart defects surveyed said they followed a special diet. "Female patients are significantly more likely to follow such diets," says Paul Helm.

However, Professor Sigrid Hahn points out that these diets are often not as healthy as they promise: "Unlike a balanced diet, special diets can lead to a lack of important nutrients. We see this as particularly critical in underweight children and adolescents".

Consideration in all Follow-Up Examinations

From the researchers' point of view, the results of the study suggest that these aspects should be integrated into routine examinations and that patients should be motivated to adopt a physically active lifestyle and a healthy diet, for example through targeted individual nutrition counselling. In many cases, the latter is covered or subsidised by statutory health insurance if prescribed by a doctor and medically necessary.