Supplementary material.

Congenital Heart Defects (CHD) are structural cardiac malformations ranging from mild to severe forms; greatly impacting childhood mortality and morbidity. Malnutrition as comorbidity in CHD raises treatment complexity, lengthens post-operative recovery period and increases risk of developmental delays. This retrospective study evaluates patterns of malnutrition in 1678 unoperated CHD cases at out-patient department of tertiary pediatric cardiac centre in India compared to 11,894 community based controls. Z-Scores based on WHO reference charts were used for Weight for Age, Height for Age and Weight for Height calculations. Majority of CHD patients belonged to poor socioeconomic background [upper lower = 49.17% and lower middle = 42.99%]. 62.46% cases were underweight, 41.3% stunted and 53.93% wasted compared to controls showing 28.88% underweight (Z = 27.38, p < 0.01), 31.15% stunting (Z = 8.32, p < 0.01) and 14.04% wasting (Z = 39.01, p < 0.01), indicating highly significant undernutrition in cases compared to controls in same age group (0–6 years). Odds ratio analysis showed that CHD cases were 7.19 times more likely to undergo wasting, 4.19 times at higher risk of being underweight and were at 1.63 times increased risk of stunting than controls (p < 0.01). Pulmonary Arterial Hypertension (PAH) significantly exacerbated undernutrition in terms of wasting and underweight status in CHD (p < 0.01). Lower birth weight was found associated with undernutrition in CHD (p < 0.05). This first large-scale study from India comparing CHD patients with community controls provides comprehensive analysis of nutritional status in unoperated CHD cases indicating significantly higher undernutrition in CHD patients compared to non-CHD controls from same age group. This highlights the need for comprehensive health screening in initial years of life which is crucial for early detection, timely CHD treatment and individualized nutritional management in pediatric cardiac care.