What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Childhood obesity (n=681). Intervention: Obesity (BMI z-score > 2) vs. Non-obese (BMI z-score ≤ 2). Primary outcome: Prevalence of left ventricular hypertrophy (LVH) (p=<0.001).

June 22, 2021Open Access

The impact of obesity on left ventricular hypertrophy and diastolic dysfunction in children and adolescents

Q: What are the key findings of this study?

Childhood obesity was associated with a significantly higher prevalence of left ventricular hypertrophy (14.0% vs 3.6%) and increased left ventricular filling pressures compared to non-obese peers.

Q: What does this research mean for the field?

Childhood obesity is associated with a significantly higher prevalence of left ventricular hypertrophy and increased left ventricular filling pressures compared to non-obese peers. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Childhood obesity was associated with a significantly higher prevalence of left ventricular hypertrophy (14.0% vs 3.6%) and increased left ventricular filling pressures compared to non-obese peers.

Study Design

Type

Cross-Sectional (n=681)

Multicenter

Yes

Structured PICO

Does obesity increase the prevalence of left ventricular hypertrophy and diastolic dysfunction in children and adolescents?

Population

681 children aged 5 to 16 years (mean age 12.2 ± 3.1 years, 50.1% male) from randomly selected schools in Arequipa, Peru. Excluded: structural heart defects, more than mild valvular lesions, missing height/weight, or missing echocardiographic parameters.

Intervention

Obesity (defined by body mass index z-score > 2)

Comparator

Non-obese (defined by body mass index z-score ≤ 2)

Outcome

Prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction (assessed using mitral inflow early-to-late diastolic flow (E/A) ratio, peak early diastolic tissue velocities of the lateral mitral annulus (E′), E/E′ ratio, and left atrial volume index (LAVI))surrogate

Childhood obesity is associated with structural and functional cardiac changes, including left ventricular hypertrophy and early signs of diastolic dysfunction, highlighting the need for early lifestyle interventions.

Main Result

Absolute Event Rate: 14% vs 3.6%

p-value: p=<0.001

Limitations

No standard definition of diastolic dysfunction in children and adolescents
One third of children excluded due to missing echocardiographic data, potentially introducing selection bias
E' measured at the lateral mitral annulus only, which may have led to underestimation of LV filling pressures
Blood pressure was not prospectively recorded
Reproducibility testing is not available
Children were not screened for disorders of the endocrine system or chromosomal disorders
Cross-sectional survey design precludes longitudinal assessment

Abstract

Abstract Childhood obesity continues to escalate worldwide and may affect left ventricular (LV) geometry and function. The aim of this study was to investigate the impact of obesity on prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in children. In this analysis of prospectively collected cross-sectional data of children between 5 and 16 years of age from randomly selected schools in Peru, parameters of LV geometry and function were compared according to presence or absence of obesity (body mass index z-score > 2). LVH was based on left ventricular mass index (LVMI) adjusted for age and sex and defined by a z-score of > 2. LV diastolic function was assessed using mitral inflow early-to-late diastolic flow (E/A) ratio, peak early diastolic tissue velocities of the lateral mitral annulus (E′), early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity (E/E′) ratio, and left atrial volume index (LAVI). Among 1023 children, 681 children (mean age 12.2 ± 3.1 years, 341 male (50.1%)) were available for the present analysis, of which 150 (22.0%) were obese. LVH was found in 21 (14.0%) obese and in 19 (3.6%) non-obese children (p adjusted < 0.001). LVMI was greater in obese than that in non-obese children (36.1 ± 8.6 versus 28.7 ± 6.9 g/m 2.7 , p < 0.001). The mean mitral E/E′ ratio and LAVI were significantly higher in obese than those in non-obese individuals (E/E′: 5.2 ± 1.1 versus 4.9 ± 0.8, p adjusted = 0.043; LAVI 11.0 ± 3.2 versus 9.6 ± 2.9, p adjusted = 0.001), whereas E′ and E/A ratio were comparable. Childhood obesity was associated with left ventricular hypertrophy and determinants of diastolic dysfunction. ClinicalTrials.gov Identifier: NCT02353663.

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