Key result
Pediatric excess weight is linked to significantly lower RMSSD and impaired cardiac autonomic modulation.
Why the study?
The association between excess weight and cardiac autonomic modulation in children and adolescents was evaluated due to unclear effects on heart rate variability.
Does excess weight alter short-term resting heart rate variability in children and adolescents compared to normal-weight controls?
Meta-Analysis (n=1,590)
Does excess weight alter short-term resting heart rate variability in children and adolescents compared to normal-weight controls?
Standardized Mean Difference: -1 (95% CI -1.68–-0.31)
p-value: p=0.0045
Pediatric obesity is associated with early signs of cardiac autonomic dysfunction, particularly reduced parasympathetic modulation, highlighting early cardiometabolic risk.
Pediatric excess weight may impair parasympathetic modulation; leaves open whether this predicts events or improves with weight loss.
OBJECTIVE: To evaluate the association between excess weight and cardiac autonomic modulation in children and adolescents. DATA SOURCE: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to April 2, 2026 for observational studies comparing short-term resting heart rate variability between children and adolescents with excess weight and normal-weight controls. The protocol was registered in PROSPERO (CRD420251005501). DATA SYNTHESIS: Eighteen studies comprising 1,590 participants were included. Random-effects meta-analyses using standardized mean differences showed lower root mean square of successive differences of RR intervals (RMSSD -1.00; 95% confidence interval [95%CI] -1.68 to -0.31), lower percentage of successive normal-to-normal intervals differing by more than 50 ms (pNN50 -0.48; 95%CI -0.68 to -0.28), and higher low-frequency/high-frequency ratio (LF/HF 0.70; 95%CI 0.30 to 1.10) in the excess weight group. No significant differences were observed for the standard deviation or mean of normal-to-normal intervals. Leave-one-out analyses supported directional robustness, and between-group body mass index difference significantly moderated LF/HF (β=-0.15; p=0.045), but not RMSSD. CONCLUSIONS: Pediatric excess weight appears to be associated with impaired cardiac autonomic modulation, mainly characterized by lower parasympathetic-related heart rate variability indices. Among the evaluated parameters, pNN50 showed the most consistent reduction, whereas RMSSD showed the largest pooled effect.
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DORNELLES et al. (2026) conducted a meta-analysis in Pediatric excess weight (obesity/overweight) (n=1,590). Excess weight (obesity/overweight) vs. Normal-weight controls was evaluated on Root mean square of successive differences of RR intervals (RMSSD) (SMD -1.00, 95% CI -1.68 to -0.31, p=0.0045). Pediatric excess weight was associated with impaired cardiac autonomic modulation, characterized by lower RMSSD (SMD -1.00) compared to normal-weight controls.
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