Effects of body size and body fatness on left ventricular mass in children and adolescents: Project HeartBeat!

Cardiac Complications Associated with Eating Disorders in Children: A Multicenter Retrospective Study

PURPOSE

Eating disorders often result in somatic complications, including cardiac abnormalities. Cardiac abnormalities may involve any part of the heart, including the cardiac conduction system, and can lead to sudden cardiac death. The current study aimed to evaluate the incidence of cardiac complications in pediatric patients with eating disorders and their associated factors.

METHODS

We retrospectively analyzed patients aged 10-18 years who were diagnosed with DSM-V (Diagnostic and Statistical Manual of Mental Disorder-V) eating disorders and underwent electrocardiography (ECG) and/or echocardiography between January 2015 and May 2020.

RESULTS

In total, 127 patients were included, of whom 113 (89.0%) were female. The median body mass index (BMI) was 15.05±3.69 kg/m². Overall, 74 patients (58.3%) had ECG abnormalities, with sinus bradycardia being the most common abnormality (91.9%). Patients with ECG abnormalities had significantly lower BMI (14.35±2.78 kg/m² vs. 16.06± 4.55 kg/m², p<0.001) than patients without ECG abnormalities, as well as lower phosphorus and higher cholesterol levels. Among the 46 patients who underwent echocardiographic evaluation, 23 (50.0%) had echocardiographic abnormalities, with pericardial effusion being the most common (60.9%). The median left ventricular mass (LVM) and ejection fraction were 67.97±21.25 g and 66.91±28.76%, respectively. LVM and BMI showed a positive correlation (r=0.604, p<0.001). After weight gain, the amount of pericardial effusion was reduced in 3 patients, and 30 patients presented with normal ECG findings.

CONCLUSION

Cardiac abnormalities are relatively frequent in patients with eating disorders. Physicians should focus on this somatic complication and careful monitoring is required.

Non-alcoholic fatty liver disease association with structural heart, systolic and diastolic dysfunction: a meta-analysis

OBJECTIVE

Several studies have documented a relationship between non-alcoholic fatty liver disease (NAFLD) and structural heart disease, particularly diastolic function. This meta-analysis will be the first to examine the echocardiographic-derived cardiac function and structural characteristics in NAFLD patients, and its association with liver disease severity and metabolic profile.

METHODS

Medline and Embase were searched and pairwise meta-analysis was conducted in DerSimonian and Laird to obtain the odds ratio (OR) and mean difference (MD) for dichotomous and continuous variables, respectively, to compare the effects of NAFLD on the echocardiography parameters.

RESULTS

Forty-one articles involving 33,891 patients underwent echocardiography. NAFLD patients had worse systolic indices with lower ejection fraction (EF, MD: - 0.693; 95% CI: - 1.112 to - 0.274; p = 0.001), and worse diastolic indices with higher E/e' (MD: 1.575; 95% CI: 0.924 to 2.227; p < 0.001) compared to non-NAFLD patients. NAFLD patients displayed increased left ventricular mass (LVM, MD: 34.484; 95% CI: 26.236 to 42.732; p < 0.001) and epicardial adipose thickness (EAT, MD: 0.1343; 95% CI: 0.055 to 0.214; p = 0.001). An increased severity of NAFLD was associated with worse diastolic indices (decreased E/A ratio, p = 0.007), but not with systolic indices.

CONCLUSIONS

NAFLD is associated with impaired systolic and diastolic function with changes in cardiac structure. Concomitant metabolic risk factors and liver disease severity are independently associated with worsening systolic and diastolic function.

Associations of Maternal Glycemia in the First Half of Pregnancy With Alterations in Cardiac Structure and Function in Childhood

OBJECTIVE

Gestational diabetes mellitus has been associated with offspring cardiac congenital malformations, ventricular hypertrophy, and diastolic dysfunction in large observational cohort studies and experimental animal models. We assessed the associations of maternal random glucose concentrations across the full range with childhood cardiac ventricular structure and function.

RESEARCH DESIGN AND METHODS

In a population-based prospective cohort among 1,959 women and their offspring, maternal random glucose concentrations were measured at a median 13.1 weeks' gestation (95% range 10.5-16.8 weeks). We obtained offspring cardiac outcomes, relative to body size, through cardiac MRI at 10 years.

RESULTS

The mean maternal random glucose concentration was 4.4 mmol/L (SD 0.8). The highest quintile of maternal glucose concentrations, compared with the lowest quintile, was associated with a lower childhood left ventricular mass (-0.19 SD score [SDS]; 95% CI -0.31, -0.07) and left ventricular end-diastolic volume (-0.17 SDS; 95% -0.28, -0.05). Also, higher maternal glucose concentrations across the full range per 1 mmol/L increase were associated with a lower childhood left ventricular mass and left ventricular end-diastolic volume (P values ≤0.05). Adjustment for maternal prepregnancy BMI, gestational age, and weight at birth or childhood BMI and blood pressure did not influence the effect estimates. Maternal glucose concentrations were not significantly associated with childhood right ventricular end-diastolic volume or left and right ventricular ejection fraction.

CONCLUSIONS

Higher maternal random glucose concentrations in the first half of pregnancy are associated with a lower childhood left ventricular mass and left ventricular end-diastolic volume, with the strongest associations for childhood left ventricular mass. These associations were not explained by maternal, birth, or childhood characteristics. Further studies are needed to replicate these findings using repeated maternal glucose measurements throughout pregnancy and offspring cardiac outcomes throughout childhood and adulthood.

Scaling left ventricular mass in adolescent female soccer players

BACKGROUND

The aim of the study was to examine the contribution of chronological age (CA), skeletal maturation, training experience and concurrent body size descriptors, to inter-individual variance in left ventricular mass (LVM) among female adolescent soccer players.

METHODS

The sample included 228 female soccer players 11.8-17.1 years. Training experience defined as years of participation in competitive soccer (range 2-9 years), was obtained by interview. Stature, body mass and skinfolds (triceps, medial calf) were measured. Fat mass was estimated; Fat-free mass was derived. LVM was assessed by echocardiography. Skeletal maturity status was as the difference of skeletal age (SA, Fels method) minus CA.

RESULTS

Fat-free mass was the most prominent single predictor of LVM (R2 = 36.6%). It was associated with an allometric coefficient close to linearity (k = 0.924, 95%CI: 0.737 to 1.112). A significant multiplicative allometric model including body mass, fat-free mass, CA, training experience and skeletal maturity status was also obtained (R = 0.684; R2 = 46.2%).

CONCLUSION

Stature has limitations as a valid size descriptor of LVM. Body mass, fat-free mass, training experience, CA, body mass and skeletal maturity status were relevant factors contributing to inter-individual variability in LVM.

Normal reference ranges for the left ventricular mass and left ventricular mass index in preterm infants

Objective:

The objective of this study is to establish normal reference ranges for the left ventricular mass (LVM) and LVM index (LVMI) in preterm infants according to the body surface area (BSA) and assess their correlation with body weight and gestational age.

Subjects and Methods:

In a prospective study, 268 preterm babies who fulfilled the criteria for inclusion were examined. Echocardiograms were performed to measure the LVM and LVMI on 0–6 day (s) of life and at weekly intervals until the babies reached 36 weeks. The preterm infants were divided into six groups according to their BSA: 0.07–0.08 m2, 0.09–0.10 m2, 0.11–0.12 m2, 0.13–0.14 m2, 0.15–0.16 m2, and 0.17–0.19 m2.

Results:

The mean gestational age was 29.8 (±2.38 standard deviation [SD]) weeks, ranging from 24 to 35 weeks. The mean body weight was 1479 (±413 SD) g, ranging from 588 to 3380 g, and the mean BSA was 0.13 m2, ranging from 0.07 to 0.19 m2. The LVM correlated well with the gestational age, body weight, and BSA. The LVMI correlated well with body weight and BSA. Reference ranges with the mean ± SD, range, and interquartile range were calculated for the LVM and LVMI according to the BSA. A significant gradual increase was observed in a LVM with increasing BSA. Overall, a progressive and significant increase in the LVM was observed during the first 9 weeks of life.

Conclusion:

The LVM and LVMI exhibited a significant correlation with the BSA and body weight. This study provides reference data that can be used as a normal reference tool for the LVM and LVMI for preterm infants based on the BSA.

Impact of Obesity on Left Ventricular Thickness in Children with Hypertrophic Cardiomyopathy

Obesity is associated with additional left ventricular hypertrophy (LVH) in adults with hypertrophic cardiomyopathy (HCM). It is not known whether obesity can lead to further LVH in children with HCM. Echocardiographic LV dimensions were determined in 504 children with HCM. Measurements of interventricular septal thickness (IVST) and posterior wall thickness (PWT), and patients' weight and height were recorded. Obesity was defined as a body mass index (BMI) ≥ 99th percentile for age and sex. IVST data was available for 498 and PWT data for 484 patients. Patient age ranged from 2 to 20 years (mean ± SD, 12.5 ± 3.9) and 340 (68%) were males. Overall, patient BMI ranged from 7 to 50 (22.7 ± 6.1). Obesity (BMI 18-50, mean 29.1) was present in 140 children aged 2-19.6 (11.3 ± 4.1). The overall mean IVST was 20.5 ± 9.6 mm and the overall mean PWT was 11.0 ± 8.4 mm. The mean IVST in the obese patients was 21.6 ± 10.0 mm and mean PWT was 13.3 ± 14.7 mm. The mean IVST in the non-obese patients was 20.1 ± 9.5 mm and mean PWT was 10.4 ± 4.3 mm. Obesity was not significantly associated with IVST (p = 0.12), but was associated with increased PWT (0.0011). Obesity is associated with increased PWT but not IVST in children with HCM. Whether obesity and its impact on LVH influences clinical outcomes in children with HCM needs to be studied.

Association of Blood Pressure Level With Left Ventricular Mass in Adolescents

Hypertension is associated with left ventricular hypertrophy (LVH), a risk factor for cardiovascular events. Since cardiovascular events in youth are rare, hypertension has historically been defined by the 95th percentile of the normal blood pressure (BP) distribution in healthy children. The optimal BP percentile associated with LVH in youth is unknown. We aimed to determine the association of systolic BP (SBP) percentile, independent of obesity, on left ventricular mass index (LVMI), and to estimate which SBP percentile best predicts LVH in youth. We evaluated SBP, anthropometrics, and echocardiogram in 303 adolescents (mean age 15.6 years, 63% white, 55% male) classified by SBP as low-risk (L=141, <80th percentile), mid-risk (M=71, 80-<90th percentile), or high-risk (H=91, ≥90th percentile) using the mean of 6 measurements at 2 visits according to the 2017 guidelines. Logistic regression was used to determine the sensitivity and specificity of various SBP percentiles associated with LVH. Results: BP groups did not differ by age or demographics but differed slightly by body mass index. Mean BP, LVMI, and prevalence of LVH increased across groups (BP: L=111/75, M=125/82, and H=133/92 mm Hg; LVMI: L=31.2, M=34.2, and H=34.9 g/m^2.7; LVH: L=13%, M=21%, H=27%, all P<0.03). SBP percentile remained a significant determinant of LVMI after adjusting for covariates. The 90th percentile for SBP resulted in the best balance between sensitivity and specificity for predicting LVH (LVMI≥38.6 g/m^2.7). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.

Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization

Background

Left ventricular mass normalization for body size is recommended, but a question remains: what is the best body size variable for this normalization—body surface area, height or lean body mass computed based on a predictive equation? Since body surface area and computed lean body mass are derivatives of body mass, normalizing for them may result in underestimation of left ventricular mass in overweight children. The aim of this study is to indicate which of the body size variables normalize left ventricular mass without underestimating it in overweight children.

Methods

Left ventricular mass assessed by echocardiography, height and body mass were collected for 464 healthy boys, 5–18 years old. Lean body mass and body surface area were calculated. Left ventricular mass z-scores computed based on reference data, developed for height, body surface area and lean body mass, were compared between overweight and non-overweight children. The next step was a comparison of paired samples of expected left ventricular mass, estimated for each normalizing variable based on two allometric equations—the first developed for overweight children, the second for children of normal body mass.

Results

The mean of left ventricular mass z-scores is higher in overweight children compared to non-overweight children for normative data based on height (0.36 vs. 0.00) and lower for normative data based on body surface area (-0.64 vs. 0.00). Left ventricular mass estimated normalizing for height, based on the equation for overweight children, is higher in overweight children (128.12 vs. 118.40); however, masses estimated normalizing for body surface area and lean body mass, based on equations for overweight children, are lower in overweight children (109.71 vs. 122.08 and 118.46 vs. 120.56, respectively).

Conclusion

Normalization for body surface area and for computed lean body mass, but not for height, underestimates left ventricular mass in overweight children.

Early cardiac abnormalities in obese children and their relationship with adiposity

OBJECTIVES

Childhood obesity rates are increasing as well as chronic disease and cardiovascular risk factors for patients at young ages. In this study, we evaluate the correlation between cardiac parameters, body mass index (BMI), and other body composition indicators in children and adolescents.

METHODS

In this cross-sectional study, we evaluated anthropometric measurements, bioelectrical impedance parameters, and echocardiographic measurements including the left ventricular mass (LVM), LVM index (LVMI), and left atrial diameter (LAD) in children and adolescents ages 7 to 15 y. We performed linear and multivariate regression analyses and analyzed the correlations between cardiac parameters, BMI, and other body composition parameters.

RESULTS

We analyzed 96 children and adolescents and found 40.6% to be obese and 29.2% overweight. LVMI and LAD indexed to height were significantly higher in individuals who were obese. LVMI increased significantly with increasing BMI (r = 0.717; P < 0.001), waist circumference (r = 0.670; P < 0.001), waist-to-height ratio (r = 0.650; P < 0.001), and body surface (r = 0.570; P < 0.001). Only BMI was significant in the multivariate analysis. LVMI was directly and positively correlated with fat mass (FM) and percentage of visceral and abdominal FM and negatively correlated with percentage of lean body mass. LAD was significantly correlated with body surface (r = 0.728; P < 0.001), BMI (r = 0.611; P < 0.001), waist circumference (r = 0.614; P < 0.001), and waist-to-height ratio (r = 0.341; P < 0.01). When indexed to height, LAD was only correlated with BMI and waist-to-height ratio.

CONCLUSIONS

Obesity is associated with cardiac disturbances at a very early age and these changes are closely related to the degree of adiposity. Cardiac structural parameters are significantly correlated with BMI and waist circumference in pediatric patients ages 7 to 15 y.

Effects of Curtailed Juvenile State on Cardiac Structure and Function in Adulthood: The Fels Longitudinal Study

OBJECTIVE

Previous studies have shown associations between body mass index and cardiac structure in both childhood and adulthood. Using Fels Longitudinal Study measurements, we investigate the relationships between a curtailed juvenile state and both adult cardiac structure and function.

METHODS

A linear mixed-effect repeated measure analysis of variance model is used to test if there is a relationship between juvenile state and each echocardiographic measurement.

RESULTS

The curtailed juvenile state is significantly associated with adult left ventricular mass index for both males and females. It is also significantly associated with the interventricular septal wall thickness index and relative wall thickness index for females. In both cases, early juvenile states led to more abnormal structural estimates in adulthood than did late juvenile states. Among cardiac function measurements such as left ventricular ejection fraction and left ventricular shortening fraction, left ventricular ejection fraction is significantly associated with the juvenile state for females.

CONCLUSION

The curtailed juvenile state at the childhood may have a long-term adverse effect on adult cardiac structure and function abnormalities.

The Prevalence of Left Ventricular Hypertrophy in Obese Children Varies Depending on the Method Utilized to Determine Left Ventricular Mass

Obesity and left ventricular hypertrophy (LVH) have been identified as independent risk factors for cardiovascular events. The definition of LVH depends on the geometric algorithm used to calculate LV mass (LVM) by echocardiography and the method used to normalize LVM for body size. This study evaluates the effect of these methods on the prevalence of LVH in obese children. LVM for 109 obese and 109 age-matched non-obese children was calculated using M-mode or two-dimensional echocardiography (2DE). LVM was then normalized to height 2.7 as indexed LVM (LVMI), to body surface area (BSA), height, and lean body mass (LBM) as LVM Z-scores. LVH was defined as LVMI >95th ‰ using age-specific normal reference values or LVM Z-scores ≥2. The prevalence of LVH by LVMI and LVM Z-scores was compared. There was a correlation between LVM determined by M-mode and by 2DE (R (2) = 0.91), although M-mode LVM was greater than 2DE LVM. However, the difference between these values was greater in obese children than in non-obese children. Based on the method of normalization, the prevalence of LVH among obese children was 64 % using LVMI, 15 % using LVM Z-scores for height, 8 % using LVM Z-scores for BSA and 1 % using LVM Z-scores for LBM. Height-based normalization correlates with obesity and hypertension. The methods used to measure and normalize LVM have a profound influence on the diagnosis of LVH in obese children. Further study is needed to determine which method identifies children at risk for cardiovascular morbidity and mortality.

Wogonin attenuates diabetic cardiomyopathy through its anti-inflammatory and anti-oxidative properties

Among diabetic cardiovascular complications cardiomyopathy is major event which if not well controlled culminates in cardiac failure. Wogonin from the root of Scutellaria baicalensis Georgi has shown specific anti-diabetes bioactivity. However, its effect on diabetic complications remains unclear. The main purpose of this study is to investigate the potential effects of wogonin on diabetic cardiomyopathy and to figure out its underlying mechanism. We found that wogonin administration suppressed hyperglycemia, improved cardiac function, and mitigated cardiac fibrosis in STZ-induced diabetic mice. Wogonin supplementation also attenuated diabetic-induced cardiomyocyte apoptosis and necrosis. In addition, wogonin treatment exhibited the properties of anti-oxidative stress and anti-inflammation in STZ diabetic mice, evidenced by improved activities of anti-oxidases including SOD1/2 and CAT, decreased ROS and MDA production, suppressed expression of inflammation factors such as IL-1β, IL-6, TNFα, and PAI-1, and inhibited NF-κB signaling. These results suggested that wogonin potentially mitigate hyperglycemia-related cardiomyocyte impairment through inhibiting inflammation and oxidative stress.

Risk profiles of lipids, blood pressure, and anthropometric measures in childhood and adolescence: project heartBeat!

Background

Many common risk factors for cardiovascular disease (CVD) originate in childhood and adolescence. There is a lack of literature examining variability within study populations, as well as a shortage of simultaneous analyses of CVD risk factors operating in tandem.

Methods

We used data from Project HeartBeat!-a multi-cohort longitudinal growth study of children and adolescents in the US - for assessing multiple profiles for lipids, blood pressure, and anthropometric measures. Principal component functional curve analysis methods were used to summarize trajectories of multiple measurements. Subsequently less favorable health (high risk) and more favorable (low risk) groups from both female and male cohorts were identified and compared to US national norms.

Results

Compared to national norms, the high risk groups have increased waist circumference, body mass index, and percent body fat as well as higher low-density lipoprotein cholesterol and triglyceride levels, and lower high-density lipoprotein cholesterol. The risk profiles also exhibit patterns of convergence and divergence across the high and low risk groups as a function of age.

Conclusions

These observations may have clinical and public health implications in identifying groups of children at high risk of CVD for earlier interventions.

The effects of sports participation on the development of left ventricular mass in adolescent boys

OBJECTIVES

To examine the contribution of body size, biological maturation, and nonelite sports participation to longitudinal changes of left ventricular mass (LVM) in healthy boys.

METHODS

One hundred and ten boys (11.0-14.5 years at baseline) were assessed biannually for 2 years. Stature, body mass, and four skinfolds were measured. Lean body mass (LBM) was estimated. Biological maturation was assessed as years from age at peak height velocity (APHV). Sports participation was assessed by questionnaire. LVM was obtained from M-mode echocardiograms using two-dimensional images. To account for the repeated measures within individual nature of longitudinal data, multilevel random effects regression analyses were used in the analysis.

RESULTS

LVM increased on average 42 ± 18 g from 11 to 15 years (P < 0.05) and 76 ± 14 g from 3.5 years pre-APHV to 1.5 years post-APHV (P < 0.05). The multilevel model with the best statistical fit (Model B) showed that changes of 1 cm in stature, 1 year post-APHV, and 1 kg of LBM predicts 4.7, 0.5, and 1 g of LVM (P < 0.05), respectively.

CONCLUSIONS

Among healthy, male adolescents aged 11-15 years individual differences in growth and biological maturation influence growth of LVM. Subcutaneous adiposity and sports participation were not associated with greater LVM.

Cardiovascular Risk Factors from Early Life Predict Future Adult Cardiac Structural and Functional Abnormalities: A Systematic Review of the Published Literature

Background

Clinical practice evaluates cardiovascular risk based on current risk factor (RF) levels [Blood pressure (BP), body mass index (BMI) and glycaemic control] largely disregarding previous risk-factor history over the totality of the life course. RFs are related to contemporaneous echocardiographic measures of cardiac structure and function which in turn are independently related to cardiovascular morbidity and mortality in cross-sectional studies. However, the effect of lifetime or earlier RF history on future echocardiographic changes has never been systematically examined.

Methods

A systematic review of the published literature identified 24 studies relating either earlier BP, BMI, glycaemic control or a combination to future cardiac structure and/or function.

Results

The majority of studies showed that elevated BP and BMI in earlier life and greater cumulative burden of these factors resulted in worse cardiac structure up to 24 years later. Studies examining glycaemic control as RF were few, but poorer glycaemic control in young adults was associated with increased future left ventricular mass.

While only 5 papers related RFs to future cardiac function, all RFs were positively associated with worse future diastolic function.

Conclusions

BP, BMI and glycaemic control measures in childhood, adolescence and early adulthood and subsequent longitudinal trajectories of BP and BMI are predictive of future abnormalities in cardiac structure and function. Lifetime RF history should be used to inform clinical practice. Further research is required to enable the identification of any sensitive periods in the life course to enable prevention when it is most likely to be effective.

Factors influencing left ventricular hypertrophy in children and adolescents with or without family history of premature myocardial infarction

BACKGROUND

Cardiovascular diseases are the highest ranking cause of mortality. The prevalence of cardiovascular diseases is increasing among people in developed and developing countries. Since left ventricular hypertrophy is one of the risk factors leading to extremely dangerous heart diseases and even sudden death at early ages, investigating its contributing factors can be beneficial. The purpose of this study was to determine factors contributing to left ventricular hypertrophy in students aged 7-18 years in Isfahan. Statistical population of this case-control study was the 7-18 year old students in Isfahan, who were studied in two groups of children with premature myocardial infarction in their parents and the control group.

MATERIALS AND METHODS

After determining the sample size of 138 people, a two-part questionnaire was designed and demographic characteristics and anthropometric measures were recorded in students' profiles. The obtained information was analyzed using SPSS15 software and logistic regression model and the results were reported at P < 0.05.

RESULT

The results showed that among the studied variables, gender, age, body mass index, and blood pressure were associated with the left ventricular hypertrophy.

CONCLUSION

Considering the results and previous studies in this field, it was observed that left ventricular hypertrophy exists at early ages, which is very dangerous and can lead to heart diseases at early ages. Factors such as being overweight, having high blood pressure, and being male cause left ventricular hypertrophy and lead to undiagnosable heart diseases.

Scaling left ventricular mass in adolescent boys aged 11-15 years

BACKGROUND

Normalizing left ventricular mass (LVM) for inter-individual variation in body size is a central issue in human biology. During the adolescent growth spurt, variability in body size descriptors needs to be interpreted in combination with biological maturation.

AIM

To examine the contribution of biological maturation, stature, sitting height, body mass, fat-free mass (FFM) and fat mass (FM) to inter-individual variability in LVM in boys, using proportional allometric modelling.

SUBJECTS AND METHODS

The cross-sectional sample included 110 boys of 11-15 years (12.9-1.0 years). Stature, sitting height, body mass, cardiac chamber dimensions and LVM were measured. Age at peak height velocity (APHV) was predicted and used as an indicator of biological maturation. Percentage fat was estimated from triceps and subscapular skinfolds; FM and FFM were derived.

RESULTS

Exponents for body size descriptors were k = 2.33 for stature, k = 2.18 for sitting height, k = 0.68 for body mass, k = 0.17 for FM and k = 0.80 for FFM (adjusted R(2 )= 19-62%). The combination of body descriptors and APHV increased the explained variance in LVM (adjusted R(2)( )= 56-69%).

CONCLUSION

Stature, FM and FFM are the best combination for normalizing LVM in adolescent boys; when body composition is not available, an indicator of biological maturity should be included with stature.

Ventricular mass in relation to body size, composition, and skeletal age in adolescent athletes

OBJECTIVE

To examine the contribution of chronological age (CA), skeletal age (SA), stature, sitting stature, fat-free mass (FFM), and fat mass (FM) to interindividual variability in left ventricular mass (LVM) in male adolescent roller hockey players using allometric models.

DESIGN

Cross sectional.

SETTING

Training and competitive sport during adolescence.

PARTICIPANTS

Seventy-three Portuguese male roller hockey players aged 14.5 to 16.5 years.

INDEPENDENT VARIABLES

Stature, sitting stature, body mass, estimated FM and FFM, and SA assessed by the Fels method.

MAIN OUTCOME MEASURES

Allometric modeling of LVM assessed in accordance with recommendations of the American Society of Echocardiography.

RESULTS

Hockey players (CA: 15.4 ± 0.6 years; SA: 16.4 ± 1.5 years) showed an eccentric remodeling of LV structure within the reference range (ie, 0.24-0.42), a dilated LV chamber, but no LVM increase. Exponents for body size descriptors were 2.69 for stature (R(2) = 27%; P < 0.001), 2.49 for sitting stature (R(2) = 37%; P < 0.001), 0.76 for FFM (R(2) = 31%; P < 0.001), and 0.22 for FM (R(2) = 26%; P < 0.001). The combination of size descriptors with CA and SA increased the explained variance in LVM slightly (26%-45%).

CONCLUSIONS

When stature and FM are used for indexing LVM in a sample of adolescent athletes, biological maturity status should also be considered.

Left ventricular structure and function in children with and without developmental coordination disorder

Children with developmental coordination disorder (DCD) are more likely to develop cardiovascular disease risk factors such as obesity and reduced cardio-respiratory fitness. However, there is limited data using laboratory measures for assessing the risk of cardiovascular disease associated with DCD. The purpose of this study was to examine differences in left ventricular structure and function between children with DCD and healthy controls. The study involved 126 children (aged 12-13 years) with significant motor impairment (n = 63) and healthy controls (n = 63) matched for age, sex, and school. The Movement ABC test (M-ABC2) was used to classify children as probable DCD (p-DCD). Cardiac dimensions were measured using ultrasound echocardiography. Left ventricular mass (LVM) was elevated in children with p-DCD (89 ± 17 g) compared to controls (87 ± 21 g), however, this difference was not significant. When LVM was normalized to height(2.7), no difference was evident between groups (26 g and 26 g for the p-DCD and controls, respectively). However, the p-DCD group demonstrated significantly elevated stroke volume (p = 0.02), cardiac output (p<0.001), end-diastolic volume (p = 0.03), and left ventricle diameter in diastole (p = 0.02). Also, peak VO(2) normalized for fat free mass (FFM) was significantly lower (p = 0.001) and systolic blood pressure (p = 0.01), body mass index (p = 0.001), heart rate (p = 0.005) and percent body fat (p<0.001) were significantly higher in p-DCD. In regression analyses, p-DCD was a significant predictor of stroke volume and cardiac output even after accounting for height, FFM, VO(2FFM), and sex. Children with p-DCD do not demonstrate significantly elevated LVM or depressed systolic function compared to healthy controls. However, cases with p-DCD demonstrate significantly elevated end-diastolic volume, diastolic chamber size, stroke volume, and cardiac output. These differences indicate obesity related changes in the left ventricle and may represent the early stages of developing left ventricle hypertrophy.

Prevalence of overweight and obesity in young adults in Uganda

BACKGROUND

Obesity in young adults is rising and predicts diabetes and cardiovascular diseases later in life. Data on prevalence and determinants of obesity in developing countries are needed for primary prevention.

OBJECTIVES

To determine the prevalence of overweight and obesity in young adults in urban (Kampala city) and rural areas (Kamuli District) of Uganda.

METHODS

Cross-sectional survey of 683 randomly selected young adults aged 18-30 years. Obesity was defined as body mass index (BMI) > 30 kg/m(2) and overweight as BMI > 25 kg/m(2). Distribution of BMI by socio-demographic characteristics was determined.

RESULTS

Of the 683 participants, 50.5% were female and 53.2% were from Kampala. The overall prevalence of obesity and overweight was 2.3% and 10.4%, respectively. The prevalence of obesity was 4.4% in Kampala and 0% in Kamuli while the prevalence of overweight was 10.2% and 10.6% in Kampala and Kamuli, respectively. Compared to males, females were more likely to be obese (2.9% vs. 1.8%) or overweight (17.4% vs. 3.3%). Residing in the city, alcohol consumption, smoking, non-engagement in sports activities, commuting to school by taxi or private vehicle and being from a rich family were the main factors significantly associated (P<0.05) with obesity. Being female (p = 0.0001) and not engaging in any sports activities (P = 0.002) were two factors significantly associated with being overweight.

CONCLUSION

We observed significant gender differences in the prevalence of obesity among young adults in Uganda. Contrary to expectation, we did not observe significant rural-urban differences in the prevalence of overweight.

The effect of feto-maternal size and childhood growth on left ventricular mass and arterial stiffness in Afro-Caribbean children

We hypothesized that maternal size, fetal size and childhood growth are associated with childhood blood pressure, left ventricular mass (LVM) and arterial stiffness. The Vulnerable Windows Cohort is a longitudinal study of 569 mothers and their offspring. Anthropometry was measured on each child at birth, at 6 weeks, once in 3 months upto 2 years and then every 6 months. Blood pressure and body composition were assessed in 185 children (age 11.5 years) and echocardiography performed. LVM was not associated with maternal size after adjustment for child's weight. LVM was significantly associated with faster growth in childhood and with current weight, fat mass and lean mass. Systolic blood pressure was not related to maternal, fetal or newborn anthropometry, but was positively associated with infant and childhood growth, as well as current body size and fat mass. The pulse pressure/stroke volume ratio (an index of arterial stiffness) was inversely associated with maternal size, placental volume at 20 weeks, fetal size at 35 weeks and childhood growth even after adjustment for current weight. In conclusion, LVM in childhood is positively associated with maternal height, child's current size and rate of growth. Arterial stiffness is inversely related to maternal, fetal and placental size as well as growth throughout childhood.

Project HeartBeat! Concept, development, and design

Major cardiovascular disease (CVD) risk factors begin development in childhood and adolescence. Project HeartBeat! studied early development of these risk factors as growth processes. Growth, body composition, sexual maturation, major CVD risk factors, and cardiac structure and function were monitored every 4 months for up to 4 years among 678 children and adolescents (49.1% girls; 20.1% blacks) aged 8, 11, or 14 years at study entry. All resided in The Woodlands or Conroe TX. Interviews were conducted at entry and annually on diet, physical activity, and health history of participants and their families. Data were collected from 1991 to 1995, and study investigators continue data analysis and reporting. Overlap in ages at examination among three cohorts (aged 8-12, 11-15, and 14-18 years at baseline) and use of multilevel modeling methods permit analysis of some 5500 observations on each principal variable for the synthetic cohort from ages 8 to 18 years. The mixed-longitudinal design provides trajectories of change with age, for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; systolic, and fourth-phase and fifth-phase diastolic blood pressure, and left ventricular mass. These trajectories are then related to concurrent measures of multiple indices of body composition and sexual maturation and adjusted for energy intake and physical activity. The data provide valuable insights into risk factor development and suggest a fresh approach to understanding influences on blood lipids, blood pressure, and left ventricular mass during the period of childhood and adolescence, a period of dynamic change in these risk factors.