Comparison of echocardiographic findings with laboratory parameters in obese children

Metabolic syndrome - cardiac structure and functional analysis by echocardiography; a cross sectional comparative study

OBJECTIVES

Metabolic syndrome (MS) is a collection of metabolic disorders including hyperglycemia, hypertension and dyslipidemia. The outcome of metabolic syndrome depends on structural changes in heart like increased left atrial size or increased left ventricular mass. This study was done to determine the echocardiography abnormalities in metabolic syndrome.

METHODS

After obtaining informed consent, 75 subjects with metabolic syndrome and 75 controls were included in the study. 2D echo/M mode examination was performed for all. Aortic root, left atrial size, left atrial volume, septal wall thickness during systole (SWs) and diastole (SWd), posterior wall thickness during systole (PWs) and diastole (PWd), left ventricle dimension during systole (LVDs) and diastole (LVDd), and ejection fraction were measured. The values were compared between the groups.

RESULTS

After adjustment for age, sex, smoking, alcohol and BMI; left ventricular diameter in systole and diastole was significantly more than controls (p<0.001); HR of 1.29 (95% CI 1.13-1.46), 1.29 (95% CI 1.15-1.45) respectively. Left ventricular mass and left atrial volume were increased significantly in subjects with metabolic syndrome (p<0.001); HR were 1.06 (95% CI 1.03-1.08), 1.13 (95% CI 1.06-1.19) respectively. Ejection fraction was low normal in subjects with metabolic syndrome compared to controls (p<0.05); HR 0.90 (95% CI 0.83-0.98).

CONCLUSIONS

Cardiac abnormalities were common in subjects with metabolic syndrome, predominantly affecting the left ventricular mass, diameter and left atrial volume. Early life style modifications are essential to prevent these complications.

The effect of overweight/obesity on diastolic function in children and adolescents: A meta-analysis

Left ventricular diastolic function (LVDF) is an important marker of early cardiovascular remodelling, which has not been well summarized in young people with overweight/obesity. Weighted, random-effects regression was used to determine the strength of associations of both body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) with LVDF measures, adjusting for age and sex. Six databases were searched after PROSPERO registration (CRD42020177470) from inception to July 2020 for studies that compared LVDF between overweight/obesity and control groups aged ≤24 years, yielding 70 studies (9983 individuals). Quality and risk of bias were assessed using NHLBI tools, with scores of good, fair, and poor for 6, 48, and 16 studies, respectively. Increased BMI was associated with worse LVDF in all measures except early mitral inflow deceleration time, with septal early diastolic tissue peak velocity to late diastolic tissue peak velocity ratio having the strongest association (n = 13 studies, 1824 individuals; r = -0.69; P < 0.001). Elevated HOMA-IR was also associated with worse LVDF. Although we could not determine the causality of reduced LVDF in young people, our findings should aid the development of paediatric guidelines for the assessment of LVDF and support further work to address the longitudinal consequences of childhood obesity and IR on LVDF.

The Effects of Resistance Training on Blood Pressure in Preadolescents and Adolescents: A Systematic Review and Meta-Analysis

The aim was to systematically review and meta-analyze the current evidence for the effects of resistance training (RT) on blood pressure (BP) as the main outcome and body mass index (BMI) in children and adolescents. Two authors systematically searched the PubMed, SPORTDiscus, Web of Science Core Collection and EMBASE electronic databases. Inclusion criteria were: (1) children and adolescents (aged 8 to 18 years); (2) intervention studies including RT and (3) outcome measures of BP and BMI. The selected studies were analyzed using the Cochrane Risk-of-Bias Tool. Eight articles met inclusion criteria totaling 571 participants. The mean age ranged from 9.3 to 15.9 years and the mean BMI of 29.34 (7.24) kg/m²). Meta-analysis indicated that RT reduced BMI significantly (mean difference (MD): −0.43 kg/m² (95% CI: −0.82, −0.03), P = 0.03; I² = 5%) and a non-significant decrease in systolic BP (SBP) (MD: −1.09 mmHg (95% CI: −3.24, 1.07), P = 0.32; I² = 67%) and diastolic BP (DBP) (MD: −0.93 mmHg (95% CI: −2.05, 0.19), P = 0.10; I² = 37%). Limited evidence suggests that RT has no adverse effects on BP and may positively affect BP in youths. More high-quality studies are needed to clarify the association between RT and BP in light of body composition changes throughout childhood and adolescence.