title: The effects of obesity and type 2 diabetes mellitus on cardiac structure and function in adolescents and young adults.
abstract: OBJECTIVE
  We sought to evaluate the effects of obesity and obesity-related type 2 diabetes mellitus on cardiac geometry (remodelling) and systolic and diastolic function in adolescents and young adults.
  
  
  METHODS
  Cardiac structure and function were compared by echocardiography in participants who were lean, obese or obese with type 2 diabetes (obese diabetic), in a cross sectional study. Group differences were assessed using ANOVA. Independent determinants of cardiac outcome measures were evaluated with general linear models.
  
  
  RESULTS
  Adolescents with obesity and obesity-related type 2 diabetes were found to have abnormal cardiac geometry compared with lean controls (16% and 20% vs <1%, p < 0.05). These two groups also had increased systolic function. Diastolic function decreased from the lean to obese to obese diabetic groups with the lowest diastolic function observed in the obese diabetic group (p < 0.05). Regression analysis showed that group, BMI z score (BMIz), group × BMIz interaction and systolic BP z score (BPz) were significant determinants of cardiac structure, while group, BMIz, systolic BPz, age and fasting glucose were significant determinants of the diastolic function (all p < 0.05).
  
  
  CONCLUSIONS
  Adolescents with obesity and obesity-related type 2 diabetes demonstrate changes in cardiac geometry consistent with cardiac remodelling. These two groups also demonstrate decreased diastolic function compared with lean controls, with the greatest decrease observed in those with type 2 diabetes. Adults with diastolic dysfunction are known to be at increased risk of progressing to heart failure. Therefore, our findings suggest that adolescents with obesity-related type 2 diabetes may be at increased risk of progressing to early heart failure compared with their obese and lean counterparts.
authors.affiliation: Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH 45229, USA. amy.shah@cchmc.org
authors.forename: A S
authors.initials: AS
authors.lastname: Shah
authors.forename: P R
authors.initials: PR
authors.lastname: Khoury
authors.forename: L M
authors.initials: LM
authors.lastname: Dolan
authors.forename: H M
authors.initials: HM
authors.lastname: Ippisch
authors.forename: E M
authors.initials: EM
authors.lastname: Urbina
authors.forename: S R
authors.initials: SR
authors.lastname: Daniels
authors.forename: T R
authors.initials: TR
authors.lastname: Kimball
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000503:physiopathology*; D013599:Systole / Q000502:physiology; D055105:Waist Circumference / Q000502:physiology; D055815:Young Adult