title: Childhood obesity: impact on cardiac geometry and function.
abstract: OBJECTIVE
  The aim of our study was to assess geometric and functional changes of the heart in obese compared with nonobese children and adolescents.
  
  
  BACKGROUND
  Obesity in children and adolescents has increased over the past decades and is considered a strong risk factor for future cardiovascular morbidity and mortality. Obesity has been associated with myocardial structural alterations that may influence cardiac mechanics.
  
  
  METHODS
  We prospectively recruited 61 obese (13.5 ± 2.7 years of age, 46% male sex, SD score body mass index, 2.52 ± 0.60) and 40 nonobese (14.1 ± 2.8 years of age, 50% male sex, SD score body mass index, -0.33 ± 0.83) consecutive, nonselected Caucasian children and adolescents. A standardized 2-dimensional (2D) echocardiography and 2D speckle-tracking analysis was performed in all children. Furthermore, blood chemistry including lipid and glucose metabolism was assessed in all children.
  
  
  RESULTS
  Compared with nonobese children, blood pressure, low-density lipoprotein cholesterol, and parameters of glucose metabolism were significantly increased in obese children, whereas high-density lipoprotein cholesterol was significantly lower. Compared with nonobese children, obese children were characterized by enlarged left- and right-sided cardiac chambers, thicker left ventricular walls, and, consequently, increased left ventricular mass. Despite a comparable left ventricular ejection fraction, decreased tissue Doppler-derived peak systolic velocity and regional basoseptal strain were found in obese children compared with nonobese children. Beyond that, 2D speckle tracking-derived longitudinal (-18.2 ± 2.0 vs. -20.5 ± 2.3, p < 0.001) and circumferential (-17.0 ± 2.7 vs. -19.5 ± 2.9, p < 0.001) strain of the left ventricle was reduced in obese children compared with nonobese children. Diastolic function was also impaired in obese compared with nonobese children. Both longitudinal strain and circumferential strain were independently associated with obesity.
  
  
  CONCLUSIONS
  The results of this study demonstrate that childhood obesity is associated with significant changes in myocardial geometry and function, indicating an early onset of potentially unfavorable alterations in the myocardium.
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany. Electronic address: norman.mangner@med.uni-leipzig.de.
authors.forename: Norman
authors.initials: N
authors.lastname: Mangner
authors.affiliation: University of Leipzig, University Hospital for Children and Adolescents, Leipzig, Germany; Center of Pediatric Research, Leipzig, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Scheuermann
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Ephraim
authors.initials: E
authors.lastname: Winzer
authors.affiliation: University of Leipzig, University Hospital for Children and Adolescents, Leipzig, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Wagner
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoellriegel
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sandri
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Zimmer
authors.affiliation: University of Leipzig, Coordination Center for Clinical Trials, Leipzig, Germany.
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.affiliation: University of Leipzig, University Hospital for Children and Adolescents, Leipzig, Germany.
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: University of Leipzig, University Hospital for Children and Adolescents, Leipzig, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Körner
authors.affiliation: University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Erbs
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology; D017380:Hypertrophy, Right Ventricular / Q000097:blood / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D015588:Observer Variation; D063766:Pediatric Obesity / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left; D044465:White People; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008078:Cholesterol, LDL
keywords: children; circumferential strain; echocardiography; longitudinal strain; obesity