title: The role of blood pressure, body weight and fat distribution on left ventricular mass, diastolic function and cardiac geometry in children.
abstract: BACKGROUND
  Hypertension and obesity in childhood are related to early cardiac damage, as left ventricular hypertrophy. Few studies have analyzed the independent effects of hypertension and weight excess on diastolic function and left ventricular geometry.
  
  
  OBJECTIVE
  We studied the effects of weight, waist circumference (as an index of fat distribution) and blood pressure on left ventricular mass index, the risk of left ventricular hypertrophy, diastolic function and left ventricular geometry in 526 children (237 girls, age range 6-15 years).
  
  
  METHODS
  Children were divided into normotensive, prehypertensive and hypertensive (US Nomograms) groups, and into normal-weight, overweight, and obese (International Obesity Task Force classification) groups. Left ventricular mass index, diastolic function and left ventricular geometry were assessed.
  
  
  RESULTS
  SBP z-scores and blood pressure categories significantly influenced cardiac mass (P < 0.001 and P = 0.02, respectively) and the prevalence of left ventricular hypertrophy (P < 0.001 and P < 0.05, respectively). Obesity, BMI, and waist circumference z-scores were significantly associated with an increment in E/Em ratio (P < 0.001, P < 0.01, and P < 0.01, respectively). Increasing blood pressure values and the presence of prehypertension (P < 0.05) and hypertension (P < 0.003), but not weight excess, were associated with concentric cardiac remodeling. In contrast, concentric hypertrophy was associated with hypertension (P < 0.01), obesity (P < 0.001), and increasing waist circumference (P < 001).
  
  
  CONCLUSIONS
  Blood pressure values and hypertension are independently associated with an increase of cardiac mass and the presence of cardiac hypertrophy. Obesity and waist circumference, but not hypertension, are associated with a worsening of diastolic function, whereas only hypertensive children show high prevalence of concentric remodeling. Blood pressure and body weight and fat distribution have an independent and different impact on left ventricular structure and function in children.
authors.affiliation: aDepartment of Health Sciences, University of Milano-Bicocca and Nephrology Unit, San Gerardo Hospital bDepartment Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza cFamily Paediatrician, Milan, and Gruppo di Studio Ipertensione-Società Italiana di Pediatria, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pieruzzi
authors.forename: Laura
authors.initials: L
authors.lastname: Antolini
authors.forename: Fabio Rosario
authors.initials: FR
authors.lastname: Salerno
authors.forename: Marco
authors.initials: M
authors.lastname: Giussani
authors.forename: Paolo
authors.initials: P
authors.lastname: Brambilla
authors.forename: Sara
authors.initials: S
authors.lastname: Galbiati
authors.forename: Silvana
authors.initials: S
authors.lastname: Mastriani
authors.forename: Paola
authors.initials: P
authors.lastname: Rebora
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Valsecchi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Genovesi
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D001835:Body Weight; D002648:Child; D003971:Diastole; D005260:Female; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology* / Q000503:physiopathology*; D056865:Ideal Body Weight; D008297:Male; D009765:Obesity / Q000453:epidemiology; D009929:Organ Size; D058246:Prehypertension / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors; D055105:Waist Circumference