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Adolescent obesity associated with abnormal heart development

A King’s College research team found abnormal cardiac development associated with childhood obesity. These abnormalities included a tilted left ventricle, an asymmetry commonly associated with aortic stenosis patients.

Rising obesity rates ranks among the most prevalent global health concerns, with nearly 39% of the global population of adults being considered overweight. Obesity is the 5th leading risk factor for global deaths, with an average of 3 million deaths per year attributed to obesity. Additionally, the childhood obesity rate (ages 5-19) is now estimated to be nearly 20% globally, or 340 million children, which is triple what the childhood obesity rate was 50 years ago.

A research group from King’s College London conducted a study focused on assessing the cardiac development of children with obesity, compared to healthy-weight children in the same age group.

The researchers found that the left ventricle of the hearts of overweight children (BMI greater than 19) tended to develop abnormally, tilting away from the usual vertical symmetry.

What’s concerning about this? This unusual tilt of the ventricle is often found in adults with aortic stenosis– abnormal narrowing of the valve in the large blood vessel of the heart- which is a potentially life-threatening condition.

The data collecting methods of the study included analyzing cardiac magnetic resonance images of 2631 children, aged 10 years old, with a balanced sex-distribution. Statistical shape models (SSMs) of the heart were used to observe 3D shape variations of the left ventricle.

Co-author Pablo Lamata, shared his thoughts, stating, “In the future, this pattern of remodeling could inform risk prediction models and raise an earlier awareness of the importance of adopting a healthier lifestyle from childhood.”

The authors of the study suggest that the obesity-related developmental abnormalities during adolescence may explain how childhood obesity progresses to adult cardiovascular disease.

First author Maciej Marciniak added, “Obesity in children is of course a major concern, as it may impact the healthy development. With more clinical information on this impact, clinicians will be able to better advise patients to follow healthier lifestyles at an earlier age. Looking further down the line, such analyses may help to inform about other remodeling patterns, connected with lifestyle choices, environmental factors and other parameters.”

The study was published in European Heart Journal, on December 21st, 2021.

Abstract. Statistical shape models (SSMs) of cardiac anatomy provide a new approach for analysis of cardiac anatomy. In adults, specific cardiac morphologies associate with cardiovascular risk factors and early disease stages. However, the relationships between morphology and risk factors in children remain unknown. We propose an SSM of the paediatric left ventricle to describe its morphological variability, examine its relationship with biometric parameters and identify adverse anatomical remodelling associated with obesity. This cohort includes 2631 children (age 10.2 ± 0.6 years), mostly Western European (68.3%) with a balanced sex distribution (51.3% girls) from Generation R study. Cardiac magnetic resonance short-axis cine scans were segmented. Three-dimensional left ventricular (LV) meshes are automatically fitted to the segmentations to reconstruct the anatomies. We analyse the relationships between the LV anatomical features and participants’ body surface area (BSA), age, and sex, and search for features uniquely related to obesity based on body mass index (BMI). In the SSM, 19 modes described over 90% of the population’s LV shape variability. Main modes of variation were related to cardiac size, sphericity, and apical tilting. BSA, age, and sex were mostly correlated with modes describing LV size and sphericity. The modes correlated uniquely with BMI suggested that obese children present with septo-lateral tilting (R2 = 4.0%), compression in the antero-posterior direction (R2 = 3.3%), and decreased eccentricity (R2 = 2.0%). We describe the variability of the paediatric heart morphology and identify anatomical features related to childhood obesity that could aid in risk stratification. Web service is released to provide access to the new shape parameters.

Maciej Marciniak, Arend W van Deutekom, Liza Toemen, Adam J Lewandowski, Romy Gaillard, Alistair A Young, Vincent W V Jaddoe, Pablo Lamata, A three-dimensional atlas of child’s cardiac anatomy and the unique morphological alterations associated with obesity, European Heart Journal – Cardiovascular Imaging, 2021;, jeab271,

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