Impact of childhood obesity on cardiac structure and function.

Obesity prevalence is still on the rise worldwide in both adults and children. In adults, obesity is a significant cardiovascular risk factor associated with increased morbidity and mortality. In children and adolescents this is more controversial, but early changes in cardiovascular function have been observed with possible long-term implications. In this review, we focus on the cardiac impact of childhood obesity. Obese children have been shown to have larger left atrial and ventricular dimensions, and increased left ventricular mass compared to normal weight controls. In contrast to the adult population, heart failure and significant ventricular dysfunction with reduced ejection fraction has not been reported in obese children. Several studies suggest the presence of sub-clinical myocardial dysfunction with reduced tissue Doppler velocities and myocardial deformation (strain and strain rate) in obese children. These early myocardial changes are associated with a variety of risk factors, such as systemic hypertension, diabetes, and lipid abnormalities (metabolic syndrome). As the long-term effect of these early changes is uncertain, and only very limited data are available on the effect of weight reduction and lifestyle changes on myocardial functional parameters, no interventional strategies are currently recommended.