Annaloro Alessandra, Invernizzi Chiara, Aguilar Francisco, Alvarez Julio, Cuspidi Cesare, Grassi Guido, Lurbe Empar
Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Ciber Fsiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain.
High Blood Press Cardiovasc Prev. 2024 Mar;31(2):167-175. doi: 10.1007/s40292-024-00633-5. Epub 2024 Mar 26.
Although a number of pathophysiological aspects of childhood obesity have been reported, few information are available on obesity-related cardiac organ damage.
The present study was aimed at assessing the impact of anthropometric, blood pressure (BP) and metabolic variable on cardiac structure and function in youth.
In 78 subjects aged 5-16 years attending the outpatient clinic of cardiovascular risk (Valencia, Spain) anthropometric and metabolic variables, clinic and ambulatory BP and echocardiographic parameters were assessed. Subjects were also classified according to the presence of insulin resistance.
Subjects mean age (± SD) amounted to 12.03 ± 2.4 years and males to 53.8%. Ten subjects were normoweight, 11 overweight, 39 obese, and 18 severely obese. No significant difference in office and ambulatory BP was detected among different bodyweight groups. A significant direct correlation was observed between left ventricular mass index (LVMI) and obesity markers [body mass index (BMI): r = 0.38, waist circumference (WC): r = 0.46, P < 0.04 for both]. Left ventricular hypertrophy, relative wall thickness and left atrial diameter were significantly related to BMI and WC. In contrast, office and ambulatory BP were unrelated to other variables, and differences in LVMI among different BP phenotypes were not significant. When partitioning the population by insulin resistance, LVMI, adjusted for confounders, was significantly greater in the insulin-resistant group.
In children and adolescents characterized by different body weight patterns, weight factors "per se" and the related insulin resistance state appear to represent the main determinants of LVMI and left ventricular hypertrophy, independently on BP values and BP phenotypes.
尽管已有多项关于儿童肥胖症病理生理学方面的报道，但关于肥胖相关心脏器官损害的信息却很少。
本研究旨在评估人体测量学、血压（BP）和代谢变量对青少年心脏结构和功能的影响。
对78名年龄在5至16岁的受试者进行了评估，这些受试者前往心血管疾病风险门诊（西班牙巴伦西亚）就诊，评估了人体测量学和代谢变量、诊室和动态血压以及超声心动图参数。受试者还根据胰岛素抵抗的情况进行了分类。
受试者的平均年龄（±标准差）为12.03±2.4岁，男性占53.8%。10名受试者体重正常，11名超重，39名肥胖，18名严重肥胖。不同体重组之间的诊室血压和动态血压没有显著差异。左心室质量指数（LVMI）与肥胖标志物[体重指数（BMI）：r = 0.38，腰围（WC）：r = 0.46，两者P < 0.04]之间存在显著的正相关。左心室肥厚、相对壁厚度和左心房直径与BMI和WC显著相关。相比之下，诊室血压和动态血压与其他变量无关，不同血压表型之间的LVMI差异不显著。当按胰岛素抵抗对人群进行划分时，校正混杂因素后，胰岛素抵抗组的LVMI显著更高。
在具有不同体重模式的儿童和青少年中，体重因素“本身”及其相关的胰岛素抵抗状态似乎是LVMI和左心室肥厚的主要决定因素，独立于血压值和血压表型。
