Cardiovascular Implications of Pediatric Obesity

Pediatric obesity represents a rapidly escalating public health challenge with profound implications for cardiovascular health. Excess adiposity in childhood initiates a cascade of structural and functional alterations in the heart and vasculature. Early in the course of obesity, increased blood volume and cardiac output drive adaptive enlargement of the left ventricle, which may progress to concentric or eccentric hypertrophy. Simultaneously, adipose depots—particularly epicardial and visceral fat—exert paracrine and inflammatory influences that impair myocardial relaxation, promote arterial stiffening and accelerate subclinical atherosclerosis. Insulin resistance, dyslipidaemia and low-grade systemic inflammation further exacerbate myocardial deformation abnormalities, detectable even in metabolically healthy obese children. Right ventricular geometry and mechanics are also compromised, suggesting a biventricular response to excess weight. Left untreated, these changes may track into adulthood, increasing the risk of hypertension, ischaemic heart disease and heart failure. Early identification of high-risk phenotypes through noninvasive imaging and metabolic profiling offers an opportunity for targeted lifestyle and pharmacological interventions aimed at reversing or mitigating cardiovascular remodelling.

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Cardiovascular Implications of Pediatric Obesity publication trend

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Technical terms

Left ventricular hypertrophy: Increase in the mass of the left ventricular myocardium, often in response to chronic pressure or volume overload.

Diastolic dysfunction: Impaired relaxation or filling of the heart during diastole, which can lead to reduced cardiac output.

Speckle tracking echocardiography: Ultrasound technique that analyses myocardial “speckles” to quantify deformation (strain) and strain rate.

Carotid intima-media thickness: Ultrasonic measurement of the combined thickness of the intimal and medial layers of the carotid artery wall, serving as an early marker of atherosclerosis.

Epicardial adipose tissue: Fat depot located between the myocardium and the visceral pericardium, associated with local inflammatory and metabolic effects on the heart.

References

1. Whole‐Body Magnetic Resonance Imaging Assessment of the Contributions of Adipose and Nonadipose Tissues to Cardiovascular Remodeling in Adolescents. Journal of the American Heart Association (2023).
2. Precocious Preclinical Cardiovascular Sonographic Markers in Metabolically Healthy and Unhealthy Childhood Obesity. Frontiers in Endocrinology (2020).
3. Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study. Journal of Cardiovascular Magnetic Resonance (2016).
4. Left Ventricular Geometrical Changes in Severely Obese Adolescents: Prevalence, Determinants, and Clinical Implications. Pediatric Cardiology (2020).