The cardiovascular impact of the pediatric obesity epidemic: is the worst yet to come?

摘要

The prevalence of overweight and obesity in children and adolescents has increased substantially in the past several decades, with current estimates indicating that 31.9% of children and adolescents (2-19 years of age) in the United States are overweight and 17.1% are obese. Recognized as a major risk factor for cardiovascular disease (CVD) in adulthood, obesity present in childhood and adolescence is associated with established risk factors for CVD and accelerated atherosclerotic processes, including elevated blood pressure, dyslipidemia, metabolic syndrome, and type 2 diabetes mellitus. Obesity in childhood and adolescence has also been associated with adverse changes in cardiac geometry, including increased left ventricular mass (LVM). Observations from the Bogalusa Heart Study, for example, have shown that change in weight (and blood pressure) during childhood is predictive of excess LVM in children and young adults and also have illustrated that obesity beginning in childhood is a consistent predictor of LVM in young adults. In this community-based, bi-racial (29% African-American) sample of 467 young adults (20-38 years of age) who had 6 assessments of cardiovascular risk factors from childhood to adulthood, adiposity (body mass index [BMI]) in childhood, adiposity and systolic blood pressure in adulthood, and the cumulative burden of adiposity and systolic blood pressure from childhood to adulthood were significant predictors of LVM (obtained with two-dimensional M-mode echocardiography) in adulthood. Increased LVM/left ventricular hypertrophy is a recognized independent predictor of cardiovascular morbidity and mortality.