Lower LV diastolic function in adulthood tied to increased childhood adiposity, decreased physical activity

Body-fat status and the level of physical activity in childhood were independently linked with left ventricular (LV) diastolic function in adulthood, according to a study from Finland and published in Pediatrics.

In the Cardiovascular Risk in Young Finns Study (YFS), which included 1,871 participants (mean age: 41.8; 45.9% male), elevated systolic blood pressure (BP) and increased adiposity in childhood were associated with worse adulthood LV diastolic function, while higher childhood physical activity levels were tied to better adulthood LV diastolic function (P<0.001 for all), reported Jarkko S. Heiskanen, MD, of the University of Turku and Turku University Hospital, Turku, Finland, and co-authors.

“The associations of childhood adiposity and physical activity with adulthood LV diastolic function remained significant (both P<0.05) but were diluted when the analyses were adjusted for adulthood systolic blood pressure, adiposity, and physical activity,” while the association between childhood systolic BP and adult LV diastolic function was diluted to one of nonsignificance (P=0.56),” wrote Heiskanen and fellow researchers.

They pointed out that “This is the first study to indicate that the cumulative cardiovascular risk factor exposure already in childhood may independently contribute to diastolic LV function in adulthood.”

In a commentary accompanying the study, William E. Hopkins, MD, of the University of Vermont Medical Center in Burlington, posed a reasonable question: “Why would a pediatrician care about a heart failure syndrome in adults?”

Hopkins explained that childhood obesity — the prevalence of which was 18.5% among U.S. kids ages 2 to 19 years, according to a 2017 CDC report — and lack of physical activity may lay the groundwork for adult heart failure with preserved ejection fraction (HFpEF).

He called the YFS study an “ambitious” one that highlighted that fact that HFpEF “prevention should begin during childhood,” because “Over the years, millions of dollars have been spent on negative clinical trials looking for the ’holy grail’ of HFpEF treatment. In reality, it is unrealistic to think that a drug is going to reverse structural changes that started decades before drug treatment commenced.”

He acknowledged that programs such as the “My Life Check Life’s Simple 7” from the American Heart Association (AHA), which advocates blood pressure management, cholesterol control, activity, healthy eating, and more, are worthwhile, but may consist of too many steps for kids to easily adopt.

Instead, Hopkins proposed starting with “the Terrific 2: increased physical activity and sodium restriction. Implementing these 2 actionable items is far simpler than 7 and should result in reduced rates of obesity and hypertension in adulthood.”

The YFS is an ongoing, multicenter, longitudinal, population-based study on CV risk factors done in the general Finnish population. The baseline study was conducted in 1980 and included 3,596 children and adolescents (49.0% male) in six age cohorts age ranging from 3 to 18 years.

Researchers defined adiposity in children using skinfold and waist circumference measurements and defined adult LV diastolic function with an E/é ratio, which is “a noninvasive measurement representing LV filling pressure in early diastole.” In the CARDIA study, they noted, “worse cardiorespiratory fitness in young adulthood was found to associate with higher LV diastolic filling pressures” regardless of CV risk factor burden in middle age. Finally, these researchers measured physical activity and sports participation in those ages 9 to 18 years with a short self-report questionnaire.

Heiskanen and colleagues found a significant trend between a higher number of childhood CV risk factors and worse LV diastolic function (P=0.007), such that participants with two or three childhood risk factors had a higher E/é ratio denoting worse LV diastolic function (P=0.047 and P=0.0066, respectively) versus those with no childhood risk factors.

Other research has shown high levels of dyslipidemia, a family history for CV diseases (CVD), and elevated weight in minority preschool children, and that minorities often face multiple structural and psychosocial barriers to managing CVD risk factors.

Heiskanen’s group stressed that “the findings from our study underline the need for guideline-recommended active prevention strategies targeted to the individuals with several cardiovascular risk factors beginning from childhood.” To that end, the National Heart, Lung, and Blood Institute, the AHA, and the American Academy of Pediatrics offer risk reduction approaches for CV health in children and adolescents.

Study limitations included potential loss to follow-up in longitudinal research and the predominance of White, European participants.

  1. An increased burden of adiposity and decreased physical activity in childhood was tied to lower left ventricular diastolic function in adulthood.

  2. Based on the results from the ongoing Cardiovascular Risk in Young Finns Study, prevention — including an emphasis on physical activity — should begin during childhood.

Shalmali Pal, Contributing Writer, BreakingMED™

The Young Finns Study was supported by the Academy of Finland, the Social Insurance Institution of Finland, Competitive State Research Financing of the Expert Responsibility Area of Kuopio, Tampere and Turku University Hospitals, Juho Vainio Foundation, Paavo Nurmi Foundation, Finnish Foundation for Cardiovascular Research, Finnish Cultural Foundation, The Sigrid Jusélius Foundation, Tampere Tuberculosis Foundation, Emil Aaltonen Foundation; Yrjö Jahnsson Foundation, Signe and Ane Gyllenberg Foundation; Diabetes Research Foundation of Finnish Diabetes Association, European Union Horizon 2020/MULTIEPIGEN project, Tampere University Hospital Supporting Foundation Aarne Koskelo Foundation, and the Diabetes Research Foundation of Finnish Diabetes Association.

Heiskanen and co-authors, as well as Hopkins, reported no relationships relevant to the contents of this paper.

Cat ID: 138

Topic ID: 85,138,730,3,138,192,925