Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-11T15:29:58.304Z Has data issue: false hasContentIssue false
  • English
  • Français

Lean body mass is the strongest anthropometric predictor of left ventricular mass in the obese paediatric population

Published online by Cambridge University Press:  16 March 2020

James R. Shea Open the ORCID record for James R. Shea [Opens in a new window] ,
Melissa H. Henshaw ,
Janet Carter  and
Shahryar M. Chowdhury Open the ORCID record for Shahryar M. Chowdhury [Opens in a new window]
James R. Shea*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Melissa H. Henshaw
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Janet Carter
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Shahryar M. Chowdhury
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
*
Author for correspondence: J. R. Shea, Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC29425, USA. Tel: +1 984 974 4601; Fax: +1 984 974 7385; E-mail: RyanShea@med.unc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Indexing left ventricular mass to body surface area or height2.7 leads to inaccuracies in diagnosing left ventricular hypertrophy in obese children. Lean body mass predictive equations provide the opportunity to determine the utility of lean body mass in indexing left ventricular mass. Our objectives were to compare the diagnostic accuracy of predicted lean body mass, body surface area, and height in detecting abnormal left ventricle mass in obese children.

Methods:

Obese non-hypertensive patients aged 4–21 years were recruited prospectively. Dual-energy X-ray absorptiometry was used to measure lean body mass. Height, weight, sex, race, and body mass index z-score were used to calculate predicted lean body mass.

Results:

We enrolled 328 patients. Average age was 12.6 ± 3.8 years. Measured lean body mass had the strongest relationship with left ventricular mass (R2 = 0.84, p < 0.01) compared to predicted lean body mass (R2 = 0.82, p < 0.01), body surface area (R2 = 0.80, p < 0.01), and height2.7 (R2 = 0.65, p < 0.01). Of the clinically derived variables, predicted lean body mass was the only measure to have an independent association with left ventricular mass (β = 0.90, p < 0.01). Predicted lean body mass was the most accurate scaling variable in detecting left ventricular hypertrophy (positive predictive value = 88%, negative predictive value = 99%).

Conclusions:

Lean body mass is the strongest predictor of left ventricular mass in obese children. Predicted lean body mass is the most accurate anthropometric scaling variable for left ventricular mass in left ventricular hypertrophy detection. Predicted lean body mass should be considered for clinical use as the body size correcting variable for left ventricular mass in obese children.

Keywords

Lean body massobesityechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 4 , April 2020 , pp. 476 - 481
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ogden, CL, Carroll, MD, Fryar, CD, Flegal, KMPrevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS Data Brief 2015, 1–8.Google Scholar
Eguchi, K, Boden-Albala, B, Jin, Z, et al.Association between diabetes mellitus and left ventricular hypertrophy in a multiethnic population. Am J Cardiol 2008; 101: 1787–1791.10.1016/j.amjcard.2008.02.082CrossRefGoogle Scholar
Kavey, RE.Left ventricular hypertrophy in hypertensive children and adolescents: predictors and prevalence. Curr Hypertens Rep 2013; 15: 453–457.10.1007/s11906-013-0370-3CrossRefGoogle ScholarPubMed
Kiencke, S, Handschin, R, von Dahlen, R, et al.Pre-clinical diabetic cardiomyopathy: prevalence, screening, and outcome. Eur J Heart Fail 2010; 12: 951–957.10.1093/eurjhf/hfq110CrossRefGoogle Scholar
Maskatia, SA, Spinner, JA, Nutting, AC, et al.Impact of obesity on ventricular size and function in children, adolescents and adults with tetralogy of fallot after initial repair. Am J Cardiol 2013; 112: 594–598.CrossRefGoogle ScholarPubMed
de Simone, G, Kizer, JR, Chinali, M, et al.Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Study. Am J Hyperten 2005; 18: 191–196.10.1016/j.amjhyper.2004.08.032CrossRefGoogle ScholarPubMed
Dewey, FE, Rosenthal, D, Murphy, DJ Jr., Froelicher, VF, Ashley, EA. Does size matter? Clinical applications of scaling cardiac size and function for body size. Circulation 2008; 117: 2279–2287.10.1161/CIRCULATIONAHA.107.736785CrossRefGoogle ScholarPubMed
Foster, BJ, Gao, T, Mackie, AS, et al.Limitations of expressing left ventricular mass relative to height and to body surface area in children. J Am Soc Echocardiogr 2013; 26: 410–418.10.1016/j.echo.2012.11.018CrossRefGoogle ScholarPubMed
Kuch, B, Gneiting, B, Doring, A, et al.Indexation of left ventricular mass in adults with a novel approximation for fat-free mass. J Hypertens 2001; 19: 135–142.10.1097/00004872-200101000-00018CrossRefGoogle ScholarPubMed
de Simone, G, Daniels, SR, Devereux, RB, et al.Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251–1260.CrossRefGoogle ScholarPubMed
Foster, BJ, Mackie, AS, Mitsnefes, M, et al.A novel method of expressing left ventricular mass relative to body size in children. Circulation 2008; 117: 2769–2775.10.1161/CIRCULATIONAHA.107.741157CrossRefGoogle ScholarPubMed
Bella, JN, Devereux, RB, Roman, MJ, et al.Relations of left ventricular mass to fat-free and adipose body mass: the strong heart study. The Strong Heart Study Investigators. Circulation 1998; 98: 2538–2544.10.1161/01.CIR.98.23.2538CrossRefGoogle Scholar
Chantler, PD, Clements, RE, Sharp, L, et al.The influence of body size on measurements of overall cardiac function. Am J Physiol Heart Circ Physiol 2005; 289: H2059–H2065.10.1152/ajpheart.00022.2005CrossRefGoogle ScholarPubMed
Collis, T, Devereux, RB, Roman, MJ, et al.Relations of stroke volume and cardiac output to body composition: the strong heart study. Circulation 2001; 103: 820–825.CrossRefGoogle ScholarPubMed
Daniels, SR, Kimball, TR, Morrison, JA, et al.Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 1995; 76: 699–701.CrossRefGoogle ScholarPubMed
George, KP, Birch, KM, Pennell, DJ, et al.Magnetic-resonance-imaging-derived indices for the normalization of left ventricular morphology by body size. Magn Reson Imaging 2009; 27: 207–213.CrossRefGoogle ScholarPubMed
Hense, HW, Gneiting, B, Muscholl, M, et al.The associations of body size and body composition with left ventricular mass: impacts for indexation in adults. J Am Coll Cardiol 1998; 32: 451–457.CrossRefGoogle ScholarPubMed
Foster, BJ, Platt, RW, Zemel, BS.Development and validation of a predictive equation for lean body mass in children and adolescents. Ann Hum Biol 2012; 39: 171–182.10.3109/03014460.2012.681800CrossRefGoogle ScholarPubMed
Jackson, LB, Henshaw, MH, Carter, J, et al.Sex-specific lean body mass predictive equations are accurate in the obese paediatric population. Anna Hum Biol 2016; 43: 417–422.CrossRefGoogle ScholarPubMed
Chowdhury, SM, Henshaw, MH, Friedman, B, et al.Lean body mass may explain apparent racial differences in carotid intima-media thickness in obese children. J Am Soc Echocardiogr 2014; 27: 561–567.10.1016/j.echo.2014.01.007CrossRefGoogle ScholarPubMed
Palmieri, VJ, Henshaw, MH, Carter, J, Chowdhury, SMAssessing truncal obesity in predicting cardiometabolic risk in children: clinical measures versus dual-energy X-ray absorptiometry. Acta Paediatr 2018; 107: 1065–1069.10.1111/apa.14175CrossRefGoogle ScholarPubMed
Lytrivi, ID, Bhatla, P, Ko, HHet al.Normal values for left ventricular volume in infants and young children by the echocardiographic subxiphoid five-sixth area by length (bullet) method. J Am Soc Echocardiogr 2011; 24: 214–218.10.1016/j.echo.2010.12.002CrossRefGoogle ScholarPubMed
Lang, RM, Bierig, M, Devereux, RB, et al.Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.10.1016/j.echo.2005.10.005CrossRefGoogle ScholarPubMed
Du Bois, D, Du Bois, EF.A formula to estimate the approximate surface area if height and weight be known. Nutrition 1989; 5: 303–311.Google Scholar
Cole, TJ.The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44: 45–60.Google ScholarPubMed
Daniels, SR, Kimball, TR, Morrison, JA, et al.Effect of lean body mass, fat mass, blood pressure, and sexual maturation on left ventricular mass in children and adolescents. Statistical, biological, and clinical significance. Circulation 1995; 92: 3249–3254.CrossRefGoogle ScholarPubMed
Foster, BJ, Khoury, PR, Kimball, TR, Mackie, AS, Mitsnefes, M.New reference centiles for left ventricular mass relative to lean body mass in children. J Am Soc Echocardiogr 2016; 29: 441–447.e442.CrossRefGoogle ScholarPubMed
Lopez, L, Colan, S, Stylianou, M, et al.Relationship of echocardiographic Z scores adjusted for body surface area to age, sex, race, and ethnicity: the pediatric heart network normal echocardiogram database. Circ Cardiovasc Imaging 2017; 10.Google Scholar
Kemna, M, Albers, E, Bradford, MCet al.Impact of donor-recipient sex match on long-term survival after heart transplantation in children: an analysis of 5797 pediatric heart transplants. Pediatr Transplant 2015; 20: 249–255.CrossRefGoogle ScholarPubMed
Gardin, JM, Wagenknecht, LE, Anton-Culver, H, et al.Relationship of cardiovascular risk factors to echocardiographic left ventricular mass in healthy young black and white adult men and women. The CARDIA study. Coronary artery risk development in young adults. Circulation 1995; 92: 380–387.10.1161/01.CIR.92.3.380CrossRefGoogle ScholarPubMed
Whincup, PH, Nightingale, CM, Owen, CG, et al.Ethnic differences in carotid intima-media thickness between UK children of black African–Caribbean and white European origin. Stroke 2012; 43: 1747–1754.10.1161/STROKEAHA.111.644955CrossRefGoogle ScholarPubMed
Moreno, M, Puig, J, Moreno-Navarrete, JM, et al.Lean mass, and not fat mass, is an independent determinant of carotid intima media thickness in obese subjects. Atherosclerosis 2015; 243: 493–498.CrossRefGoogle Scholar