Childhood obesity can lead to structural and functional changes in the heart, according to a new study published in the August 2014 issue of the Journal of the American College of Cardiology. The study found that obese children had thickened left ventricles, increased left ventricular weight and impaired systolic function compared to normal children. The study found no difference in ejection fraction between obese and normal children and showed that mean left ventricular strain, strain rate and displacement were greatly impaired in obese children, as assessed by two-dimensional tracing echocardiography of longitudinal left ventricular systolic function. Norman Mangner said that because obesity is associated with poor glucose tolerance, diabetes, high blood pressure and high cholesterol levels, the relationship between obesity and cardiovascular disease risk is difficult to assess. Because it was in a different echocardiographic study, children did not have the interference of other cardiovascular risk factors, so the children are likely good candidates to explore the relationship between obesity and myocardial changes, with thickened ventricular walls and increased left ventricular mass. The study included 61 obese children and 41 normal children (between 9 and 16 years of age, with a mean age of 14 years), with subjects matched for age, sex, and height, respectively. However, obese children had high body mass index (BMI: 31 vs 19 kg/m2), large waist circumference, high systolic blood pressure, high adiposity and impaired glucose metabolism parameters. Compared to normal children, obese children had a thickened left ventricular wall, a 29% increase in left ventricular end-diastolic volume; and a 40% increase in left ventricular weight; . Left atrial volume, left atrial volume index, right atrial area, and right ventricular diameter were also significantly larger in obese children, and differences persisted after physical development and growth, although left ventricular systolic and diastolic diameters were similar in both groups. This demonstrates that left ventricular dilatation and left ventricular hypertrophy, as well as left atrial enlargement, are associated with adverse cardiac events and a poor prognosis,” Mangner and colleagues wrote. Left atrial enlargement is also a feature of impaired left ventricular diastolic function.” The researchers observed significant differences in echocardiography by two-dimensional speckle tracking. In addition, they observed a decrease in mean circumferential strain in obese children, but no significant difference in mean strain rate. In multiple regression analysis, left ventricular longitudinal strain was independently associated with BMI and HDL cholesterol, however circumferential strain was only associated with BMI. Regarding the mechanism, Mangner, as well as others, said that blood pressure differences, despite being within the normal range for the obese group, may be associated with changes in cardiac structure. Previous studies have shown that insulin tolerance mediates obesity and congestive heart failure. In that study, it was noted that obese children already have features of peripheral insulin resistance.