Association between obesity and ECG variables in children and adolescents: A cross-sectional study

Abstract

Obesity exhibits a wide variety of electrocardiogram (ECG) abnormalities in adults, which often lead to cardiovascular events. However, there is currently no evidence of an association between obesity and ECG variables in children and adolescents. The present study aimed to explore the associations between obesity and ECG intervals and axes in children and adolescents. A cross-sectional observational study of 5,556 students aged 5–18 years was performed. Anthropometric data, blood pressure and standard 12-lead ECGs were collected for each participant. ECG variables were measured manually based on the temporal alignment of simultaneous 12 leads using a CV200 ECG Work Station. Overweight and obese groups demonstrated significantly longer PR intervals, wider QRS durations and leftward shifts of frontal P-wave, QRS and T-wave axes, while the obese group also demonstrated significantly higher heart rates, compared with normal weight groups within normotensive or hypertensive subjects (P<0.05). Abdominal obesity was also associated with longer PR intervals, wider QRS duration and a leftward shift of frontal ECG axes compared with normal waist circumference (WC) within normotensive or hypertensive subjects (P<0.05). Gender was a possible factor affecting the ECG variables. Furthermore, the ECG variables, including PR interval, QRS duration and frontal P-wave, QRS and T-wave axes, were significantly linearly correlated with body mass index, WC and waist-to-height ratio adjusted for age, gender, ethnicity and blood pressure. However, there was no significant association between obesity and the corrected QT interval (P>0.05). The results of the current study indicate that in children and adolescents, general and abdominal obesity is associated with longer PR intervals, wider QRS duration and a leftward shift of frontal P-wave, QRS and T-wave axes, independent of age, gender, ethnicity and blood pressure.

Increased epicardial adipose tissue volume is associated with PR interval prolongation

“…Our study results reveal a positive association between PR interval and both BMI and WHR. This is consistent with reports noting PR interval prolongation with increasing obesity [8,31,32]. In particular, increasing obesity marks increasing pro-inflammatory cytokines.…”

Electrocardiographic characteristics, anthropometric features, and cardiovascular risk factors in a large cohort of adolescents

“…This observation confirms with more robust data the results of a previous study which focused on the heart rate and QTc interval of 781 children aged 10–18 years. 17 Overall ECG abnormalities were found more often in males than in females, consistent with other reports, 7–10 with a total prevalence of ECG abnormalities of 22%, close to that found in another Italian study which involved a smaller sample of students. 11 The higher prevalence of an incomplete RBBB reported in underweight subjects and lower rate in obese subjects is consistent with data observed in adults, where the incomplete RBBB was found to be associated with a lower BMI.…”

“…Data which are available were largely obtained from adult populations and when adolescents were evaluated, major ECG abnormalities were not systematically assessed. 7 Furthermore, published ECG findings in large young populations were mainly focused on athletes as report of pre-participation evaluation aiming at sudden cardiac death prevention, 8 not systematically dealing with anthropometric parameters 8–11 and in some cases focused on young males in military conscription older than our population. To the best of our knowledge this is the largest report on non-selected adolescents which evaluates ECG and anthropometric characteristics and the first which attempts to assess the correlations between ECG abnormalities and anthropometric parameters.…”

The Effect of Body Mass Index on Acute Cardiometabolic Responses to Graded Exercise Testing in Children: A Narrative Review

“…HR rest has been well discussed by many studies on overweight and obese children [18,20,24,61,62,63,64]. HR rest in most of these studies has been measured in a seated position [18,24,26,62,63,65], in a few studies in a supine position [61,64], and position was not reported in one case [20]. HR recording usually lasted from 3 min [24] to 15 min [61].…”