DOI 10.1515/jpem-2013-0157 J Pediatr Endocr Met 2014; 27(3-4): 261–271
Abdurrahman Üner, Murat Doğan*, Zerrin Epcacan and Serdar Epçaçan
The effect of childhood obesity on cardiac functions Abstract: Obesity is a metabolic disorder defined as excessive accumulation of body fat, which is made up of genetic, environmental, and hormonal factors and has various social, psychological, and medical complications. Childhood obesity is a major indicator of adult obesity. The aim of this study is to evaluate the cardiac functions via electrocardiography (ECG), echocardiography (ECHO), and treadmill test in childhood obesity. A patient group consisting of 30 obese children and a control group consisting of 30 non-obese children were included in the study. The age range was between 8 and 17 years. Anthropometric measurements, physical examination, ECG, ECHO, and treadmill test were done in all patients. P-wave dispersion (PD) was found to be statistically significantly high in obese patients. In ECHO analysis, we found that end-diastolic diameter, end-systolic diameter, left ventricle posterior wall thickness, and interventricular septum were significantly greater in obese children. In treadmill test, exercise capacity was found to be significantly lower and the hemodynamic response to exercise was found to be defective in obese children. Various cardiac structural and functional changes occur in childhood obesity and this condition includes important cardiovascular risks. PD, left ventricle end-systolic and end-diastolic diameter, left ventricle posterior wall thickness, interventricular septum thickness, exercise capacity, and hemodynamic and ECG measurements during exercise testing are useful tests to determine cardiac dysfunctions and potential arrhythmias even in early stages of childhood obesity. Early recognition and taking precautions for obesity during childhood is very important to intercept complications that will occur in adulthood. Keywords: cardiac functions; childhood; obesity. *Corresponding author: Murat Doğan, MD, Division of Pediatric Endocrinology, Department of Pediatrics, YYU School of Medicine, 65100, Van, Turkey, E-mail: [email protected] Abdurrahman Üner and Serdar Epçaçan: Division of Pediatric Cardiology, Department of Pediatrics, YYU School of Medicine, Van, Turkey Zerrin Epcacan: Department of Pediatrics, YYU School of Medicine, Van, Turkey
Introduction In children, the terms “obese” and “overweight” are frequently used interchangeably. The term “overweight” is preferred. With the increase of obesity in adolescents and children, the complications of this condition are better understood. This resulted in an increased interest in the importance of its prevention, diagnosis, and treatment among pediatricians (1). Many centers define obesity as a body mass index (BMI) above 95 percentile for age and sex (1). In most cases, there are no detected underlying diseases; this type of obesity is called primary obesity or exogenic obesity (2). Similar to adults, the prevalence of obesity is rapidly increasing in children and is defined as an epidemic (3). Especially in developed countries, obesity is associated with significantly increased mortality and morbidity. There has been a significant increase in the prevalence in childhood obesity and this leads to more serious problems in early adulthood (1). Development of obesity in childhood is a leading marker for cardiovascular risk with increasing age. Being overweight during childhood is a strong indicator of being overweight later on in life (4). The complications of childhood obesity are hypertension, hyperlipidemia, as well as psychosocial, endocrinologic, gastrointestinal, pulmonary, orthopedic, and neurologic diseases. Besides significantly affecting morbidity and mortality, it is a problem with serious social and economic dimensions (5, 6). Early diagnosis of obesity, which is a chronic disease, and initiating treatment along with necessary precautions, is important for the prevention of possible complications both in childhood and adulthood (7–9). The aim of this study is to evaluate cardiac functions of obese children with conventional echocardiogram (ECHO), electrocardiogram (ECG), and treadmill test.
Materials and methods Patients presenting to the Pediatric Cardiology Polyclinic of Research Hospital of Hundredth Year University Medical Faculty with simple obesity were enrolled into the study. The study was conducted between March and May 2011. Thirty obese patients between ages
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262 Üner et al.: Obesity and cardiac functions 8 and 17 (Group 1) and 30 non-obese patients as the control group (Group 2) were enrolled into the study. Obesity was diagnosed according to BMI. Cases with BMI > 95 percentile were placed into obese group. Thirty patients similar in age and gender without any chronic diseases, not obese according to BMI percentile criteria, presenting to the Pediatric Cardiology Polyclinic for various reasons and have received ECG, ECHO, and stress ECG indications and tests in association with their reason for presenting, were chosen from the records as the control group. The study was approved by the research Ethics Committee and informed consent was taken from the parents of all children who enrolled into the study.
Clinic examination For all cases, age, gender, height, weight, waist circumference, hip circumference, waist/height ratio, and BMI have been recorded. During physical examination, acanthosis nigricans and stria were investigated. Height was measured with a wall-mounted tape measure while standing up straight and barefooted. Weight was measured with a Nan brand platform scale without shoes or outerwear. Waist circumference was measured with a non-flexible tape measure placed to the middle of the distance between lateral costa and iliac crest covering the entire circumference of the waist. Hip circumference was measured with a standard non-flexible tape measure placed at the widest axis of both hips covering the entire circumference of the hips. Waist/hip circumference ratio was calculated by dividing the waist circumference by hip circumference. BMI was calculated by taking the ratio of the weight (kg) and square of height (m2). Systolic and diastolic blood pressure of all patients in obese and normal groups were measured twice (within a 10–20 min interval) between 09:00 and 12:00 after a 20 min rest by the same person using the same sphygmomanometer with a clamping sleeve covering two-thirds of the left arm, in sitting position, and the results were averaged. Systolic pressure was defined as the value where the sound begins and diastolic pressure was defined as the fifth Korotkoff phase. Values were recorded in mm Hg.
Laboratory examination On all obese cases, after at least 8 h of fasting, hemogram, fasting blood sugar, renal and liver functions test (urea, creatinine, serum sodium, potassium, aspartate aminotransferase, and alanine aminotransferase), total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, cholesterol, very low density lipoprotein (VLDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol were investigated.
Electrocardiogram The Nihon Kohden Cardiofax M ECG device was used and ECG with 12 derivations was performed on all patients in the patient and control groups at 10 mm/mV amplitude and 25 mm/s velocity after a 20 min rest. All ECGs were evaluated for rhythm, velocity, axis, PR distance,
QRS, P-wave amplitude, time and dispersion, QT segment and dispersion, corrected QT (QTc) and QTc dispersion (QTcD), atrial dilatation, and ventricular hypertrophy.
Echocardiogram The M-mode, two-dimensional, and Doppler ECHO examinations of the children in the patient and control groups were performed with General Electrics Vivid 5 brand color Doppler ECHO device with 2.5 and 3.5 Hz probes suitable for patient’s age, with patient laying on his/her back in a mild left lateral decubitus position. After it was shown that the patient did not have congenital or acquired valve diseases, the systolic and diastolic functions of the heart were evaluated. Measurements were done according to the recommendation of the American Echocardiography Society (10). Patients with congenital or acquired heart diseases such as congenital or acquired narrowing or deficiency of atrioventricular or semilunar valves, interatrial or interventricular septum defects, congenital defects of large blood vessels, cardiomyopathies, carditis, and pericardial effusion, were excluded from the study.
Cardiovascular stress test Cardiovascular stress test was performed with a Tepa brand device. Bruce treadmill protocol was used for the test (Table 1). Heart rates before and after exercise, peak heart rate, blood pressure before and after exercise, maximum blood pressure, time to reach submaximal heart rate, and maximum load was noted for all patients and control group. Throughout the process, the ECG record was studied for arrhythmia, ST segment, and T wave changes. In addition, chest pain, shortness of breath, consciousness changes, syncope, and any other complaints, not present during rest, were evaluated.
Statistical analysis Definitive statistics to emphasize properties was stated as average, SD, minimum, and maximum values. Group averages for these properties were compared using Student’s t test. To specify the relationship between the above-mentioned properties, Pearson correlation coefficients were calculated. In the calculation, statistical significance was specified as 5%, and for calculations, SPSS 17 statistic package was used.
Table 1 Bruce exercise test protocol. Stage
Speed, m/s
Incline, %
Time, min
1 2 3 4 5 6
1.7 2.5 3.4 4.2 5 5.5
10 12 14 16 18 20
3 3 3 3 3 3
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Üner et al.: Obesity and cardiac functions 263
Results Obese patient group (Group 1) consisted of 16 (53.3%) girls and 14 (46.7%) boys. Control group (Group 2) consisted of 16 (53.3%) girls and 14 (46.7%) boys. There were no statistically significant differences between the groups with respect to age and gender (p > 0.05). Comparison of Groups 1 and 2 for anthropometric measurements showed statistically significant differences for almost all measurements (Table 2). In addition, between systolic (r = 0.682) and diastolic (r = 0.601) blood pressure, P-wave dispersion (PD) in ECG (r = 0.471), aorta (Ao) diameter (r = 0.476) and left atrium diameter in ECHO (r = 0.476), left ventricle end-diastolic diameter (LVEDD; r = 0.457), left ventricle end-systolic diameter (LVESD; r = 0.404), interventricular septum diameter (IVSD; r = 0.469), positive correlation was observed. A statistically significant positive correlation was observed between waist circumference (r = 0.571), diastolic blood pressure (r = 0.381), total cholesterol (r = 0.392), LDL-cholesterol (r = 0.369), Ao diameter (r = 0.405), and IVSD (r = 0.538), whereas a statistically significant negative correlation was observed between PR distance (r = –0.376) and fractional shortening (FS; r = –0.410). Comparison of systolic and diastolic blood pressure showed a significant difference between systolic and diastolic blood pressure between the two groups (p = 0.001). Systolic and diastolic blood pressure were positively correlated with PD (r = 0.453 and 0.503). Serum electrolytes, calcium, phosphorus, and hemoglobin values in both groups were within age-specific normal limits and there were no significant difference between the groups (p > 0.05). When fasting blood was
evaluated, there was no significant difference between Groups 1 and 2 (p > 0.05). A significant difference was detected between the groups when serum lipids were compared (p 0.05); there was statistically significant positive correlation between heart rate and QT dispersion (p 0.05). Compared with Group 1, the PR time was longer in Group 2, but this difference was not statistically significant (p > 0.05). Compared with Group 2 (64.33 ± 14.55 ms), P-wave time was significantly longer in Group 1 (72.83 ± 15.29 ms; p 0.05), PD was significantly different between Group 1 (51.33 ± 11.67 ms) and Group 2 (39.67 ± 11.59 ms; p = 0.001). There was a positive correlation between PD and weight (r = 0.559), BMI (r = 0.523), systolic (r = 0.453) and diastolic
Table 2 Demographic features of obese and control groups. Age, years Body weight, kg Body weight SDS IWFH BMI, kg/m2 Height, cm Waist/height ratio Systolic blood pressure, mm Hg Diastolic blood pressure, mm Hg Fasting blood glucose, g/dL Total cholesterol, mg/dL Triglyceride, mg/dL LDL-cholesterol, mg/dL HDL-cholesterol, mg/dL
Group 1 (n = 30) Mean 12.11 69.68 3.43 154.40 29.95 151.49 0.63 120.17 80.17 93.33 170.67 136.3 98.5 44.03
SD
2.11 16.77 1.41 21.68 4.84 8.59 0.07 17.44 13.86 20.51 30.11 50.26 20.76 13.13
Min
8.33 38 2.1 111 20.6 133.3 0.5 90 60 73 109 67 60 15
Max
17 108.5 8.4 204 39.2 169 0.79 150 110 196 228 234 140 94
Group 2 (n = 30) Mean 11.87 36.53 –0.31 93.77 17.39 143.93 0.43 103.33 67.17 93.37 155.17 69.29 79.23 53
SD
2.16 10.87 0.96 10.74 2.91 12.57 0.03 9.32 5.52 7.65 24.07 28.11 22.03 11.76
IWFH, ideal weight for height.
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Min
16.16 60 1.8 111 23.8 165 0.48 120 80 112 200 160 133 75
8.58 19 –1.9 72 13.6 118 0.36 90 60 74 99 34 40 27
Max
p-Value > 0.05 0.001 0.001 0.001 0.001 0.009 0.001 0.001 0.001 > 0.05 0.03 0.001 0.001 0.007
264 Üner et al.: Obesity and cardiac functions Table 3 Correlation analysis between the physical examinations findings and laboratory findings with effort capacity, BMI, LVEDD, and PD. Body weight, kg IWFH BMI Waist circumference Waist/height ratio Acanthosis nigricans Striate Systolic blood pressure Diastolic blood pressure Fasting blood glucose Total cholesterol Triglyceride LDL-cholesterol HDL-cholesterol Insulin HOMA-IR
METs –0.629 –0.657a –0.642a –0.648a –0.642a –0.114 –0.235 –0.428a –0.464a 0.02 –0.104 –0.421a –0.244 0.254b –0.141 –0.144 a
BMI LVEDD
0.955 0.961b 1 0.958a 0.914b 0.462b 0.446b 0.758a 0.689a 0.046 0.301b 0.568a 0.417a –0.338a 0.386b 0.368b a
0.528 0.454a 0.486a 0.403a 0.336a 239 222 0.375a 0.380a –0.196 0.23 0.274b 0.264b –0.09 0.278 0.278 a
PD
0.559a 0.478a 0.523a 0.468a 0.418b 0.153 0.273 0.453a 0.503a –0.277b 0.271b 0.293b 0.386a –0.148 0.456b 0.475a
p 0.05). The ECHO findings of the groups are shown in Table 4. Before exercising the minute heart rate was 87.67 ± 14.929 in Group 1 and 90.43 ± 15.38 in Group 2 and there was no statistically significant difference between the groups (p > 0.05). When evaluated in terms of time to
target heart rate, the time it took Group 2 (518.67 ± 95.54 s) to reach the target heart race was longer compared with Group 1 (429.33 ± 172.94 s) and this difference was statistically significant (p 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 0.001 > 0.05 > 0.05 > 0.05 > 0.05 0.03 0.001 0.01 0.001 > 0.05 > 0.05 0.001 0.001 > 0.05 > 0.05 0.01 0.02 > 0.05
Abdurrahman Üner, Murat Doğan*, Zerrin Epcacan and Serdar Epçaçan
The effect of childhood obesity on cardiac functions Abstract: Obesity is a metabolic disorder defined as excessive accumulation of body fat, which is made up of genetic, environmental, and hormonal factors and has various social, psychological, and medical complications. Childhood obesity is a major indicator of adult obesity. The aim of this study is to evaluate the cardiac functions via electrocardiography (ECG), echocardiography (ECHO), and treadmill test in childhood obesity. A patient group consisting of 30 obese children and a control group consisting of 30 non-obese children were included in the study. The age range was between 8 and 17 years. Anthropometric measurements, physical examination, ECG, ECHO, and treadmill test were done in all patients. P-wave dispersion (PD) was found to be statistically significantly high in obese patients. In ECHO analysis, we found that end-diastolic diameter, end-systolic diameter, left ventricle posterior wall thickness, and interventricular septum were significantly greater in obese children. In treadmill test, exercise capacity was found to be significantly lower and the hemodynamic response to exercise was found to be defective in obese children. Various cardiac structural and functional changes occur in childhood obesity and this condition includes important cardiovascular risks. PD, left ventricle end-systolic and end-diastolic diameter, left ventricle posterior wall thickness, interventricular septum thickness, exercise capacity, and hemodynamic and ECG measurements during exercise testing are useful tests to determine cardiac dysfunctions and potential arrhythmias even in early stages of childhood obesity. Early recognition and taking precautions for obesity during childhood is very important to intercept complications that will occur in adulthood. Keywords: cardiac functions; childhood; obesity. *Corresponding author: Murat Doğan, MD, Division of Pediatric Endocrinology, Department of Pediatrics, YYU School of Medicine, 65100, Van, Turkey, E-mail: [email protected] Abdurrahman Üner and Serdar Epçaçan: Division of Pediatric Cardiology, Department of Pediatrics, YYU School of Medicine, Van, Turkey Zerrin Epcacan: Department of Pediatrics, YYU School of Medicine, Van, Turkey
Introduction In children, the terms “obese” and “overweight” are frequently used interchangeably. The term “overweight” is preferred. With the increase of obesity in adolescents and children, the complications of this condition are better understood. This resulted in an increased interest in the importance of its prevention, diagnosis, and treatment among pediatricians (1). Many centers define obesity as a body mass index (BMI) above 95 percentile for age and sex (1). In most cases, there are no detected underlying diseases; this type of obesity is called primary obesity or exogenic obesity (2). Similar to adults, the prevalence of obesity is rapidly increasing in children and is defined as an epidemic (3). Especially in developed countries, obesity is associated with significantly increased mortality and morbidity. There has been a significant increase in the prevalence in childhood obesity and this leads to more serious problems in early adulthood (1). Development of obesity in childhood is a leading marker for cardiovascular risk with increasing age. Being overweight during childhood is a strong indicator of being overweight later on in life (4). The complications of childhood obesity are hypertension, hyperlipidemia, as well as psychosocial, endocrinologic, gastrointestinal, pulmonary, orthopedic, and neurologic diseases. Besides significantly affecting morbidity and mortality, it is a problem with serious social and economic dimensions (5, 6). Early diagnosis of obesity, which is a chronic disease, and initiating treatment along with necessary precautions, is important for the prevention of possible complications both in childhood and adulthood (7–9). The aim of this study is to evaluate cardiac functions of obese children with conventional echocardiogram (ECHO), electrocardiogram (ECG), and treadmill test.
Materials and methods Patients presenting to the Pediatric Cardiology Polyclinic of Research Hospital of Hundredth Year University Medical Faculty with simple obesity were enrolled into the study. The study was conducted between March and May 2011. Thirty obese patients between ages
Brought to you by | University of California - San Francisco Authenticated Download Date | 2/17/15 7:37 PM
262 Üner et al.: Obesity and cardiac functions 8 and 17 (Group 1) and 30 non-obese patients as the control group (Group 2) were enrolled into the study. Obesity was diagnosed according to BMI. Cases with BMI > 95 percentile were placed into obese group. Thirty patients similar in age and gender without any chronic diseases, not obese according to BMI percentile criteria, presenting to the Pediatric Cardiology Polyclinic for various reasons and have received ECG, ECHO, and stress ECG indications and tests in association with their reason for presenting, were chosen from the records as the control group. The study was approved by the research Ethics Committee and informed consent was taken from the parents of all children who enrolled into the study.
Clinic examination For all cases, age, gender, height, weight, waist circumference, hip circumference, waist/height ratio, and BMI have been recorded. During physical examination, acanthosis nigricans and stria were investigated. Height was measured with a wall-mounted tape measure while standing up straight and barefooted. Weight was measured with a Nan brand platform scale without shoes or outerwear. Waist circumference was measured with a non-flexible tape measure placed to the middle of the distance between lateral costa and iliac crest covering the entire circumference of the waist. Hip circumference was measured with a standard non-flexible tape measure placed at the widest axis of both hips covering the entire circumference of the hips. Waist/hip circumference ratio was calculated by dividing the waist circumference by hip circumference. BMI was calculated by taking the ratio of the weight (kg) and square of height (m2). Systolic and diastolic blood pressure of all patients in obese and normal groups were measured twice (within a 10–20 min interval) between 09:00 and 12:00 after a 20 min rest by the same person using the same sphygmomanometer with a clamping sleeve covering two-thirds of the left arm, in sitting position, and the results were averaged. Systolic pressure was defined as the value where the sound begins and diastolic pressure was defined as the fifth Korotkoff phase. Values were recorded in mm Hg.
Laboratory examination On all obese cases, after at least 8 h of fasting, hemogram, fasting blood sugar, renal and liver functions test (urea, creatinine, serum sodium, potassium, aspartate aminotransferase, and alanine aminotransferase), total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, cholesterol, very low density lipoprotein (VLDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol were investigated.
Electrocardiogram The Nihon Kohden Cardiofax M ECG device was used and ECG with 12 derivations was performed on all patients in the patient and control groups at 10 mm/mV amplitude and 25 mm/s velocity after a 20 min rest. All ECGs were evaluated for rhythm, velocity, axis, PR distance,
QRS, P-wave amplitude, time and dispersion, QT segment and dispersion, corrected QT (QTc) and QTc dispersion (QTcD), atrial dilatation, and ventricular hypertrophy.
Echocardiogram The M-mode, two-dimensional, and Doppler ECHO examinations of the children in the patient and control groups were performed with General Electrics Vivid 5 brand color Doppler ECHO device with 2.5 and 3.5 Hz probes suitable for patient’s age, with patient laying on his/her back in a mild left lateral decubitus position. After it was shown that the patient did not have congenital or acquired valve diseases, the systolic and diastolic functions of the heart were evaluated. Measurements were done according to the recommendation of the American Echocardiography Society (10). Patients with congenital or acquired heart diseases such as congenital or acquired narrowing or deficiency of atrioventricular or semilunar valves, interatrial or interventricular septum defects, congenital defects of large blood vessels, cardiomyopathies, carditis, and pericardial effusion, were excluded from the study.
Cardiovascular stress test Cardiovascular stress test was performed with a Tepa brand device. Bruce treadmill protocol was used for the test (Table 1). Heart rates before and after exercise, peak heart rate, blood pressure before and after exercise, maximum blood pressure, time to reach submaximal heart rate, and maximum load was noted for all patients and control group. Throughout the process, the ECG record was studied for arrhythmia, ST segment, and T wave changes. In addition, chest pain, shortness of breath, consciousness changes, syncope, and any other complaints, not present during rest, were evaluated.
Statistical analysis Definitive statistics to emphasize properties was stated as average, SD, minimum, and maximum values. Group averages for these properties were compared using Student’s t test. To specify the relationship between the above-mentioned properties, Pearson correlation coefficients were calculated. In the calculation, statistical significance was specified as 5%, and for calculations, SPSS 17 statistic package was used.
Table 1 Bruce exercise test protocol. Stage
Speed, m/s
Incline, %
Time, min
1 2 3 4 5 6
1.7 2.5 3.4 4.2 5 5.5
10 12 14 16 18 20
3 3 3 3 3 3
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Üner et al.: Obesity and cardiac functions 263
Results Obese patient group (Group 1) consisted of 16 (53.3%) girls and 14 (46.7%) boys. Control group (Group 2) consisted of 16 (53.3%) girls and 14 (46.7%) boys. There were no statistically significant differences between the groups with respect to age and gender (p > 0.05). Comparison of Groups 1 and 2 for anthropometric measurements showed statistically significant differences for almost all measurements (Table 2). In addition, between systolic (r = 0.682) and diastolic (r = 0.601) blood pressure, P-wave dispersion (PD) in ECG (r = 0.471), aorta (Ao) diameter (r = 0.476) and left atrium diameter in ECHO (r = 0.476), left ventricle end-diastolic diameter (LVEDD; r = 0.457), left ventricle end-systolic diameter (LVESD; r = 0.404), interventricular septum diameter (IVSD; r = 0.469), positive correlation was observed. A statistically significant positive correlation was observed between waist circumference (r = 0.571), diastolic blood pressure (r = 0.381), total cholesterol (r = 0.392), LDL-cholesterol (r = 0.369), Ao diameter (r = 0.405), and IVSD (r = 0.538), whereas a statistically significant negative correlation was observed between PR distance (r = –0.376) and fractional shortening (FS; r = –0.410). Comparison of systolic and diastolic blood pressure showed a significant difference between systolic and diastolic blood pressure between the two groups (p = 0.001). Systolic and diastolic blood pressure were positively correlated with PD (r = 0.453 and 0.503). Serum electrolytes, calcium, phosphorus, and hemoglobin values in both groups were within age-specific normal limits and there were no significant difference between the groups (p > 0.05). When fasting blood was
evaluated, there was no significant difference between Groups 1 and 2 (p > 0.05). A significant difference was detected between the groups when serum lipids were compared (p 0.05); there was statistically significant positive correlation between heart rate and QT dispersion (p 0.05). Compared with Group 1, the PR time was longer in Group 2, but this difference was not statistically significant (p > 0.05). Compared with Group 2 (64.33 ± 14.55 ms), P-wave time was significantly longer in Group 1 (72.83 ± 15.29 ms; p 0.05), PD was significantly different between Group 1 (51.33 ± 11.67 ms) and Group 2 (39.67 ± 11.59 ms; p = 0.001). There was a positive correlation between PD and weight (r = 0.559), BMI (r = 0.523), systolic (r = 0.453) and diastolic
Table 2 Demographic features of obese and control groups. Age, years Body weight, kg Body weight SDS IWFH BMI, kg/m2 Height, cm Waist/height ratio Systolic blood pressure, mm Hg Diastolic blood pressure, mm Hg Fasting blood glucose, g/dL Total cholesterol, mg/dL Triglyceride, mg/dL LDL-cholesterol, mg/dL HDL-cholesterol, mg/dL
Group 1 (n = 30) Mean 12.11 69.68 3.43 154.40 29.95 151.49 0.63 120.17 80.17 93.33 170.67 136.3 98.5 44.03
SD
2.11 16.77 1.41 21.68 4.84 8.59 0.07 17.44 13.86 20.51 30.11 50.26 20.76 13.13
Min
8.33 38 2.1 111 20.6 133.3 0.5 90 60 73 109 67 60 15
Max
17 108.5 8.4 204 39.2 169 0.79 150 110 196 228 234 140 94
Group 2 (n = 30) Mean 11.87 36.53 –0.31 93.77 17.39 143.93 0.43 103.33 67.17 93.37 155.17 69.29 79.23 53
SD
2.16 10.87 0.96 10.74 2.91 12.57 0.03 9.32 5.52 7.65 24.07 28.11 22.03 11.76
IWFH, ideal weight for height.
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Min
16.16 60 1.8 111 23.8 165 0.48 120 80 112 200 160 133 75
8.58 19 –1.9 72 13.6 118 0.36 90 60 74 99 34 40 27
Max
p-Value > 0.05 0.001 0.001 0.001 0.001 0.009 0.001 0.001 0.001 > 0.05 0.03 0.001 0.001 0.007
264 Üner et al.: Obesity and cardiac functions Table 3 Correlation analysis between the physical examinations findings and laboratory findings with effort capacity, BMI, LVEDD, and PD. Body weight, kg IWFH BMI Waist circumference Waist/height ratio Acanthosis nigricans Striate Systolic blood pressure Diastolic blood pressure Fasting blood glucose Total cholesterol Triglyceride LDL-cholesterol HDL-cholesterol Insulin HOMA-IR
METs –0.629 –0.657a –0.642a –0.648a –0.642a –0.114 –0.235 –0.428a –0.464a 0.02 –0.104 –0.421a –0.244 0.254b –0.141 –0.144 a
BMI LVEDD
0.955 0.961b 1 0.958a 0.914b 0.462b 0.446b 0.758a 0.689a 0.046 0.301b 0.568a 0.417a –0.338a 0.386b 0.368b a
0.528 0.454a 0.486a 0.403a 0.336a 239 222 0.375a 0.380a –0.196 0.23 0.274b 0.264b –0.09 0.278 0.278 a
PD
0.559a 0.478a 0.523a 0.468a 0.418b 0.153 0.273 0.453a 0.503a –0.277b 0.271b 0.293b 0.386a –0.148 0.456b 0.475a
p 0.05). The ECHO findings of the groups are shown in Table 4. Before exercising the minute heart rate was 87.67 ± 14.929 in Group 1 and 90.43 ± 15.38 in Group 2 and there was no statistically significant difference between the groups (p > 0.05). When evaluated in terms of time to
target heart rate, the time it took Group 2 (518.67 ± 95.54 s) to reach the target heart race was longer compared with Group 1 (429.33 ± 172.94 s) and this difference was statistically significant (p 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 0.001 > 0.05 > 0.05 > 0.05 > 0.05 0.03 0.001 0.01 0.001 > 0.05 > 0.05 0.001 0.001 > 0.05 > 0.05 0.01 0.02 > 0.05
