Left Ventricular Hypertrophy Found in Children Who Appear Healthy
Children who don't appear to be overweight may actually fit the clinical diagnosis and exhibit dangerous signs of heart disease, according to new research from Cincinnati Children's Hospital Medical Center.
The study, presented at the spring American College of Cardiology meeting, found that a number of children who appeared to be normal and healthy had already begun to develop left ventricular hypertrophy (LVH), the thickening of the heart wall typically associated with children who are clearly obese. Later calculation of the children's body mass index (BMI) revealed that, contrary to appearances, they were actually overweight.
The research team also compared children who doctors viewed as normal during the past three years with a similar group from the late 1980s. The more than 1,000 subjects ranged in age from 2 to 17.
The team found BMI for the more recent group averaged 18.8 compared with 17.9 for the 1980s cohort. Echocardiograms showed 10 percent greater incidence of LVH in the current group. Even accounting for age and gender, the link with increased risk for heart disease was clear.
"The higher your BMI, the worse your hypertrophy," says Sandy Witt, RDCS, research sonographer at Cincinnati Children's and lead author of the study.
Left unaddressed, such changes can raise a child's risk for premature coronary artery disease and worse. "LVH is a proven cardiovascular risk factor in adults for subsequent heart attacks," says Tom Kimball, MD, a pediatric cardiologist at Cincinnati Children's.
He acknowledges it's easy to miss the diagnosis of overweight. "We've become desensitized to what a normal child should look like. So when we see another overweight child come in, we think nothing of it."
Dr. Kimball urges doctors to make BMI a routine part of each patient visit – and to be prepared for surprises. "I do it on all my patients now before I go into the room. Based on the number, I expect a child to look overweight. Often he doesn't. If I hadn't done the BMI, I wouldn't have counseled that child and parent."
Dr. Kimball recommends the pediatric BMI calculator at http://www.cdc.gov/. "It gives the absolute BMI and relates it to age and gender, so you get a percentile ranking." Above the 85th percentile is considered overweight; over 95 obese.
But while research shows that losing weight can reverse heart changes, moving families to act takes patience, persistence and guidance that many aren't getting, says Christopher Bolling, MD, medical director of the Comprehensive Weight Management Center at Cincinnati Children's.
"Parents want to know the clinical facts. Then they'll decide what to do with them," Dr. Bolling says. Often parents immediately feel criticized for their parenting and question the diagnosis. "We have to meet parents where they are. They need time to process. So if you're rebuffed, don't get frustrated. Identify the weight problem, and give them information. When they're ready to hear, counsel them."
And finally, Dr. Bolling urges doctors to identify weight loss resources in their communities, and make a list they can share with families.
