Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome

Andrea Kelly, Samuel S. Gidding, Rachel Walega, Claire Cochrane, Sarah Clauss, Ray R. Townsend, Melissa Xanthopoulos, Mary E. Pipan, Babette S. Zemel, Sheela Magge, Meryl S. Cohen

Research output: Contribution to journalArticle

Abstract

Median survival in Down syndrome (DS) is 60 years, but cardiovascular disease risk and its markers such as left ventricular mass (LVM) have received limited attention. In youth, LVM is typically scaled to height2.7 as a surrogate for lean body mass (LBM), the strongest predictor of LVM, but whether this algorithm applies to DS, a condition which features short stature, is unknown. To examine the relationships of LVM and function with height, LBM, and moderate-to-vigorous physical activity(MVPA) in DS, DS youth aged 10–20 years, and age-, sex-, BMI-, race-matched nonDS controls underwent echocardiography for LVM, ejection fraction (EF), and left ventricular diastolic function (measured as E/E′); dual-energy X-ray absorptiometry (DXA)-measured LBM; accelerometry for MVPA. (DS vs. nonDS median [min–max]): DS had lower height (cm) (144.5 [116.7–170.3] vs. 163.3 [134.8–186.7]; p < 0.0001); LBM (kg) (33.48 [14.5–62.3] vs 41.8 [18.07–72.46], p < 0.0001); and LVM (g) (68.3 [32.1–135] vs 94.0 [43.9–164.6], p < 0.0001); similar EF (%) (65 [54–77] vs 64 [53–77], p = 0.59); and higher E/E′ (8.41 [5.54–21.4] vs 5.81 [3.44–9.56], p < 0.0001). In height2.7-adjusted models, LVM was lower in DS (β = − 7.7, p = 0.02). With adjustment for LBM, LVM was even lower in DS (β = − 15.1, p < 0.0001), a finding not explained by MVPA. E/E′ remained higher in DS after adjustment for age, height, HR, SBP, and BMI (β = 2.6, p < 0.0001). DS was associated with stiffer left ventricles and lower LVM, the latter magnified with LBM adjustment. Scaling to height2.7, the traditional approach for assessing LVM in youth, may underestimate LVM differences in DS. Whether lower LVM and diastolic function are intrinsic to DS, pathologic, or protective remains unknown. Clinical Trial Registration: NCT01821300.

Original languageEnglish (US)
JournalPediatric Cardiology
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Down Syndrome
Body Composition
Exercise
Left Ventricular Function
Accelerometry
Body Height
Photon Absorptiometry
Stroke Volume
Heart Ventricles
Echocardiography
Cardiovascular Diseases
Clinical Trials

Keywords

  • Body composition
  • Down syndrome
  • Echocardiogram
  • Left ventricular diastolic function
  • Left ventricular mass

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome. / Kelly, Andrea; Gidding, Samuel S.; Walega, Rachel; Cochrane, Claire; Clauss, Sarah; Townsend, Ray R.; Xanthopoulos, Melissa; Pipan, Mary E.; Zemel, Babette S.; Magge, Sheela; Cohen, Meryl S.

In: Pediatric Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Kelly, Andrea ; Gidding, Samuel S. ; Walega, Rachel ; Cochrane, Claire ; Clauss, Sarah ; Townsend, Ray R. ; Xanthopoulos, Melissa ; Pipan, Mary E. ; Zemel, Babette S. ; Magge, Sheela ; Cohen, Meryl S. / Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome. In: Pediatric Cardiology. 2018.
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abstract = "Median survival in Down syndrome (DS) is 60 years, but cardiovascular disease risk and its markers such as left ventricular mass (LVM) have received limited attention. In youth, LVM is typically scaled to height2.7 as a surrogate for lean body mass (LBM), the strongest predictor of LVM, but whether this algorithm applies to DS, a condition which features short stature, is unknown. To examine the relationships of LVM and function with height, LBM, and moderate-to-vigorous physical activity(MVPA) in DS, DS youth aged 10–20 years, and age-, sex-, BMI-, race-matched nonDS controls underwent echocardiography for LVM, ejection fraction (EF), and left ventricular diastolic function (measured as E/E′); dual-energy X-ray absorptiometry (DXA)-measured LBM; accelerometry for MVPA. (DS vs. nonDS median [min–max]): DS had lower height (cm) (144.5 [116.7–170.3] vs. 163.3 [134.8–186.7]; p < 0.0001); LBM (kg) (33.48 [14.5–62.3] vs 41.8 [18.07–72.46], p < 0.0001); and LVM (g) (68.3 [32.1–135] vs 94.0 [43.9–164.6], p < 0.0001); similar EF ({\%}) (65 [54–77] vs 64 [53–77], p = 0.59); and higher E/E′ (8.41 [5.54–21.4] vs 5.81 [3.44–9.56], p < 0.0001). In height2.7-adjusted models, LVM was lower in DS (β = − 7.7, p = 0.02). With adjustment for LBM, LVM was even lower in DS (β = − 15.1, p < 0.0001), a finding not explained by MVPA. E/E′ remained higher in DS after adjustment for age, height, HR, SBP, and BMI (β = 2.6, p < 0.0001). DS was associated with stiffer left ventricles and lower LVM, the latter magnified with LBM adjustment. Scaling to height2.7, the traditional approach for assessing LVM in youth, may underestimate LVM differences in DS. Whether lower LVM and diastolic function are intrinsic to DS, pathologic, or protective remains unknown. Clinical Trial Registration: NCT01821300.",
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AU - Kelly, Andrea

AU - Gidding, Samuel S.

AU - Walega, Rachel

AU - Cochrane, Claire

AU - Clauss, Sarah

AU - Townsend, Ray R.

AU - Xanthopoulos, Melissa

AU - Pipan, Mary E.

AU - Zemel, Babette S.

AU - Magge, Sheela

AU - Cohen, Meryl S.

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N2 - Median survival in Down syndrome (DS) is 60 years, but cardiovascular disease risk and its markers such as left ventricular mass (LVM) have received limited attention. In youth, LVM is typically scaled to height2.7 as a surrogate for lean body mass (LBM), the strongest predictor of LVM, but whether this algorithm applies to DS, a condition which features short stature, is unknown. To examine the relationships of LVM and function with height, LBM, and moderate-to-vigorous physical activity(MVPA) in DS, DS youth aged 10–20 years, and age-, sex-, BMI-, race-matched nonDS controls underwent echocardiography for LVM, ejection fraction (EF), and left ventricular diastolic function (measured as E/E′); dual-energy X-ray absorptiometry (DXA)-measured LBM; accelerometry for MVPA. (DS vs. nonDS median [min–max]): DS had lower height (cm) (144.5 [116.7–170.3] vs. 163.3 [134.8–186.7]; p < 0.0001); LBM (kg) (33.48 [14.5–62.3] vs 41.8 [18.07–72.46], p < 0.0001); and LVM (g) (68.3 [32.1–135] vs 94.0 [43.9–164.6], p < 0.0001); similar EF (%) (65 [54–77] vs 64 [53–77], p = 0.59); and higher E/E′ (8.41 [5.54–21.4] vs 5.81 [3.44–9.56], p < 0.0001). In height2.7-adjusted models, LVM was lower in DS (β = − 7.7, p = 0.02). With adjustment for LBM, LVM was even lower in DS (β = − 15.1, p < 0.0001), a finding not explained by MVPA. E/E′ remained higher in DS after adjustment for age, height, HR, SBP, and BMI (β = 2.6, p < 0.0001). DS was associated with stiffer left ventricles and lower LVM, the latter magnified with LBM adjustment. Scaling to height2.7, the traditional approach for assessing LVM in youth, may underestimate LVM differences in DS. Whether lower LVM and diastolic function are intrinsic to DS, pathologic, or protective remains unknown. Clinical Trial Registration: NCT01821300.

AB - Median survival in Down syndrome (DS) is 60 years, but cardiovascular disease risk and its markers such as left ventricular mass (LVM) have received limited attention. In youth, LVM is typically scaled to height2.7 as a surrogate for lean body mass (LBM), the strongest predictor of LVM, but whether this algorithm applies to DS, a condition which features short stature, is unknown. To examine the relationships of LVM and function with height, LBM, and moderate-to-vigorous physical activity(MVPA) in DS, DS youth aged 10–20 years, and age-, sex-, BMI-, race-matched nonDS controls underwent echocardiography for LVM, ejection fraction (EF), and left ventricular diastolic function (measured as E/E′); dual-energy X-ray absorptiometry (DXA)-measured LBM; accelerometry for MVPA. (DS vs. nonDS median [min–max]): DS had lower height (cm) (144.5 [116.7–170.3] vs. 163.3 [134.8–186.7]; p < 0.0001); LBM (kg) (33.48 [14.5–62.3] vs 41.8 [18.07–72.46], p < 0.0001); and LVM (g) (68.3 [32.1–135] vs 94.0 [43.9–164.6], p < 0.0001); similar EF (%) (65 [54–77] vs 64 [53–77], p = 0.59); and higher E/E′ (8.41 [5.54–21.4] vs 5.81 [3.44–9.56], p < 0.0001). In height2.7-adjusted models, LVM was lower in DS (β = − 7.7, p = 0.02). With adjustment for LBM, LVM was even lower in DS (β = − 15.1, p < 0.0001), a finding not explained by MVPA. E/E′ remained higher in DS after adjustment for age, height, HR, SBP, and BMI (β = 2.6, p < 0.0001). DS was associated with stiffer left ventricles and lower LVM, the latter magnified with LBM adjustment. Scaling to height2.7, the traditional approach for assessing LVM in youth, may underestimate LVM differences in DS. Whether lower LVM and diastolic function are intrinsic to DS, pathologic, or protective remains unknown. Clinical Trial Registration: NCT01821300.

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KW - Down syndrome

KW - Echocardiogram

KW - Left ventricular diastolic function

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