Higher adiposity in adulthood, measured by body mass index and waist-to-hip ratio, may be associated with adverse cardiac structure and function at ages 60 to 64 years, according to a recent study. Some of these associations were independent of adiposity in later life, suggesting a potential lasting impact of excess weight earlier in adulthood.

In the longitudinal study, published in the European Heart Journal, investigators recruited 1,690 patients born in March 1946 in England, Scotland, and Wales who participated in the Medical Research Council National Survey of Health and Development birth cohort. Body mass index (BMI) was measured at ages 20, 26, 36, 43, 53, and 60 to 64 years; whereas waist-to-hip ratio (WHR) was measured from age 43 onward. At the ages of 60 to 64 years, the participants underwent echocardiography using GE Vivid I machines. Echocardiographic measurements included left ventricular mass (LVM), left ventricular internal diameter in diastole (LVIDd), relative wall thickness (RWT), ejection fraction (EF), systolic mitral annular velocity (S'), myocardial contraction fraction (MCF), E/e' ratio, e' velocity, and left atrial volume index (LAVi).

The mean age at outcome measurement was 63.2 ± 1.1 years, and 48.3% of the participants were male. The mean BMI increased from 22.0 ± 2.6 kg/m² at age 20 years to 27.6 ± 4.6 kg/m² at ages 60 to 64 years.

Multivariable linear regression models were used to analyze the relationships between BMI and WHR at different ages and cardiac measures at ages 60 to 64 years. The models were adjusted for age, sex, socioeconomic status, education, and current BMI and WHR.

The investigators found that in participants aged 20 years and older, increased BMI was associated with a greater LVM and LVIDd. For LVM, associations at ages 26, 43, and 53 years remained significant after adjusting for current BMI (β = 1.85, 95% confidence interval [CI] = 0.39–3.31 at age 26; β = 2.62, 95% CI = 1.14–4.10 at age 43; β = 3.01, 95% CI = 1.30–4.71 at age 53). For LVIDd, associations remained significant at all ages after adjusting for current BMI.

Higher BMI from age 43 years was associated with a greater RWT; however, these associations were attenuated to null when adjusting for current BMI.

Regarding cardiac function, the investigators discovered that elevated BMI from age 26 years was associated with lower EF and MCF (worse systolic function) as well as a higher E/e' ratio and lower e' velocity (poorer diastolic function). After accounting for current BMI, associations with systolic function were largely attenuated. However, for diastolic function, the relationship between BMI and LAVi remained significant from age 26 years independent of BMI at ages 60 to 64 (β = 0.56, 95% CI = 0.23–0.89 at age 26).

Similar findings were observed for WHR starting at age 43, with associations between WHR and LAVi and MCF remaining significant after adjusting for current WHR.

The investigators noted that the study population was predominantly comprised of White participants from England, limiting generalizability. Self-reported height and weight measurements at ages 20 and 26 may be subject to reporting bias. Unmeasured confounders, particularly dietary calorie intake, were not accounted for in the models.

The investigators concluded that adiposity over a patient's life span may have a lasting adverse impact on cardiac structure and function, highlighting the potential significance of preventing excess weight gain starting early in adulthood. 

The authors declared having no competing interests.