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Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes.
Pediatr Diabetes. 2018 06; 19(4):794-800.PD

Abstract

BACKGROUND

Obesity is associated with an increased risk of cardiovascular morbidity in adults with diabetes.

OBJECTIVE

To examine the predictive role of body mass index (BMI) and adiposity on cardiac autonomic function in childhood onset type 1 diabetes.

SUBJECTS

Two hundred and fifty-three participants with type 1 diabetes (aged 8-30 years) were assessed for diabetes complications at a tertiary hospital, and followed over 7 years (total 922 visits).

METHODS

Heart rate variability (HRV) measures assessed by 10-minute electrocardiography recording using LabChart Pro were standard deviation of RR intervals, time between consecutive QRS complexes, [SDNN], root mean squared difference of successive RR intervals (RMSSD), triangular index (TI), and low to high frequency ratio [LF:HF]. Multivariable generalized estimating equations were used to model the longitudinal associations between HRV measures and clinical variables (BMI standard deviation scores [SDS], waist:height ratio, total daily insulin dose/kg (TDD) and hemoglobin A1c [HbA1c]).

RESULTS

At baseline, mean age was 14.4 ± 2.7 years, diabetes duration 7.1 ± 3.7 years, HbA1c 8.3% ± 1.5% (67 ± 16 mmol/mol), and 33% were overweight/obese (BMI ≥85th percentile). At final visit, mean age was 18.5 ± 2.7 years, duration 11.3 ± 3.9 years, HbA1c 9.0% ± 1.8% (75 ± 20 mmol/mol), and 40% were overweight/obese. Adiposity (higher BMI SDS or waist: height ratio) was a significant predictor of worse HRV (lower SDNN, RMSSD; P < .05), while higher HbA1c and TDD predicted all adverse HRV measures (lower SDNN, RMSSD, TI; P < .05) and abnormal sympathovagal balance (higher LF:HF ratio; P < .05).

CONCLUSIONS

Higher BMI and central adiposity are associated with cardiac autonomic dysfunction in childhood onset type 1 diabetes, after adjusting for HbA1c. Interventions targeting overweight/obesity during adolescence may optimize long-term vascular health in type 1 diabetes.

Authors+Show Affiliations

The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia. University of Sydney, Discipline of Child and Adolescent Health, Camperdown, Australia.The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia. University of Sydney, Discipline of Child and Adolescent Health, Camperdown, Australia. University of New South Wales, School of Women's and Children's Health, Randwick, Australia.The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia.The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia.The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia. University of Sydney, Discipline of Child and Adolescent Health, Camperdown, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29383813

Citation

Cho, Yoon H., et al. "Higher Body Mass Index Predicts Cardiac Autonomic Dysfunction: a Longitudinal Study in Adolescent Type 1 Diabetes." Pediatric Diabetes, vol. 19, no. 4, 2018, pp. 794-800.
Cho YH, Craig ME, Jopling T, et al. Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes. Pediatr Diabetes. 2018;19(4):794-800.
Cho, Y. H., Craig, M. E., Jopling, T., Chan, A., & Donaghue, K. C. (2018). Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes. Pediatric Diabetes, 19(4), 794-800. https://doi.org/10.1111/pedi.12642
Cho YH, et al. Higher Body Mass Index Predicts Cardiac Autonomic Dysfunction: a Longitudinal Study in Adolescent Type 1 Diabetes. Pediatr Diabetes. 2018;19(4):794-800. PubMed PMID: 29383813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes. AU - Cho,Yoon H, AU - Craig,Maria E, AU - Jopling,Tracey, AU - Chan,Albert, AU - Donaghue,Kim C, Y1 - 2018/01/31/ PY - 2017/07/30/received PY - 2017/12/04/revised PY - 2017/12/25/accepted PY - 2018/2/1/pubmed PY - 2019/2/13/medline PY - 2018/2/1/entrez KW - adolescents KW - body mass index KW - cardiac autonomic neuropathy KW - obesity KW - type 1 diabetes SP - 794 EP - 800 JF - Pediatric diabetes JO - Pediatr Diabetes VL - 19 IS - 4 N2 - BACKGROUND: Obesity is associated with an increased risk of cardiovascular morbidity in adults with diabetes. OBJECTIVE: To examine the predictive role of body mass index (BMI) and adiposity on cardiac autonomic function in childhood onset type 1 diabetes. SUBJECTS: Two hundred and fifty-three participants with type 1 diabetes (aged 8-30 years) were assessed for diabetes complications at a tertiary hospital, and followed over 7 years (total 922 visits). METHODS: Heart rate variability (HRV) measures assessed by 10-minute electrocardiography recording using LabChart Pro were standard deviation of RR intervals, time between consecutive QRS complexes, [SDNN], root mean squared difference of successive RR intervals (RMSSD), triangular index (TI), and low to high frequency ratio [LF:HF]. Multivariable generalized estimating equations were used to model the longitudinal associations between HRV measures and clinical variables (BMI standard deviation scores [SDS], waist:height ratio, total daily insulin dose/kg (TDD) and hemoglobin A1c [HbA1c]). RESULTS: At baseline, mean age was 14.4 ± 2.7 years, diabetes duration 7.1 ± 3.7 years, HbA1c 8.3% ± 1.5% (67 ± 16 mmol/mol), and 33% were overweight/obese (BMI ≥85th percentile). At final visit, mean age was 18.5 ± 2.7 years, duration 11.3 ± 3.9 years, HbA1c 9.0% ± 1.8% (75 ± 20 mmol/mol), and 40% were overweight/obese. Adiposity (higher BMI SDS or waist: height ratio) was a significant predictor of worse HRV (lower SDNN, RMSSD; P < .05), while higher HbA1c and TDD predicted all adverse HRV measures (lower SDNN, RMSSD, TI; P < .05) and abnormal sympathovagal balance (higher LF:HF ratio; P < .05). CONCLUSIONS: Higher BMI and central adiposity are associated with cardiac autonomic dysfunction in childhood onset type 1 diabetes, after adjusting for HbA1c. Interventions targeting overweight/obesity during adolescence may optimize long-term vascular health in type 1 diabetes. SN - 1399-5448 UR - https://www.unboundmedicine.com/medline/citation/29383813/Higher_body_mass_index_predicts_cardiac_autonomic_dysfunction:_A_longitudinal_study_in_adolescent_type_1_diabetes_ L2 - https://doi.org/10.1111/pedi.12642 DB - PRIME DP - Unbound Medicine ER -