Publication:

Association between adolescent obesity and subclinical cardiac dysfunction: a systematic review and meta‑analysis

Rising rates of adolescent obesity raise concerns about early cardiac changes that may silently progress to dysfunction. Sensitive imaging techniques can detect subclinical cardiac impairment in youth, even when standard echocardiography appears normal. We conducted a comprehensive systematic review and meta‑analysis to evaluate the association between adolescent obesity and subclinical cardiac dysfunction, focusing on measures such as myocardial relaxation velocity (e′), e′/a′ ratio, global longitudinal strain (GLS), ventricular mass changes, right ventricular (RV) strain, and metabolic modulators like insulin resistance and leptin. Database searches (PubMed, PMC, JACC, AHA Journals, ScienceDirect) up to July 2025 identified 24 studies (n=2,200 adolescents, ages 10–19). Among them, 16 provided sufficient numeric data for meta‑analysis. Studies used tissue Doppler imaging (TDI), speckle-tracking echocardiography (STE), and MRI. Random-effects models yielded standardized mean differences (SMD) for e′, e′/a′, and GLS; heterogeneity assessed via I²; bias via funnel plots. Obese adolescents consistently exhibited reduced e′ (SMD=–0.75; p<0.00; I²=52%), reduced e′/a′ ratio (SMD=–0.60; p<0.001; I²=48%), and lower GLS (SMD=–0.68; p<0.001; I²=55%). Most studies also reported increased left ventricular mass, concentric remodeling, and impaired RV strain. Metabolic factors (insulin resistance, elevated leptin, dysglycemia) correlated with worse strain outcomes. Adolescent obesity is linked to measurable subclinical biventricular cardiac dysfunction, detectable via advanced echocardiographic techniques. These abnormalities often precede overt disease, underscoring the need for early detection and targeted intervention to halt progression.