Increased total body fat and abdominal fat from adolescence predicted worsening cardiac structural and functional outcomes by young adulthood, a new study concludes. However, in younger children body fat was not linked to adverse cardiac changes.
“The period from around 17 years appears crucial for lifestyle interventions to avoid excess body fat and potentially harmful cardiac changes, and to increase the chances of healthy adulthood. It’s also a critical time when young people start to become independent from their parents and may significantly change their diet and lifestyle habits,” says Andrew Agbaje, physician and associate professor (docent) of Clinical Epidemiology and Child Health at the University of Eastern Finland.
One indicator of cardiovascular risk is excess heart growth. From late teens, an increase in body fat was associated with increased cardiac mass, which could predict a higher risk of cardiovascular diseases in adulthood. An increase in muscle mass in childhood and adolescence was also linked to increased cardiac mass – but in this case it is more likely to reflect regular, physiological development of the heart muscle along with total muscle mass, Agbaje says.
The study was conducted in collaboration between the University of Bristol in the UK and the University of Eastern Finland. The results were published in the prestigious European Journal of Endocrinology.
In previous studies among children and adolescents, higher body mass index (BMI) has been associated with higher cardiac mass. However, BMI does not distinguish between fat mass and muscle mass. Cross-sectional studies measuring fat mass and muscle mass directly using dual-energy Xray absorptiometry (DXA) have reported that higher muscle mass, but not higher fat mass in childhood was associated with higher cardiac mass.
The present study assessed for the first time the long-term association of directly measured total body fat mass, abdominal fat mass and lean muscle mass during growth from childhood through young adulthood, with changes in cardiac structure and function. 1,803 children from the University of Bristol’s Children of the 90s cohort were followed up from the age of 9 to 24 years. Fat mass and muscle mass were measured with a DXA scan at age 9, 11, 15, 17, and 24 years. An echocardiography scan measured cardiac structure and function at age 17 and 24 years.
During the follow-up, increased total and abdominal fat were cumulatively associated with better heart structure and function until age 17. Conversely, after that they were associated with increased cardiac mass and adverse functional changes in the heart. This shift happened along with a decreasing muscle to fat mass ratio.
“On average, children had 4 times more muscle mass than fat mass, but the ratio had decreased from 4 to 2.4 by mid-twenties. Maintaining the childhood ratio could significantly contribute to a healthy heart,” Agbaje notes.
He adds that childhood obesity should not be diagnosed based on BMI alone, but confirmed with another measure, such as waist-to-height ratio. “In addition, we need to exercise extreme caution in treating childhood obesity, in order to safeguard the development of muscle mass and the heart.”
Increased systolic blood pressure and inflammation explained a combined one-fifth of the association between increased body fat and increased cardiac mass after age 17. Abdominal fat mass accumulation had a two-fold worse effect on the heart compared to total body fat mass.
The participants' fasting blood glucose, insulin, and cholesterol levels were measured at ages 17 and 24 years, blood pressure, heart rate, socio-economic status, family history of cardiovascular disease, smoking status, accelerometer measure of sedentary behaviour and physical activity, as well as inflammation, were accounted for in the analyses.
Agbaje’s research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, Eino Räsänen Fund, Matti and Vappu Maukonen Fund, Foundation for Pediatric Research, Alfred Kordelin Foundation and Novo Nordisk Foundation.
For further information, please contact:
Andrew Agbaje, MD, MPH, PhD, FACC, FESC, FAHA, FNYAM, Cert. Clinical Research (Harvard), Professor (associate) of Clinical Epidemiology and Child Health, Principal Investigator (urFIT-child). Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland. [email protected], +358 46 896 5633
Webpage and waist-to-hight ratio calculator: https://urfit-child.com/waist-height-calculator/
Link to article:
Agbaje AO. DXA-measured truncal adiposity in adolescence but not in childhood longitudinally predicts worsening cardiac outcomes. Eur J Endocrinol. 2026 Apr 6;194(4):454-466. https://doi.org/10.1093/ejendo/lvag044
