Impact of weight loss on cardiovascular function in adolescents and young adults with overweight/ obesity and intellectual and developmental disabilities.
Geetha Haligheri, Tyler Johnson, Melanie Kathol and 7 others
Weight loss of about 6.5% over six months was associated with a small improvement in left ventricular contraction (GLS from −17.3% to −19.6%) in 49 young people with Down syndrome or autism and obesity.
Blood pressure, arterial stiffness, and exercise capacity did not change.
Key findings
1Left ventricular global longitudinal strain (GLS) improved from −17.3% (low-normal) to −19.6% (normal) over six months, and this was the strongest correlation with BMI change among all cardiovascular measures tested.
2There was no significant change in blood pressure, pulse wave velocity (arterial stiffness), or peak oxygen uptake (exercise capacity) across the cohort over the six-month period.
3Whether a participant had Down syndrome or autism did not significantly affect the cardiovascular changes associated with weight loss, suggesting obesity rather than the specific disability diagnosis drives the cardiac effects.
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What it does not show
Only 49 participants, representing 45% of those enrolled in the parent trial; the rest could not commit to the extra travel and time for cardiovascular testing. The six-month window is short; the authors themselves note that changes in left ventricular mass and other structural measures may take longer to appear. No typically developing comparison group, so it is impossible to say whether the same degree of weight loss would produce the same cardiac changes in a peer group without IDD. Congenital heart disease was excluded, which limits generalisability to the Down syndrome population where CHD is common. Multiple cardiovascular outcomes were tested; the authors acknowledge that some statistically significant p-values may reflect chance and recommend reading point estimates and confidence intervals over p-values. The study was not designed or powered to determine the biological mechanism behind the cardiac changes (inflammation, oxidative stress, afterload were not measured). 81% of participants were White, limiting generalisability across ethnic groups. Some participants could not complete the treadmill exercise test due to gait abnormalities, sensory issues with the face mask, or reluctance to transition from walking to running.
Declared interests
Funded by the US National Institutes of Health (R01HD079642; NCT0256175). Portion-controlled entrées and shakes for the enhanced Stop Light Diet arm were supplied by HMR Weight Management Services Corp. The authors declare no competing interests relevant to the article.
The easy way to misread this
Do not read the 2.3-percentage-point improvement in LV GLS as proof that dietary weight loss reverses cardiac dysfunction in young people with IDD. The change is small, the sample is 49, the authors themselves flag that multiple comparisons make some p-values unreliable, and the study was not designed to test whether any specific dietary approach caused the change. Correlation with BMI loss does not establish that the weight loss produced the cardiac improvement.
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