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Body and Heart: Effects of Weight Gain and Loss on Left Ventricular Size and Function.

The metabolic and hemodynamic consequences of obesity, and even overweight, adversely affect the health of millions of individuals across the world and have become a global epidemic.1 Body weight comprises both fat (FM) and fat free (lean) mass (FFM). In older adults, while lean tissue mass is associated with reduced cardiovascular mortality, very low or high FM can be associated with adverse outcomes.2 Much of the adverse effects of obesity may be mediated through adverse effects on cardiac structure and function. Decades of research3–5 have established that increased left ventricular (LV) mass (weight), even below levels exceeding reference values which demarcate hypertrophy, and alterations of the geometry of the LV are associated with adverse cardiovascular outcomes, including diastolic dysfunction and heart failure—often with preserved ejection fraction.

See Article by Markus et al 

In this issue of Circulation: Cardiovascular Imaging , using data from the SHIP (Study of Health in Pomerania), a population-based study of 7008 subjects in northeast Germany, Markus et al6 document that changes in body weight over a 5-year period are correlated with changes in LV morphology and function and that the direction and magnitude of these associations depend on the type of body mass composition. Using weight- and height-derived measures of FM and FFM, the authors found that changes in FM, but not FFM, are associated with parallel changes in LV mass. In addition, they report that increases in FM are related to concentric ventricular remodeling, as well as worsened diastolic and systolic function, whereas increases in FFM are associated with eccentric remodeling and improved diastolic and systolic function.

These findings are important in the context of the increasing prevalence of obesity. In this editorial, we address (1) potential pathophysiological mechanisms that may account for the observed associations, (2) methodological issues …