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. 2018 Apr 10;8(4):e019675. doi: 10.1136/bmjopen-2017-019675

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This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Pathways to altered left ventricular (LV) structure and function that will be investigated in IndEcho. Factors contributing to LV hypertrophy. Intrauterine undernutrition alters the fetal circulation, which may have direct and persistent effects on ventricular structure. Intrauterine and infant undernutrition impairs the development of key metabolic tissues (muscle, pancreas, liver, blood vessels and kidneys) during critical periods of growth and increases adipose tissue deposition, leading to the ‘thin-fat’ phenotype and later obesity, T2DM, dyslipidaemia, hypertension and chronic renal disease, which adversely impact on LV size and function. BMI, body mass index; LV, left ventricular; T2DM, type 2 diabetes mellitus.