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Blüher S, Petroff D, Keller A, Wagner A, Classen J, Baum P. Effect of a 1-Year Obesity Intervention (KLAKS Program) on Preexisting Autonomic Nervous Dysfunction in Childhood Obesity. J Child Neurol 2015; 30:1174-81. [PMID: 25406153 DOI: 10.1177/0883073814555190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 09/19/2014] [Indexed: 11/16/2022]
Abstract
Childhood obesity may involve autonomic nervous system dysfunction. Whether it improves following weight loss remains unclear. Thirty-one obese children (body mass index standard deviation scores 2.33 ± 0.47; age 11.2 ± 2.0) completed a 1-year lifestyle intervention (KLAKS: Concept Leipzig: Adiposity Therapy for School-Aged Children). Anthropometric/biochemical parameters and autonomic nervous system function (heart rate variability, quantitative pupillography) were assessed at baseline and follow-up. A multivariate model for changes in body mass index standard deviation scores considered age, gender, and changes in autonomic nervous system function. Weight status (Δ body mass index standard deviation scores: 0.16 [0.05, 0.29], P = .008), glycemic control, and free fatty acids (all P < .05) improved after the intervention. Redilation velocity increased by 0.22 mm/s [0.06, 0.38] (P = .008), and changes tended to be negatively associated with Δ body mass index standard deviation scores (P = .08 [-0.61, 0.03]). Relative reflex amplitude (23.4 vs 26.3, P = .004) and constriction velocity (4.97 mm/s vs 5.47 mm/s, P < .001) also improved. Our data provide preliminary evidence that lifestyle-intervention induced improvement of weight status/metabolic risk factors may ameliorate some parameters of autonomic nervous system dysfunction in childhood obesity.
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Affiliation(s)
- Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Germany Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | | | | | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Petra Baum
- Department of Neurology, University of Leipzig, Leipzig, Germany
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Cozzolino D, Grandone A, Cittadini A, Palmiero G, Esposito G, De Bellis A, Furlan R, Perrotta S, Perrone L, Torella D, Miraglia del Giudice E. Subclinical myocardial dysfunction and cardiac autonomic dysregulation are closely associated in obese children and adolescents: the potential role of insulin resistance. PLoS One 2015; 10:e0123916. [PMID: 25906397 PMCID: PMC4408004 DOI: 10.1371/journal.pone.0123916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/09/2015] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of obesity is increasing among children/adolescents. Subtle cardiovascular abnormalities, responsible for a higher mortality later in life, have been reported in obese children/adolescents. The aims of the study were to evaluate cardiovascular autonomic regulation, by means of spectrum analysis of R-R interval variability, and myocardial function, by means of standard and tissue Doppler echocardiography, in a group of non-hypertensive asymptomatic obese children and adolescents; furthermore, the influence of insulin resistance was tested. Subjects and Methods R-R interval variability was analyzed during both the 70° head-up tilt and 24-hour electrocardiographic holter monitoring. Spectrum analysis of R-R interval variability provided the indices of sympathetic (low frequency [LFRR]) and vagal (high frequency [HFRR]) modulation of the sinoatrial node. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to classify obese children/adolescents (n=72) as insulin resistant (n=37) and non-insulin resistant (n=35). Results In obese subjects: a) left ventricular mass was significantly (p<0.05) increased, whereas both the e/a ratio and the e'/a' ratio were decreased; b) at rest, HFRR was lower, and the LFRR/HFRR ratio was higher; c) during tilting, magnitude of tilt-induced inhibition of HFRR was lower; d) during 24-hour electrocardiographic holter monitoring, LFRR and the LFRR/HFRR ratio were higher, whereas HFRR was lower; e) HOMA-IR inversely correlated with both the e'/a' ratio (r=-0.655; p<0.001) and the tilt-induced LFRR/HFRR ratio (r=-0.933; p<0.001); and, f) the e'/a' ratio correlated with the tilt-induced LFRR/HFRR ratio (r=0.501; p<0.001). Moreover, HFRR at rest, magnitude of tilt-induced HFRR reduction, and the e'/a' ratio in insulin resistant obese children/adolescents were markedly lower when compared with the remaining subjects. Conclusions Subclinical abnormalities of myocardial function and of cardiac autonomic regulation were closely associated in obese children/adolescents and both correlated with the degree of insulin resistance.
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Affiliation(s)
- Domenico Cozzolino
- Department of Internal Medicine, Second University of Naples, Naples, Italy
- * E-mail:
| | - Anna Grandone
- Department of Women, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Palmiero
- Department of Internal Medicine, Second University of Naples, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Annamaria De Bellis
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - Raffaello Furlan
- Internal Medicine, Humanitas Research Hospital, University of Milan, Rozzano, Italy
| | - Silverio Perrotta
- Department of Women, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Laura Perrone
- Department of Women, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Daniele Torella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Santos-Magalhaes AF, Aires L, Martins C, Silva G, Teixeira AM, Mota J, Rama L. Heart rate variability, adiposity, and physical activity in prepubescent children. Clin Auton Res 2015; 25:169-78. [PMID: 25820790 DOI: 10.1007/s10286-015-0277-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 12/04/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed at examining the associations between weight status, body fat mass, and heart rate variability in prepubescent children, adjusting for physical activity levels. METHODS A cross-sectional investigation in which a total of 50 Caucasian pre-pubertal children (21 normal weight; 8 overweight; 21 obese), aged 6-10 years (8.33 ± 1.14), including both boys (n = 24) and girls (n = 26), were recruited from local schools. Total body fat and trunk fat were evaluated through dual-energy X-ray absorptiometry. Free-living physical activity levels were evaluated by accelerometer. Short-term heart rate variability acquisition was performed; time- and frequency-domain parameters were analysed. Logarithmic transformations of the low-frequency (LnLFnu), high-frequency (LnHFnu) normalized units and low-frequency/high-frequency (LnLFnu/HFnu) ratio were computed. RESULTS Adjusting for age, Tanner stage, and moderate to vigorous physical activity levels, obese children compared to normal weight children showed a significant decreased LnHfnu (3.8 ± 0.2 vs 4.1 ± 0.2 %) and both higher LnLFnu (4.0 ± 0.4 vs 3.7 ± 0.3 %) and LnLFnu/LnHFnu ratio (1.1 ± 0.1 vs 0.9 ± 0.1). LnHFnu showed significant negative correlation with waist circumference (r = -0.598; P = 0.000), total body fat (r = -0.409; P = 0.011) and trunk fat (r = -0.472; P = 0.003). Both LnLFnu and LnLFnu/LnHFnu ratio showed positive correlations with waist circumference (r = 0.455; r = 0.513) and trunk fat (r = 0.370; r = 0.415). CONCLUSIONS A higher amount of body fat mass, particularly central fat, was shown to be related to decreased parasympathetic modulation in time-domain heart rate variability. This finding highlights the potential cardiovascular risk that excessive fat mass may represent even at very young age.
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Salivary alpha amylase diurnal pattern and stress response are associated with body mass index in low-income preschool-aged children. Psychoneuroendocrinology 2015; 53:40-8. [PMID: 25588701 PMCID: PMC4336565 DOI: 10.1016/j.psyneuen.2014.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/08/2014] [Accepted: 12/15/2014] [Indexed: 11/24/2022]
Abstract
Physiological stress responses are proposed as a pathway through which stress can "get under the skin" and lead to health problems, specifically obesity. We tested associations of salivary alpha amylase (sAA) diurnal patterns and stress responses with body mass index (BMI) in young, low-income children (51% male; 54% non-Hispanic white). Diurnal saliva samples were collected three times per day across three days for 269 children (M age 50.8 months, SD 6.3). Individual sAA intercept and slope values were calculated using random effect models to represent morning sAA levels and rate of sAA change across the day. A subset of children (n=195; M age 56.6 months, SD 6.9) participated in a lab-based behavioral stress protocol. Area under the curve increase (AUCI) across four timepoints was calculated to represent increase in sAA output during stress elicitation. Children were weighed and height measured and BMI z-score was calculated. Linear regression was used to evaluate associations of sAA intercept, sAA slope, and sAA AUCI with BMI z-score, controlling for child age, sex, and race/ethnicity; maternal weight status; and family income-to-needs ratio. Diurnal and stress-response sAA patterns were related to child adiposity: for each 1-standard deviation unit (SDU) decrease in morning sAA level, the child's BMI z-score increased by 0.11 (SE 0.05) SDU's (p<.04); for each 1-SDU increase in sAA slope across the day, the child's BMI z-score increased by 0.12 (SE 0.05) SDU's (p<.03); and for each 1-SDU decrease in sAA AUCI during the stress elicitation, the child's BMI z-score increased by 0.14 (SE 0.06) SDU's (p<.03). Blunted stress responses and atypical diurnal patterns of sAA have been found following exposure to chronic life stressors such as poverty. Findings suggest that associations of stress, sAA, and elevated body mass index may develop very early in the lifespan.
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Chintala KK, Krishna BH, N MR. Heart rate variability in overweight health care students: correlation with visceral fat. J Clin Diagn Res 2015; 9:CC06-8. [PMID: 25737980 PMCID: PMC4347071 DOI: 10.7860/jcdr/2015/12145.5434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/10/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Increased sympathetic activity, decreased parasympathetic activity and sympathovagal imbalance (SVI) has been reported in obese individuals. However, the SVI and its association with visceral fat in overweight health care students have not been explored. Therefore, in the present study, we have assessed heart rate variability (HRV) and its association with visceral fat in overweight health care students. MATERIALS AND METHODS Frequency domain parameters of HRV, body fat distribution and baseline anthropometric parameters were recorded in the control (n=40) and overweight (n=40) individuals. Further, the association of visceral fat with HRV was analysed. RESULTS There was no significant difference in age and height of overweight group and control group (p = 0.732). The baseline heart rate and blood pressure (p<0.001) were higher in the overweight group. Total body fat, subcutaneous fat and visceral fat were higher in the overweight group (p<0.001). Among frequency domain parameter of HRV, LFnu and LF: HF were more in the overweight group (p<0.001). Further, HFnu was less in the overweight group (p<0.001). CONCLUSION Sympathovagal imbalance due to increased sympathetic activity and its association with visceral fat was observed in overweight individuals.
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Affiliation(s)
- Kiran Kumar Chintala
- Assistant Professor, Department of Physiology, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Bandi Hari Krishna
- Tutor, Department of Physiology, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Mallikarjuna Reddy N
- Professor & HOD, Department of Physiology, Narayana Medical College, Nellore, Andhra Pradesh, India
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Association of sympathovagal imbalance with obesity indices, and abnormal metabolic biomarkers and cardiovascular parameters. Obes Res Clin Pract 2015; 9:55-66. [DOI: 10.1016/j.orcp.2014.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 01/01/2014] [Accepted: 01/20/2014] [Indexed: 12/23/2022]
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Dippacher S, Willaschek C, Buchhorn R. Different nutritional states and autonomic imbalance in childhood. Eur J Clin Nutr 2014; 68:1271-3. [DOI: 10.1038/ejcn.2014.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/25/2014] [Accepted: 08/08/2014] [Indexed: 11/09/2022]
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Cozzolino D, Esposito K, Palmiero G, De Bellis A, Furlan R, Perrotta S, Perrone L, Torella D, Miraglia del Giudice E. Cardiac autonomic regulation in response to a mixed meal is impaired in obese children and adolescents: the role played by insulin resistance. J Clin Endocrinol Metab 2014; 99:3199-207. [PMID: 24840808 DOI: 10.1210/jc.2013-4211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT Obesity in children/adolescents has been associated with subtle cardiac abnormalities, including myocardial dysfunction and cardiac autonomic dysregulation at rest, both likely responsible for a higher mortality in adulthood. Food intake induces remarkable adjustments of cardiovascular autonomic activity in healthy subjects. OBJECTIVE The objective of the study was to evaluate in obese children/adolescents meal-induced cardiac autonomic response and the role played by insulin resistance. DESIGN AND SETTING Sixty-eight obese and 30 matched normal-weight children/adolescents underwent blood sampling and cardiovascular autonomic analysis while recumbent and 20 minutes after a mixed meal ingestion. Spectrum analysis of the R-R interval and systolic blood pressure (SBP) variability provided the indices of sympathetic [low frequency (LFRR)] and vagal [high frequency (HFRR)] modulation of the sinoatrial node and the low frequency component of SBP. The homeostasis model assessment of insulin resistance served to separate insulin resistant (n = 35) from non insulin resistant (n = 33) obese children/adolescents. RESULTS At baseline, C-reactive protein, the LFRR to HFRR ratio, SBP, and low frequency oscillatory component of SBP variability in obese children/adolescents were significantly (P < .05) greater than in referent subjects, whereas high-density lipoprotein cholesterol and HFRR were lower; meal-induced increase in the LFRR to HFRR ratio was significantly less than in controls and exaggeratedly scanty (or opposite) among insulin resistant subjects. The homeostasis model assessment of insulin resistance index strongly and inversely correlated (r = -0.871; P < .001) with meal-induced changes in the LFRR to HFRR ratio among obese subjects. CONCLUSIONS Autonomic modulation of the heart was impaired after eating in obese children/adolescents. This abnormality was exaggerated among insulin resistant subjects and strongly correlated with the degree of insulin resistance.
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Affiliation(s)
- Domenico Cozzolino
- Division of Internal Medicine (D.C., G.P.), Division of Endocrinology (K.E., A.D.B.), and Department of Pediatrics (S.P., L.P., E.M.d.G.), Second University of Naples, 80131 Naples, Italy; Department of Internal Medicine (R.F.), Humanitas Clinical and Research Center, Rozzano, BIOMETRA Department, University of Milan, 20122 Milan, Italy; and Division of Cardiology (D.T.), University of Catanzaro, 88100 Catanzaro, Italy
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Liao D, Rodríguez-Colón SM, He F, Bixler EO. Childhood obesity and autonomic dysfunction: risk for cardiac morbidity and mortality. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:342. [PMID: 25143120 DOI: 10.1007/s11936-014-0342-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OPINION STATEMENT The epidemic of childhood obesity is becoming a major predictor for risk of cardiovascular diseases (CVD) and mortality during adulthood. Alterations in the morphology of the heart due to obesity could be a predictor for the dysfunction of cardiac autonomic modulation (CAM). A number of epidemiologic studies have evaluated the effect of obesity and CAM in children, finding that obesity impaired the balance of CAM toward a sympathetic overflow and reduced parasympathetic modulation, a significant predictor of CVD morbidity and mortality in adults. Lifestyle modifications, for example long-term exercise programs, have been shown to improve CAM in the obese. This review discusses the recent evidence on childhood and adolescent obesity and its impact on CAM, as well as how early lifestyle changes could help improve CAM, which may in turn reduce the burden of CVD in adults.
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Affiliation(s)
- Duanping Liao
- Department of Public Health Sciences, Penn State University College of Medicine, 90 Hope Drive, Suite 2000/A210, PO Box 855, Hershey, PA, 17033, USA,
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Alkon A, Harley KG, Neilands TB, Tambellini K, Lustig RH, Boyce WT, Eskenazi B. Latino children's body mass index at 2-3.5 years predicts sympathetic nervous system activity at 5 years. Child Obes 2014; 10:214-24. [PMID: 24745554 PMCID: PMC4038992 DOI: 10.1089/chi.2013.0063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To understand whether the relationship between young children's autonomic nervous system (ANS) responses predicted their BMI, or vice versa, the association between standardized BMI (zBMI) at 2, 3.5, and 5 years of age and ANS reactivity at 3.5-5 years of age, and whether zBMI predicts later ANS reactivity or whether early ANS reactivity predicts later zBMI, was studied. METHODS Low-income, primarily Latino children (n=112) were part of a larger cohort study of mothers recruited during early pregnancy. Study measures included maternal prenatal weight, children's health behaviors (i.e., time watching television, fast food consumption, and time playing outdoors), children's height and weight at 2, 3.5, and 5 years, and children's ANS reactivity at 3.5 and 5 years. ANS measures of sympathetic nervous system (i.e., pre-ejection period) and parasympathetic nervous system (i.e., respiratory sinus arrhythmia) activity were monitored during rest and four challenges. Reactivity was calculated as the difference between mean challenge response and rest. Structural equation models analyzed the relationship between children's zBMI at 2, 3.5, and 5 years and ANS reactivity at 3.5 and 5 years, adjusting for mother's BMI, children's behaviors, and changes in height. RESULTS There was no association between zBMI and ANS cross-sectionally. Children with high zBMI at 2 or 3.5 years or large zBMI increases from 2 to 3.5 years of age had decreased sympathetic activity at 5 years. Neither sympathetic nor parasympathetic reactivity at 3.5 years predicted later zBMI. CONCLUSIONS Increased zBMI early in childhood may dampen young children's SNS responses later in life.
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Affiliation(s)
- Abbey Alkon
- School of Nursing, University of California, San Francisco, San Francisco, CA
| | - Kim G. Harley
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention, University of California, San Francisco, San Francisco, CA
| | - Katelyn Tambellini
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Robert H. Lustig
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, San Francisco, CA
| | - W. Thomas Boyce
- Division of Developmental and Behavioral Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, Berkeley, CA
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Wang Y, Carreras A, Lee S, Hakim F, Zhang SX, Nair D, Ye H, Gozal D. Chronic sleep fragmentation promotes obesity in young adult mice. Obesity (Silver Spring) 2014; 22:758-62. [PMID: 24039209 PMCID: PMC3947647 DOI: 10.1002/oby.20616] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/01/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Short sleep confers a higher risk of obesity in humans. Restricted sleep increases appetite, promotes higher calorie intake from fat and carbohydrate sources, and induces insulin resistance. However, the effects of fragmented sleep (SF), such as occurs in sleep apnea, on body weight, metabolic rates, and adipose tissue distribution are unknown. METHODS C57BL/6 mice were exposed to SF for 8 weeks. Their body weight, food consumption, and metabolic expenditure were monitored over time, and their plasma leptin levels measured after exposure to SF for 1 day as well as for 2 weeks. In addition, adipose tissue distribution was assessed at the end of the SF exposure using MRI techniques. RESULTS Chronic SF-induced obesogenic behaviors and increased weight gain in mice by promoting increased caloric intake without changing caloric expenditure. Plasma leptin levels initially decreased and subsequently increased. Furthermore, increases in both visceral and subcutaneous adipose tissue volumes occurred. CONCLUSIONS These results suggest that SF, a frequent occurrence in many disorders and more specifically in sleep apnea, is a potent inducer of obesity via activation of obesogenic behaviors and possibly leptin resistance, in the absence of global changes in energy expenditure.
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Affiliation(s)
- Yang Wang
- Section of Sleep Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
- Corresponding author: David Gozal, Department of Pediatrics, The University of Chicago, 5721 S. Maryland Avenue, MC 8000, Suite K-160, Chicago, IL 60637. Tel: (773) 702-6205; (773) 702-4523 – FAX;
| | - Alba Carreras
- Section of Sleep Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - SeungHoon Lee
- Section of Sleep Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Fahed Hakim
- Section of Sleep Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Shelley X. Zhang
- Section of Sleep Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Deepti Nair
- Section of Sleep Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Honggang Ye
- Section of Endocrinology, Department of Medicine, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, The University of Chicago, Chicago, IL
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Blüher S, Petroff D, Wagner A, Warich K, Gausche R, Klemm T, Wagner M, Keller A. The one year exercise and lifestyle intervention program KLAKS: Effects on anthropometric parameters, cardiometabolic risk factors and glycemic control in childhood obesity. Metabolism 2014; 63:422-30. [PMID: 24405751 DOI: 10.1016/j.metabol.2013.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/08/2013] [Accepted: 11/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Regular physical exercise within structured lifestyle programs may improve weight status and minimize metabolic risk factors in childhood obesity. The aim of this study was to evaluate the effect of the one-year combined physical exercise/lifestyle program KLAKS on anthropometric and metabolic parameters and glycemic control in childhood obesity. MATERIALS AND METHODS 142 overweight/obese (BMI>90th percentile) candidates (7-18years) were enrolled, 115 participants completed the program. Anthropometrics and biochemical parameters were obtained at beginning and completion. An oral glucose tolerance test (OGTT) was performed in a subgroup of participants. Course of glucose and insulin levels within OGTT was correlated with several parameters and is reported here for those who completed the program. RESULTS The mean standard deviation scores (SDS) decreased significantly for BMI, waist circumference, waist-to-height ratio (WHtR) and percentage body fat (all p≤0.01). Improved metabolic risk markers included mean glucose levels within an OGTT at follow-up compared to baseline (p<0.0001) and HbA1c (p=0.05) as well as indications of improvement for gamma-glutamyl-transferase and free fatty acids. CONCLUSIONS The one-year combined exercise/lifestyle program KLAKS significantly improves markers of obesity and glycemic control. Impaired cardiometabolic risk markers, even subclinical, are also favorably influenced by program participation.
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Affiliation(s)
- Susann Blüher
- Leipzig University Medical Center, IFB AdiposityDiseases, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany.
| | - David Petroff
- Leipzig University Medical Center, IFB AdiposityDiseases, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany; Center for Clinical Studies, University of Leipzig, Härtelstrasse 16 - 18, 04107 Leipzig, Germany
| | - Antje Wagner
- KLAKS e.V., Lessingstrasse 2, 04109 Leipzig, Germany
| | - Katja Warich
- KLAKS e.V., Lessingstrasse 2, 04109 Leipzig, Germany
| | - Ruth Gausche
- CrescNet gGmbH, University of Leipzig, Philipp-Rosenthal-Str. 27b, 04103 Leipzig, Germany
| | - Thorsten Klemm
- MVZ Labor Dr. Reising-Ackermann & Colleagues, Strümpellstraße 40, 04289 Leipzig, 04289, Leipzig, Germany
| | - Mario Wagner
- Gesundheitssportverein Leipzig e.V., Lessingstrasse 2, 04109 Leipzig, Germany
| | - Alexandra Keller
- CrescNet gGmbH, University of Leipzig, Philipp-Rosenthal-Str. 27b, 04103 Leipzig, Germany; Pediatric Medical Center, Johannisplatz 1, 04103 Leipzig, Germany
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Carvalho de Lima D, Guimarães JB, Rodovalho GV, Silveira SA, Haibara AS, Coimbra CC. Exercise training starting at weaning age preserves cardiac pacemaker function in adulthood of diet-induced obese rats. Appl Physiol Nutr Metab 2014; 39:888-94. [PMID: 24806307 DOI: 10.1139/apnm-2013-0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Peripheral sympathetic overdrive in young obese subjects contributes to further aggravation of insulin resistance, diabetes, and hypertension, thus inducing worsening clinical conditions in adulthood. Exercise training has been considered a strategy to repair obesity autonomic dysfunction, thereby reducing the cardiometabolic risk. Therefore, the aim of this study was to assess the effect of early exercise training, starting immediately after weaning, on cardiac autonomic control in diet-induced obese rats. Male Wistar rats (weaning) were divided into four groups: (i) a control group (n = 6); (ii) an exercise-trained control group (n = 6); (iii) a diet-induced obesity group (n = 6); and (iv) an exercise-trained diet-induced obesity group (n = 6). The development of obesity was induced by 9 weeks of palatable diet intake, and the training program was implemented in a motor-driven treadmill (5 times per week) during the same period. After this period, animals were submitted to vein and artery catheter implantation to assess cardiac autonomic balance by methylatropine (3 mg/kg) and propranolol (4 mg/kg) administration. Exercise training increased running performance in both groups (p < 0.05). Exercise training also prevented the increased resting heart rate in obese rats, which seemed to be related to cardiac pacemaker activity preservation (p < 0.05). Additionally, the training program preserved the pressure and bradycardia responses to autonomic blockade in obese rats (p < 0.05). An exercise program beginning at weaning age prevents cardiovascular dysfunction in obese rats, indicating that exercise training may be used as a nonpharmacological therapeutic strategy for the treatment of cardiometabolic diseases.
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Affiliation(s)
- Daniel Carvalho de Lima
- a Department of Physiology and Biophysics, Institute of Biological Sciences; Federal University of Minas Gerais, 31270-901 Belo Horizonte, Brazil
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Vogt MC, Paeger L, Hess S, Steculorum SM, Awazawa M, Hampel B, Neupert S, Nicholls HT, Mauer J, Hausen AC, Predel R, Kloppenburg P, Horvath TL, Brüning JC. Neonatal insulin action impairs hypothalamic neurocircuit formation in response to maternal high-fat feeding. Cell 2014; 156:495-509. [PMID: 24462248 DOI: 10.1016/j.cell.2014.01.008] [Citation(s) in RCA: 258] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/04/2013] [Accepted: 01/06/2014] [Indexed: 11/17/2022]
Abstract
Maternal metabolic homeostasis exerts long-term effects on the offspring's health outcomes. Here, we demonstrate that maternal high-fat diet (HFD) feeding during lactation predisposes the offspring for obesity and impaired glucose homeostasis in mice, which is associated with an impairment of the hypothalamic melanocortin circuitry. Whereas the number and neuropeptide expression of anorexigenic proopiomelanocortin (POMC) and orexigenic agouti-related peptide (AgRP) neurons, electrophysiological properties of POMC neurons, and posttranslational processing of POMC remain unaffected in response to maternal HFD feeding during lactation, the formation of POMC and AgRP projections to hypothalamic target sites is severely impaired. Abrogating insulin action in POMC neurons of the offspring prevents altered POMC projections to the preautonomic paraventricular nucleus of the hypothalamus (PVH), pancreatic parasympathetic innervation, and impaired glucose-stimulated insulin secretion in response to maternal overnutrition. These experiments reveal a critical timing, when altered maternal metabolism disrupts metabolic homeostasis in the offspring via impairing neuronal projections, and show that abnormal insulin signaling contributes to this effect.
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Affiliation(s)
- Merly C Vogt
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Lars Paeger
- Biocenter, Institute for Zoology, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Simon Hess
- Biocenter, Institute for Zoology, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Sophie M Steculorum
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Motoharu Awazawa
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Brigitte Hampel
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Susanne Neupert
- Biocenter, Institute for Zoology, University of Cologne, 50674 Cologne, Germany
| | - Hayley T Nicholls
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Jan Mauer
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - A Christine Hausen
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Reinhard Predel
- Biocenter, Institute for Zoology, University of Cologne, 50674 Cologne, Germany
| | - Peter Kloppenburg
- Biocenter, Institute for Zoology, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany
| | - Tamas L Horvath
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Section of Comparative Medicine, Department of Obstetrics/Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Jens C Brüning
- Max Planck Institute for Neurological Research, 50931 Cologne, Germany; Department of Mouse Genetics and Metabolism, Institute for Genetics, University of Cologne, 50674 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, 50674 Cologne, Germany; Center for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, 50924 Cologne, Germany.
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Abu Hanifah R, Mohamed MNA, Jaafar Z, Mohsein NASA, Jalaludin MY, Majid HA, Murray L, Cantwell M, Su TT. The correlates of body composition with heart rate recovery after step test: an exploratory study of Malaysian adolescents. PLoS One 2013; 8:e82893. [PMID: 24349388 PMCID: PMC3857804 DOI: 10.1371/journal.pone.0082893] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In adults, heart rate recovery is a predictor of mortality, while in adolescents it is associated with cardio-metabolic risk factors. The aim of this study was to examine the relationship between body composition measures and heart rate recovery (HRR) after step test in Malaysian secondary school students. METHODS In the Malaysian Health and Adolescents Longitudinal Research Team (MyHEART) study, 1071 healthy secondary school students, aged 13 years old, participated in the step test. Parameters for body composition measures were body mass index z-score, body fat percentage, waist circumference, and waist height ratio. The step test was conducted by using a modified Harvard step test. Heart rate recovery of 1 minute (HRR1min) and heart rate recovery of 2 minutes (HRR2min) were calculated by the difference between the peak pulse rate during exercise and the resting pulse rate at 1 and 2 minutes, respectively. Analysis was done separately based on gender. Pearson correlation analysis was used to determine the association between the HRR parameters with body composition measures, while multiple regression analysis was used to determine which body composition measures was the strongest predictor for HRR. RESULTS For both gender groups, all body composition measures were inversely correlated with HRR1min. In girls, all body composition measures were inversely correlated with HRR2min, while in boys all body composition measures, except BMI z-score, were associated with HRR2min. In multiple regression, only waist circumference was inversely associated with HRR2min (p=0.024) in boys, while in girls it was body fat percentage for HRR2min (p=0.008). CONCLUSION There was an inverse association between body composition measurements and HRR among apparently healthy adolescents. Therefore, it is important to identify cardio-metabolic risk factors in adolescent as an early prevention of consequent adulthood morbidity. This reiterates the importance of healthy living which should start from young.
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Affiliation(s)
- Redzal Abu Hanifah
- Sports Medicine Unit, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Zulkarnain Jaafar
- Sports Medicine Unit, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nabilla Al-Sadat Abdul Mohsein
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Hazreen Abdul Majid
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Liam Murray
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University, Belfast, Northern Ireland
| | - Marie Cantwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University, Belfast, Northern Ireland
| | - Tin Tin Su
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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Santisteban MM, Zubcevic J, Baekey DM, Raizada MK. Dysfunctional brain-bone marrow communication: a paradigm shift in the pathophysiology of hypertension. Curr Hypertens Rep 2013; 15:377-89. [PMID: 23715920 PMCID: PMC3714364 DOI: 10.1007/s11906-013-0361-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It is widely accepted that the pathophysiology of hypertension involves autonomic nervous system dysfunction, as well as a multitude of immune responses. However, the close interplay of these systems in the development and establishment of high blood pressure and its associated pathophysiology remains elusive and is the subject of extensive investigation. It has been proposed that an imbalance of the neuro-immune systems is a result of an enhancement of the "proinflammatory sympathetic" arm in conjunction with dampening of the "anti-inflammatory parasympathetic" arm of the autonomic nervous system. In addition to the neuronal modulation of the immune system, it is proposed that key inflammatory responses are relayed back to the central nervous system and alter the neuronal communication to the periphery. The overall objective of this review is to critically discuss recent advances in the understanding of autonomic immune modulation, and propose a unifying hypothesis underlying the mechanisms leading to the development and maintenance of hypertension, with particular emphasis on the bone marrow, as it is a crucial meeting point for neural, immune, and vascular networks.
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Affiliation(s)
- Monica M. Santisteban
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
| | - Jasenka Zubcevic
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
| | - David M. Baekey
- Department of Physiological Sciences, University of Florida, College of Veterinary Medicine. 1600 SW Archer Road, PO Box 100144, Gainesville, FL 32610
| | - Mohan K. Raizada
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
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