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Hollstein T, Schlicht K, Krause L, Hagen S, Rohmann N, Schulte DM, Türk K, Beckmann A, Ahrens M, Franke A, Schreiber S, Becker T, Beckmann J, Laudes M. Effect of various weight loss interventions on serum NT-proBNP concentration in severe obese subjects without clinical manifest heart failure. Sci Rep 2021; 11:10096. [PMID: 33980890 PMCID: PMC8115663 DOI: 10.1038/s41598-021-89426-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Obesity is associated with a “natriuretic handicap” indicated by reduced N-terminal fragment of proBNP (NT-proBNP) concentration. While gastric bypass surgery improves the natriuretic handicap, it is presently unclear if sleeve gastrectomy exhibits similar effects. We examined NT-proBNP serum concentration in n = 72 obese participants without heart failure before and 6 months after sleeve gastrectomy (n = 28), gastric bypass surgery (n = 19), and 3-month 800 kcal/day very-low calorie diet (n = 25). A significant weight loss was observed in all intervention groups. Within 6 months, NT-proBNP concentration tended to increase by a median of 44.3 pg/mL in the sleeve gastrectomy group (p = 0.07), while it remained unchanged in the other groups (all p ≥ 0.50). To gain insights into potential effectors, we additionally analyzed NT-proBNP serum concentration in n = 387 individuals with different metabolic phenotypes. Here, higher NT-proBNP levels were associated with lower nutritional fat and protein but not with carbohydrate intake. Of interest, NT-proBNP serum concentrations were inversely correlated with fasting glucose concentration in euglycemic individuals but not in individuals with prediabetes or type 2 diabetes. In conclusion, sleeve gastrectomy tended to increase NT-proBNP levels in obese individuals and might improve the obesity-associated “natriuretic handicap”. Thereby, nutritional fat and protein intake and the individual glucose homeostasis might be metabolic determinants of NT-proBNP serum concentration.
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Affiliation(s)
- Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Kristina Schlicht
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Laura Krause
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Stefanie Hagen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Nathalie Rohmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Dominik M Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Kathrin Türk
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Alexia Beckmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Markus Ahrens
- Helios Klinik Lengerich, Martin-Luther-Straße 49, 49525, Lengerich, Germany
| | - Andre Franke
- Institute for Clinical Molecular Biology, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Stefan Schreiber
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany.,Institute for Clinical Molecular Biology, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Thomas Becker
- Department of General and Abdominal Surgery, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Jan Beckmann
- Department of General and Abdominal Surgery, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University of Kiel, Arnold Heller Straße 3, 24105, Kiel, Germany.
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Spannella F, Giulietti F, Bordicchia M, Burnett JC, Sarzani R. Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis. Sci Rep 2019; 9:19178. [PMID: 31844088 PMCID: PMC6915780 DOI: 10.1038/s41598-019-55680-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/20/2019] [Indexed: 02/08/2023] Open
Abstract
Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid metabolism. We performed a systematic review and meta-analysis of studies investigating the association of NPs with serum lipid profile. A PubMed and Scopus search (2005–2018) revealed 48 studies reporting the association between NPs and components of lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG)]. Despite high inconsistency across studies, NPs levels were inversely associated with TC [k = 32; pooled r = −0.09; I2 = 90.26%], LDLc [k = 31; pooled r = −0.09; I2 = 82.38%] and TG [k = 46; pooled r = −0.11; I2 = 94.14%], while they were directly associated with HDLc [k = 41; pooled r = 0.06; I2 = 87.94%]. The relationship with LDLc, HDLc and TG lost significance if only studies on special populations (works including subjects with relevant acute or chronic conditions that could have significantly affected the circulating levels of NPs or lipid profile) or low-quality studies were taken into account. The present study highlights an association between higher NP levels and a favorable lipid profile. This confirms and extends our understanding of the metabolic properties of cardiac NPs and their potential in CV prevention.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Marica Bordicchia
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - John C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy. .,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy.
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Almuwaqqat Z, O'Neal WT, Norby FL, Lutsey PL, Selvin E, Soliman EZ, Chen LY, Alonso A. Joint Associations of Obesity and NT-proBNP With the Incidence of Atrial Fibrillation in the ARIC Study. J Am Heart Assoc 2019; 8:e013294. [PMID: 31564186 PMCID: PMC6806039 DOI: 10.1161/jaha.119.013294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Circulating NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels, a well‐known indicator of atrial wall stress and remodeling, inversely correlate with body mass index. Both are strongly predictive of atrial fibrillation (AF). Their potential interaction in relation to incident AF, however, has not been explored. Methods and Results In total, 9556 participants of the ARIC (Atherosclerosis Risk in Communities) study who had 2 measurements of NT‐proBNP and no baseline AF or heart failure were followed from 1996 to 1998 through 2016 for the occurrence of incident AF. Participants were categorized as obese (body mass index ≥30) and nonobese (body mass index <30) and by NT‐proBNP levels (using the median of 68.2 pg/mL as the cutoff). Over a median follow‐up of 18.3 years, we identified 1806 incident cases of AF. Analysis using multivariable Cox regression models showed that obese participants with high NT‐proBNP levels at visit 4 had a higher adjusted risk of incident AF (hazard ratio: 3.64; 95% CI, 3.15–4.22) compared with nonobese individuals with low NT‐proBNP levels. The association of obesity with AF risk was not modified by NT‐proBNP levels (P=0.46 for interaction). Increasing BNP among participants from 1990–1992 to 1996–1998 was associated with increased AF risk. After further adjustment for clinical risk factors and medications, results were similar. Conclusions Individuals who had both elevated body mass index and NT‐proBNP and were free of clinically recognized heart failure were at higher risk of AF development. Those who experienced an increase in NT‐proBNP levels between visits 2 and 4 were at higher risk of AF.
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Affiliation(s)
- Zakaria Almuwaqqat
- Department of Medicine Emory School of Medicine Atlanta GA.,Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Wesley T O'Neal
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Faye L Norby
- Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Division of General Internal Medicine Department of Medicine Johns Hopkins University Baltimore MD
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center Department of Epidemiology and Prevention Wake Forest School of Medicine Winston-Salem NC
| | - Lin Y Chen
- Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Alvaro Alonso
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
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Carbone F, Nulli Migliola E, Bonaventura A, Vecchié A, De Vuono S, Ricci MA, Vaudo G, Boni M, Dallegri F, Montecucco F, Lupattelli G. High serum levels of C-reactive protein (CRP) predict beneficial decrease of visceral fat in obese females after sleeve gastrectomy. Nutr Metab Cardiovasc Dis 2018; 28:494-500. [PMID: 29502925 DOI: 10.1016/j.numecd.2018.01.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/10/2018] [Accepted: 01/25/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Gender-related differences represent an emerging investigation field to better understand obesity heterogeneity and paradoxically associated cardiovascular (CV) risk. Here, we investigated if high-sensitivity C-reactive protein (hs-CRP) might differently affect adiposity and predict the clinical response to bariatric surgery in obese males and females. METHODS AND RESULTS In 110 morbidly obese patients undergoing laparoscopic sleeve gastrectomy, hs-CRP as well as anthropometric assessment of adiposity, completed by electric bioimpedance and ultrasonography quantification of visceral fat area (VFA), were measured before and one year after surgery. As compared to males, obese female showed less severe overweight and prevalent subcutaneous fat deposition, but higher circulating hs-CRP. In obese females, hs-CRP was associated with VFA at baseline, independently of body mass index (BMI) and visceral adiposity index (OR 1.022 [95% CI 1.001-1.044]; p = 0.039). Based on decreases and increases in hs-CRP levels after surgery, two distinct subgroups of females were identified. Post-surgery decreases in hs-CRP was predominantly observed in patients with higher baseline levels of hs-CRP and associated with greater reduction of weight, BMI, fat and lean mass, VFA and visceral to subcutaneous fat ratio. Finally, we observed that high baseline values of hs-CRP were able to predict VFA reduction one-year after surgery, independently of BMI and visceral adiposity index (VAI) loss (OR 1.031 [95% CI 1.009-1.053]; p = 0.005). CONCLUSION In obese females, hs-CRP levels might be a promising biomarker of visceral fat amount and dysfunction, in addition to predict the effectiveness of bariatric surgery in terms of loss of VFA one-year after surgery.
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Affiliation(s)
- F Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy.
| | - E Nulli Migliola
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - A Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - A Vecchié
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - S De Vuono
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - M A Ricci
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - G Vaudo
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - M Boni
- Surgery Department, San Giovanni Battista Hospital, Via Massimo Arcamone, 06034, Foligno, Italy
| | - F Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132, Genoa, Italy
| | - G Lupattelli
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
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Benomar K, Espiard S, Loyer C, Jannin A, Vantyghem MC. [Atrial natriuretic hormones and metabolic syndrome: recent advances]. Presse Med 2018; 47:116-124. [PMID: 29496376 DOI: 10.1016/j.lpm.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/21/2017] [Accepted: 12/04/2017] [Indexed: 01/20/2023] Open
Abstract
Natriuretic peptides are a group of hormones including atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C type (CNP), urodilatin and guanilyn. ANP (half-life: 2-4 min), is secreted by the atrium, BNP (half-life: 20 min) by the ventricle, CNP by the vascular endothelium, urodilatin by the kidney and guanylin by the intestine. These natriuretic peptides prevent water and salt retention through renal action, vasodilatation and hormonal inhibition of aldosterone, vasopressin and cortisol. These peptides also have a recently demonstrated metabolic effect through an increase of lipolysis, thermogenesis, beta cell proliferation and muscular sensitivity to insulin. Blood levels of these natriuretic peptides depend on "active NPR-A receptors/clearance NPR-C receptors", the last ones being abundant on adipocytes. Therefore, natriuretic peptides act as adipose tissue regulator and constitute a link between blood pressure and metabolic syndrome. They are used as markers and treatment of cardiac failure. Other applications are on going. BNP and NT-proBNP (inactive portion de la pro-hormone) are used as markers of cardiac failure since they have a longer half-life than ANP. BNP decrease is quicker and more important than that one of NT-ProBNP in case of improvement of cardiac failure. Chronic renal insufficiency and beta-blockers increase BNP levels. BNP measurement is useless under treatment with neprilysine inhibitors such as sacubitril, one of the neutral endopeptidases involved in catabolism of natriuretic peptides. The association sacubitril/valsartan is a new treatment of chronic cardiac failure, acting through the decrease of ANP catabolism.
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Affiliation(s)
- Kanza Benomar
- Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France; UMR 1190 recherche translationnelle sur le diabète Inserm, 59000 Lille, France; EGID (European Genomic Institute for Diabetes), université de Lille, 59000 Lille, France
| | - Stéphanie Espiard
- Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France
| | - Camille Loyer
- Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France
| | - Arnaud Jannin
- Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France
| | - Marie-Christine Vantyghem
- Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France; UMR 1190 recherche translationnelle sur le diabète Inserm, 59000 Lille, France; EGID (European Genomic Institute for Diabetes), université de Lille, 59000 Lille, France.
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Heidrich FM, Melz C, Buechau MS, Pfluecke C, Quick S, Speiser U, Poitz DM, Augstein A, Ruf T, Wässnig NK, Youssef A, Strasser RH, Wiedemann S. Regulation of circulating chromogranin B levels in heart failure. Biomarkers 2017; 23:78-87. [PMID: 29098879 DOI: 10.1080/1354750x.2017.1395079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Chromogranin B (CGB) regulates B-type natriuretic peptide (BNP) production. Circulating CGB levels are elevated in heart failure (HF) animal models and HF patients, but also increase in healthy individuals in response to physical activity. Therefore, CGB seems to integrate information from myocardial stress and systemic neuro-endocrine activation. Substantial gaps remain in our understanding of CGB regulation in HF. METHODS AND RESULTS We conducted a retrospective registry study including 372 patients. CGB and N-terminal pro-BNP (NT-proBNP) plasma levels were assessed in acute HF and chronic valvular HF patients and controls. CGB levels were significantly increased in acute HF and chronic valvular HF, but significantly higher in the latter. Patients in chronic valvular HF with severe mitral regurgitation (cHF-MR) showed significantly higher CGB levels than patients in chronic valvular HF with severe aortic stenosis. CGB levels progressively increased with worsening NYHA functional status and were moderately correlated to NT-proBNP, but independent of left ventricular (LV) ejection fraction (LVEF), LV mass, age and body weight. Finally, cHF-MR patients showed significant reductions of CGB levels after interventional mitral valve repair. CONCLUSION CGB is a promising emerging biomarker in HF patients with unique potential to integrate information from myocardial stress and neuro-endocrine activation.
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Affiliation(s)
- Felix M Heidrich
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Carolin Melz
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Mimi S Buechau
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Christian Pfluecke
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Silvio Quick
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Uwe Speiser
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - David M Poitz
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Antje Augstein
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Tobias Ruf
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Nadine K Wässnig
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Akram Youssef
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Ruth H Strasser
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
| | - Stephan Wiedemann
- a Technische Universität Dresden , Heart Center Dresden University Hospital , Dresden , Germany
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Baldassarre S, Fragapani S, Panero A, Fedele D, Pinach S, Lucchiari M, Vitale AR, Mengozzi G, Gruden G, Bruno G. NTproBNP in insulin-resistance mediated conditions: overweight/obesity, metabolic syndrome and diabetes. The population-based Casale Monferrato Study. Cardiovasc Diabetol 2017; 16:119. [PMID: 28946871 PMCID: PMC5613356 DOI: 10.1186/s12933-017-0601-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/17/2017] [Indexed: 01/03/2023] Open
Abstract
Background and aims NTproBNP and BNP levels are reduced in obese subjects, but population-based data comparing the pattern of this relationship in the full spectrum of insulin-resistance mediated conditions, overweight/obesity, metabolic syndrome and diabetes, are limited. Methods The study-base were 3244 individuals aged 45–74 years, none of whom had heart failure, 1880 without diabetes and 1364 with diabetes, identified as part of two surveys of the population-based Casale Monferrato Study. All measurements were centralized. We examined with multiple linear regression and cubic regression splines the relationship between NTproBNP and BMI, independently of known risk factors and confounders. A logistic regression analysis was also performed to assess the effect of overweight/obesity (BMI ≥ 25 kg/m2), diabetes and metabolic syndrome on NTproBNP values. Results Out of the overall cohort of 3244 people, overweight/obesity was observed in 1118 (59.4%) non-diabetic and 917 (67.2%) diabetic subjects, respectively. In logistic regression, compared to normal weight individuals, those with a BMI ≥ 25 kg/m2 had a OR of 0.70 (95% CI 0.56–0.87) of having high NTproBNP values, independently of diabetes. As interaction between diabetes and NTproBNP was evident (p < 0.001), stratified analyses were performed. Diabetes either alone or combined with overweight/obesity or metabolic syndrome enhanced fourfold and over the OR of having high NTproBNP levels, while the presence of metabolic syndrome alone had a more modest effect (OR 1.54, 1.18–2.01) even after having excluded individuals with CVD. In the non-diabetic cohort, obesity/overweight and HOMA-IR ≥ 2.0 decreased to a similar extent the ORs of high NTproBNP [0.76 (0.60–0.95) and 0.74 (0.59–0.93)], but the association between overweight/obesity and NTproBNP was no longer significant after the inclusion into the model of HOMA-IR, whereas CRP > 3 mg/dl conferred a fully adjusted OR of 0.65 (0.49–0.86). Conclusions NT-proBNP levels are lower in overweight/obesity, even in those with diabetes. Both insulin-resistance and chronic low-grade inflammation are involved in this relationship. Further intervention studies are required to clarify the potential role of drugs affecting the natriuretic peptides system on body weight and risk of diabetes.
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Affiliation(s)
- Stefano Baldassarre
- Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy
| | - Salvatore Fragapani
- Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy
| | - Antonio Panero
- Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy
| | - Debora Fedele
- Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy
| | - Silvia Pinach
- Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy
| | - Manuela Lucchiari
- Clinical Chemistry Laboratory, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Anna Rita Vitale
- Clinical Chemistry Laboratory, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Giulio Mengozzi
- Clinical Chemistry Laboratory, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Gabriella Gruden
- Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy
| | - Graziella Bruno
- Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy.
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8
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Gentili A, Frangione MR, Albini E, Vacca C, Ricci MA, De Vuono S, Boni M, Rondelli F, Rotelli L, Lupattelli G, Orabona C. Modulation of natriuretic peptide receptors in human adipose tissue: molecular mechanisms behind the "natriuretic handicap" in morbidly obese patients. Transl Res 2017. [PMID: 28651075 DOI: 10.1016/j.trsl.2017.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The B-type natriuretic peptide (BNP) hormone plays a crucial role in the regulation of cardiovascular and energy homeostasis. Obesity is associated with low circulating levels of BNP, a condition known as "natriuretic handicap." Recent evidences suggest an altered expression of BNP receptors-both the signaling natriuretic peptide receptors (NPR)-A and the clearance NPR-C receptor-in adipose tissue (AT) as one of the putative causes of natriuretic handicap. The current study aims at clarifying the molecular mechanisms behind the natriuretic handicap, focusing on NPR modulation in the AT of obese and control subjects. The study enrolled 34 obese and 20 control subjects undergoing bariatric or abdominal surgery, respectively. The main clinical and biochemical parameters, including circulating BNP, were assessed. In visceral (VAT) and subcutaneous AT (SAT) samples, collected during surgery, the adipocytes and stromal vascular fraction (SVF) expression of NPR-A and NPR-C and the SVF secretion of interleukin 6 (IL-6) were determined. Both VAT and SAT from obese patients expressed a lower NPR-A/NPR-C ratio in adipocytes and the SVF secreted a higher level of IL-6, compared with the controls. Moreover, NPR-A/NPR-C ratio expressed by VAT and SAT adipocytes negatively correlated with body mass index, insulin, the Homeostasis Model Assessment of Insulin resistance, and IL-6 secreted by SVF, and the expression of the clearance receptor NPR-C, in both the VAT and SAT adipocytes, showed a negative correlation with circulating BNP. Overall, insulin resistance/hyperinsulinemia and AT inflammation (ie, high level of IL-6) are the major determinants of the lower NPR-A/NPR-C ratio in adipocytes, thus contributing to the natriuretic handicap in obese subjects.
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Affiliation(s)
- Alessandra Gentili
- Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy.
| | | | - Elisa Albini
- Pharmacology, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Carmine Vacca
- Pharmacology, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Stefano De Vuono
- Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marcello Boni
- Department of Surgery, "San Giovanni Battista" Hospital, Perugia, Italy
| | - Fabio Rondelli
- Department of Surgery, "San Giovanni Battista" Hospital, Perugia, Italy
| | - Luciana Rotelli
- Department of Anesthesiology and Reanimation, "S. Giovanni Battista" Hospital, Foligno, Italy
| | - Graziana Lupattelli
- Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Ciriana Orabona
- Pharmacology, Department of Experimental Medicine, University of Perugia, Perugia, Italy
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Fedele D, Bicchiega V, Collo A, Barutta F, Pistone E, Gruden G, Bruno G. Short term variation in NTproBNP after lifestyle intervention in severe obesity. PLoS One 2017; 12:e0181212. [PMID: 28704534 PMCID: PMC5509288 DOI: 10.1371/journal.pone.0181212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/28/2017] [Indexed: 11/26/2022] Open
Abstract
Aim Natriuretic peptides are not only involved in cardiovascular adaption to various conditions, but also in metabolic diseases. We performed this study to assess the effect of a very short time of lifestyle inpatient intervention on NTproBNP values in normotensive subjects with severe obesity and normal cardiac function. Methods We recruited 14 consecutive obese normotensive subjects with normal cardiac function who were aged 30 years and more and were referred to inpatient rehabilitation in an academic clinic over a two months period. They were examined at baseline and after a 3-weeks program including dietary intervention with hypocaloric diet and assisted personalized physical aerobic and anaerobic activities and compared to age, sex and BMI-matched control subjects under usual care. Results BMI significantly decreased (40.8 ±1.6 vs 42.3 ± 1.6 kg/m2, p <0.0001). Median reduction in body weight was 4.9 kg (interquartile range 2.4–5.2 kg). After diet and exercise-induced weight loss, plasma NTproBNP levels showed an almost two-fold increase, which was statistically significant (28.2 ± 12.3 vs 17.2 ± 13.2 ng/L, p = 0.01), and particularly relevant in the subgroup with NT-proBNP values below median values compared to those with higher values (p = 0.02). No significant variations were found in control subjects (18.0 ± 13.0 vs 16.5 ± 11.2 ng/L, p = 0.18). The lipid profile was significantly ameliorated, and both HbA1c and insulin levels showed a marginally non-significant decrease after treatment. Conclusions An almost two-fold increase in NTproBNP levels was evident after a very short time period of lifestyle intervention in normotensive severe obese patients without cardiac disease. This finding might have clinical relevance, considering the role of NT-proBNP as risk factor of impaired glucose tolerance.
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Affiliation(s)
- Debora Fedele
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Alessandro Collo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federica Barutta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Erika Pistone
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gabriella Gruden
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Graziella Bruno
- Department of Medical Sciences, University of Turin, Turin, Italy
- * E-mail:
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Ricci MA, Ministrini S, De Vuono S, Camilli M, Gentili A, Daviddi G, Boni M, Lupattelli G. Sleeve Gastrectomy Efficacy on Metabolic and Cardiovascular Dysfunction With a Focus on the Role of Comorbidities. Angiology 2017; 69:475-482. [PMID: 28681646 DOI: 10.1177/0003319717718707] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We evaluated the effects of sleeve gastrectomy (SG) on metabolic/cardiovascular parameters according to weight loss, visceral fat area (VFA), and homeostasis model assessment (HOMA)-insulin resistance index; we also assessed the influence of SG on comorbidities (diabetes/hypertension). At baseline and 10 to 12 months after SG, we assessed anthropometric and biochemical parameters, bioimpedentiometry, ultrasonographic VFA, liver steatosis, flow-mediated dilation, and echocardiography in 110 patients with obesity. We found that 23 (21%) patients had diabetes. Diabetic patients who normalized their glycated hemoglobin A1C (HbA1C) level experienced greater total weight loss (TWL), and the probability of normalizing HbA1C levels directly correlated with TWL. Diabetic patients experienced a greater improvement in systolic blood pressure, VFA, and high-density lipoprotein cholesterol than nondiabetics, while patients with hypertension experienced a greater improvement in VFA, triglycerides, HOMA, and HbA1C than nonhypertensive patients. The most important determinant of glucose control in diabetic patients was weight loss. Patients with diabetes and hypertension experienced a greater improvement in vascular and metabolic status after SG.
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Affiliation(s)
- Maria Anastasia Ricci
- 1 Internal Medicine, Department of Medicine, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Stefano Ministrini
- 1 Internal Medicine, Department of Medicine, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Stefano De Vuono
- 1 Internal Medicine, Department of Medicine, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Matteo Camilli
- 1 Internal Medicine, Department of Medicine, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessandra Gentili
- 1 Internal Medicine, Department of Medicine, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giulia Daviddi
- 1 Internal Medicine, Department of Medicine, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Marcello Boni
- 2 Surgery Department, S. Giovanni Battista Hospital, Foligno, Italy
| | - Graziana Lupattelli
- 1 Internal Medicine, Department of Medicine, S. Maria della Misericordia Hospital, Perugia, Italy
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