1
|
Chien SC, Chandramouli C, Lo CI, Lin CF, Sung KT, Huang WH, Lai YH, Yun CH, Su CH, Yeh HI, Hung TC, Hung CL, Lam CSP. Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study. PLoS Med 2021; 18:e1003661. [PMID: 34061848 PMCID: PMC8205172 DOI: 10.1371/journal.pmed.1003661] [Citation(s) in RCA: 22] [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: 04/21/2020] [Revised: 06/15/2021] [Accepted: 05/17/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. METHODS AND FINDINGS We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, ≤25 kg/m2 [lean]; high, >25 kg/m2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, <45 g/L [malnourished]; high, ≥45 g/L [well-nourished]), and secondarily by the prognostic nutritional index (PNI) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Cox proportional hazard models were used to examine a 1-year composite outcome of hospitalization for HF or all-cause mortality while adjusting for age, sex, and other clinical confounders. Our community-based cohort consisted of 2,096 (39.0%) lean-well-nourished (low BMI, high SA), 1,369 (25.8%) obese-well-nourished (high BMI, high SA), 1,154 (21.8%) lean-malnourished (low BMI, low SA), and 681 (12.8%) obese-malnourished (high BMI, low SA) individuals. Obese-malnourished participants were on average older (54.5 ± 11.4 years) and more often women (41%), with a higher mean waist circumference (91.7 ± 8.8 cm), the highest percentage of body fat (32%), and the highest prevalence of hypertension (32%), diabetes (12%), and history of cardiovascular disease (11%), compared to all other subgroups (all p < 0.001). N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were substantially increased in the malnourished (versus well-nourished) groups, to a similar extent in lean (70.7 ± 177.3 versus 36.8 ± 40.4 pg/mL) and obese (73.1 ± 216.8 versus 33.2 ± 40.8 pg/mL) (p < 0.001 in both) participants. The obese-malnourished (high BMI, low SA) group also had greater left ventricular remodeling (left ventricular mass index, 44.2 ± 1.52 versus 33.8 ± 8.28 gm/m2; relative wall thickness 0.39 ± 0.05 versus 0.38 ± 0.06) and worse diastolic function (TDI-e' 7.97 ± 2.16 versus 9.87 ± 2.47 cm/s; E/e' 9.19 ± 3.01 versus 7.36 ± 2.31; left atrial volume index 19.5 ± 7.66 versus 14.9 ± 5.49 mL/m2) compared to the lean-well-nourished (low BMI, high SA) group, as well as all other subgroups (p < 0.001 for all). Over a median 3.6 years (interquartile range 2.5 to 4.8 years) of follow-up, the obese-malnourished group had the highest multivariable-adjusted risk of the composite outcome (hazard ratio [HR] 2.49, 95% CI 1.43 to 4.34, p = 0.001), followed by the lean-malnourished (HR 1.78, 95% CI 1.04 to 3.04, p = 0.034) and obese-well-nourished (HR 1.41, 95% CI 0.77 to 2.58, p = 0.27) groups (with lean-well-nourished group as reference). Results were similar when indexed by other anthropometric indices (waist circumference and body fat) and other measures of nutritional status (PNI and GLIM criteria). Potential selection bias and residual confounding were the main limitations of the study. CONCLUSIONS In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome.
Collapse
Affiliation(s)
- Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Chi-In Lo
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Chao-Feng Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Tzu Sung
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Hung Huang
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yau-Huei Lai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Chun-Ho Yun
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei, Taiwan
- * E-mail:
| | - Carolyn S. P. Lam
- National Heart Centre Singapore, Singapore
- Duke–NUS Medical School, Singapore
- University Medical Centre Groningen, Groningen, the Netherlands
- George Institute for Global Health, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Pinotti MF, Matias AM, Sugizaki MM, Nascimento AFD, Pai MD, Leopoldo APL, Cicogna AC, Leopoldo AS. Fasting/Refeeding Cycles Prevent Myocardial Dysfunction and Morphology Damage in the Spontaneously Hypertensive Rats. Arq Bras Cardiol 2018; 111:400-409. [PMID: 30133552 PMCID: PMC6173345 DOI: 10.5935/abc.20180152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/09/2018] [Indexed: 11/23/2022] Open
Abstract
Background Caloric restriction is known to impair the cardiac function and morphology in
hypertrophied hearts of spontaneously hypertensive rats (SHR); however, the
influence of fasting/refeeding (RF) is unknown. Objective To investigate the fasting/refeeding approach on myocardial remodeling and
function. In addition, the current study was designed to bring information
regarding the mechanisms underlying the participation of Ca2+
handling and β-adrenergic system. Methods Sixty-day-old male SHR rats were submitted to food ad
libitum (C), 50% food restriction (R50) or RF cycles
for 90 days. Cardiac remodeling was assessed by ultrastructure analysis and
isolated papillary muscle function. The level of significance considered was
5% (α = 0.05). Results The RF rats presented lower cardiac atrophy than R50 in relation
to C rats. The C rats increased weight gain, R50 maintained their
initial body weight and RF rats increased and decreased weight during RF.
The RF did not cause functional impairment because the isotonic and
isometric parameters showed similar behavior to those of C. The isotonic and
isometric cardiac parameters were significantly elevated in RF rats compared
to R50 rats. In addition, the R50 rats had cardiac
damage in relation to C for isotonic and isometric variables. While the
R50 rats showed focal changes in many muscle fibers, the RF
rats displayed mild alterations, such as loss or disorganization of
myofibrils. Conclusion Fasting/refeeding promotes cardiac beneficial effects and attenuates
myocardial injury caused by caloric restriction in SHR rats, contributing to
reduce the cardiovascular risk profile and morphological injuries.
Furthermore, RF promotes mild improvement in Ca2+ handling and
β-adrenergic system.
Collapse
Affiliation(s)
- Matheus Fécchio Pinotti
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP - Brazil
| | - Amanda Martins Matias
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brazil
| | | | | | - Maeli Dal Pai
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP - Brazil.,Departamento de Morfologia, Instituto de Biosciências da Universidade Estadual Paulista UNESP, Botucatu, SP - Brazil
| | - Ana Paula Lima Leopoldo
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brazil
| | - Antônio Carlos Cicogna
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP - Brazil
| | - André Soares Leopoldo
- Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brazil
| |
Collapse
|
3
|
Pinotti MF, Leopoldo AS, Silva MDP, Sugizaki MM, do Nascimento AF, Lima-Leopoldo AP, Aragon FF, Padovani CR, Cicogna AC. A comparative study of myocardial function and morphology during fasting/refeeding and food restriction in rats. Cardiovasc Pathol 2009; 19:e175-82. [PMID: 19914094 DOI: 10.1016/j.carpath.2009.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 08/10/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This study compared the influence of fasting/refeeding cycles and food restriction on rat myocardial performance and morphology. METHODS Sixty-day-old male Wistar rats were submitted to food ad libitum (C), 50% food restriction (R50), and fasting/refeeding cycles (RF) for 12 weeks. Myocardial function was evaluated under baseline conditions and after progressive increase in calcium and isoproterenol. Myocardium ultrastructure was examined in the papillary muscle. RESULTS Fasting/refeeding cycles maintained rat body weight and left ventricle weight between control and food-restricted rats. Under baseline conditions, the time to peak tension (TPT) was more prolonged in R50 than in RF and C rats. Furthermore, the maximum tension decline rate (-dT/dt) increased less in R50 than in RF with calcium elevation. While the R50 group showed focal changes in many muscle fibers, such as the disorganization or loss of myofilaments, polymorphic mitochondria with disrupted cristae, and irregular appearance or infolding of the plasma membrane, the RF rats displayed few alterations such as loss or disorganization of myofibrils. CONCLUSION Food restriction promotes myocardial dysfunction, not observed in RF rats, and higher morphological damage than with fasting/refeeding. The increase in TPT may be attributed possibly to the disorganization and loss of myofibrils; however, the mechanisms responsible for the alteration in -dT/dt in R50 needs to be further clarified.
Collapse
Affiliation(s)
- Matheus Fécchio Pinotti
- Department of Internal Medicine, School of Medicine, State University "Júlio de Mesquita Filho", UNESP, Botucatu, São Paulo, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Okoshi MP, Okoshi K, Pai VD, Pai-Silva MD, Matsubara LS, Cicogna AC. Mechanical, biochemical, and morphological changes in the heart from chronic food-restricted rats. Can J Physiol Pharmacol 2001. [DOI: 10.1139/y01-060] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Food restriction (FR) has been shown to induce important morphological changes in rat myocardium. However, its influence on myocardial performance is not completely defined. We examined the effects of chronic FR on cardiac muscle function and morphology. Sixty-day-old WistarKyoto rats were fed a control (C) or a restricted diet (daily intake reduced to 50% of the amount of food consumed by the control group) for 90 days. Myocardial performance was studied in isolated left ventricular (LV) papillary muscle. Fragments of the LV free wall were analysed by light microscopy, and the ultrastructure of the myocardium was examined in t...he LV papillary muscle. The myocardial collagen concentration was also evaluated. FR decreased body weight (BW) and LV weight (LVW); the LVW/BW ratio was higher in the restricted group (C, 1.86 ± 0.17 mg/g; FR, 2.19 ± 0.31 mg/g; p < 0.01). In the FR animals, the cardiac fibers were polymorphic, some of them were of small diameter and others presented lateral infoldings; the ultrastructural alterations were focal and included reduction of sarcoplasmic content, absence and (or) disorganization of myofilaments and Z line, numerous electron dense and polymorphic mitochondria, and deep infoldings of the plasma membrane. The hydroxyproline concentration was higher in the FR animals (p < 0.01). FR prolonged the contraction and relaxation time of the papillary muscle and did not change its ability to contract and shorten. In conclusion, although a 90-day period of FR caused striking myocardial ultrastructural alterations and increased the collagen concentration, it only minimally affected the mechanical function.Key words: diet, papillary muscle, undernutrition, myocardium, ultrastructure.
Collapse
|