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Rahmouni K. Energy metabolism and syncope. Clin Auton Res 2022; 32:391-393. [PMID: 36326945 DOI: 10.1007/s10286-022-00906-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Kamal Rahmouni
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA. .,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Fraternal Order of Eagles Diabetes Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Obesity Research and Education Initiative, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Veterans Affairs Health Care System, Iowa City, IA, USA.
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2
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De Gioannis R, Ewald AC, Gerlach DA, Heusser K, Hoffmann F, Frings-Meuthen P, Heer M, Tank J, Jordan J. Effects of short-term hypercaloric nutrition on orthostatic tolerance in healthy individuals: a randomized controlled crossover study. Clin Auton Res 2022; 32:423-430. [PMID: 36195683 PMCID: PMC9719449 DOI: 10.1007/s10286-022-00900-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
Reduced-caloric intake lowers blood pressure through sympathetic inhibition, and worsens orthostatic tolerance within days. Conversely, hypercaloric nutrition augments sympathetic activity and blood pressure. Because dietary interventions could be applied in patients with syncope, we tested the hypothesis that short-term hypercaloric dieting improves orthostatic tolerance. In a randomized crossover trial, 20 healthy individuals (7 women, 26.7 ± 8 years, 22.6 ± 2 kg/m2) followed a 4-day hypercaloric (25% increase of energy intake by fat) or normocaloric nutritional plan, with a washout period of at least 23 days between interventions. We then performed head-up tilt table testing with incremental lower body negative pressure while recording beat-by-beat blood pressure and heart rate. The primary endpoint was orthostatic tolerance defined as time to presyncope. Time to presyncope during combined head-up tilt and lower body negative pressure did not differ between hypercaloric and normocaloric dieting (median 23.19 versus 23.04 min, ratio of median 1.01, 95% CI of ratio 0.5-1.9). Heart rate, blood pressure, heart rate variability, and blood pressure variability in the supine position and during orthostatic testing did not differ between interventions. We conclude that 4 days of moderate hypercaloric nutrition does not significantly improve orthostatic tolerance in healthy individuals. Nevertheless, given the important interaction between energy balance and cardiovascular autonomic control in the brain, caloric intake deserves more attention as a potential contributor and treatment target for orthostatic intolerance.
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Affiliation(s)
- Riccardo De Gioannis
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ann C Ewald
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Darius A Gerlach
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Karsten Heusser
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Fabian Hoffmann
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Martina Heer
- IU International University of Applied Sciences, Erfurt, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany.
- Chair of Aerospace Medicine, University of Cologne, Cologne, Germany.
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3
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Giacomello E, Toniolo L. The Potential of Calorie Restriction and Calorie Restriction Mimetics in Delaying Aging: Focus on Experimental Models. Nutrients 2021; 13:2346. [PMID: 34371855 PMCID: PMC8308705 DOI: 10.3390/nu13072346] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Aging is a biological process determined by multiple cellular mechanisms, such as genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication, that ultimately concur in the functional decline of the individual. The evidence that the old population is steadily increasing and will triplicate in the next 50 years, together with the fact the elderlies are more prone to develop pathologies such as cancer, diabetes, and degenerative disorders, stimulates an important effort in finding specific countermeasures. Calorie restriction (CR) has been demonstrated to modulate nutrient sensing mechanisms, inducing a better metabolic profile, enhanced stress resistance, reduced oxidative stress, and improved inflammatory response. Therefore, CR and CR-mimetics have been suggested as powerful means to slow aging and extend healthy life-span in experimental models and humans. Taking into consideration the difficulties and ethical issues in performing aging research and testing anti-aging interventions in humans, researchers initially need to work with experimental models. The present review reports the major experimental models utilized in the study of CR and CR-mimetics, highlighting their application in the laboratory routine, and their translation to human research.
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Affiliation(s)
- Emiliana Giacomello
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Luana Toniolo
- Laboratory of Muscle Biophysics, Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
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4
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Bychkov A, Reshetnikova P, Bychkova E, Podgorbunskikh E, Koptev V. The current state and future trends of space nutrition from a perspective of astronauts' physiology. Int J Gastron Food Sci 2021. [DOI: 10.1016/j.ijgfs.2021.100324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Al Obeed OA, Traiki TB, Alfahad YF, Abdulla MH, AlAli MN, Alharbi AA, Alharbi R, Nouh T, Hersi A. Prevalence of vasovagal syncope following bariatric surgery. Saudi J Anaesth 2021; 15:161-164. [PMID: 34188635 PMCID: PMC8191276 DOI: 10.4103/sja.sja_922_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Obesity is a major global public health problem. Observational studies have shown an increasing incidence of syncope and pre-syncope following bariatric surgery in obese patients. However, there is paucity of the true incidence of syncope following bariatrics sugary in the literature. METHODS We have randomly surveyed 200 patients who underwent bariatric surgery between 2016-2018 using Calgary Syncope Score (CSS). RESULTS Of the 200 patients enrolled, 107 (53.5%) were female with 167 patients (83.5%) between 18 and 50 years of age. The most-reported comorbidities were diabetes mellitus 26 (13%) hypertension 25 (12.5%) and pulmonary disease 18 (9%). The majority 98 (49%) of the patients had pre-operative body mass index (BMI) of 40-50 kg/m 2, and most of them had laparoscopic sleeve gastrectomy (LSG). Sixty-two (31%) patients had vasovagal syncope (VVS), 52 (26%) patients had non-VVS and 86 (43%) had no syncope. CONCLUSION Vasovagal syncope in patients following bariatric sugary is quite common and affects 15% of bariatric patients in our series in the first year postoperatively. Further randomized controlled trials are required to prove our results.
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Affiliation(s)
- Omar A. Al Obeed
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Thamer Bin Traiki
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Yara F. Alfahad
- Department of Cardiac Sciences, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Maha-Hamadien Abdulla
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed N. AlAli
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulhamed A. Alharbi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Reem Alharbi
- Department of Surgery, College of Medicine, Prince Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Thamer Nouh
- Trauma and Acute Care Surgery Unit, Department of Surgery, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Hersi
- Department of Cardiac Sciences, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
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6
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Fukuda APM, Camandona VDL, Francisco KJM, Rios-Anjos RM, Lucio do Lago C, Ferreira-Junior JR. Simulated microgravity accelerates aging in Saccharomyces cerevisiae. LIFE SCIENCES IN SPACE RESEARCH 2021; 28:32-40. [PMID: 33612178 DOI: 10.1016/j.lssr.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/01/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
The human body experiences physiological changes under microgravity environment that phenocopy aging on Earth. These changes include early onset osteoporosis, skeletal muscle atrophy, cardiac dysfunction, and immunosenescence, and such adaptations to the space environment may pose some risk to crewed missions to Mars. To investigate the effect of microgravity on aging, many model organisms have been used such as the nematode Caenorhabditis elegans, the fruit fly Drosophila melanogaster, and mice. Herein we report that the budding yeast Saccharomyces cerevisiae show decreased replicative lifespan (RLS) under simulated microgravity in a clinostat. The reduction of yeast lifespan is not a result of decreased tolerance to heat shock or oxidative stress and could be overcome either by deletion of FOB1 or calorie restriction, two known interventions that extend yeast RLS. Deletion of the sirtuin gene SIR2 worsens the simulated microgravity effect on RLS, and together with the fob1Δ mutant phenotype, it suggests that simulated microgravity augments the formation of extrachromosomal rDNA circles, which accumulate in yeast during aging. We also show that the chronological lifespan in minimal medium was not changed when cells were grown in the clinostat. Our data suggest that the reduction in longevity due to simulated microgravity is conserved in yeast, worms, and flies, and these findings may have potential implications for future crewed missions in space, as well as the use of microgravity as a model for human aging.
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Affiliation(s)
| | | | | | | | - Claudimir Lucio do Lago
- Departamento de Química Fundamental - Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
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7
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Ishitsuka K, Yamawaki K, Horikawa M, Nakadate H, Nagai A, Ishiguro A. Clinical Prognostic Factors in Pediatric Patients With Orthostatic Intolerance. Glob Pediatr Health 2020; 7:2333794X20971980. [PMID: 33241086 PMCID: PMC7672775 DOI: 10.1177/2333794x20971980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022] Open
Abstract
Midodrine is widely used for orthostatic intolerance (OI); however, little is known about the prognostic factors of OI after midodrine treatment. We retrospectively reviewed electronic medical charts to investigate clinical prognostic factors of OI on 159 OI patients aged 7 to 18 years who were treated with midodrine at a children's hospital. Logistic regression was conducted to clarify predictors for improving symptoms at the first month of the treatment. Patients with orthostatic uncomfortable feeling or fainting were significantly more likely to improve symptoms at the first month of the treatment (odds ratio [OR], 3.48; 95% confidence interval [95%CI], 1.36-8.89), but patients with underweight were significantly less likely to improve symptoms (OR, 0.19; 95%CI, 0.06-0.56). Our results suggest that predictive factors for OI by midodrine treatments are orthostatic symptoms and underweight in pediatric patients. These findings are useful to develop further studies for OI treatments.
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Affiliation(s)
- Kazue Ishitsuka
- National Center for Child Health and Development, Tokyo, Japan
| | - Kaori Yamawaki
- National Center for Child Health and Development, Tokyo, Japan.,Kyushu University, Fukuoka, Japan
| | - Miwako Horikawa
- National Center for Child Health and Development, Tokyo, Japan
| | - Hisaya Nakadate
- National Center for Child Health and Development, Tokyo, Japan
| | - Akira Nagai
- National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- National Center for Child Health and Development, Tokyo, Japan
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8
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Turroni S, Magnani M, Kc P, Lesnik P, Vidal H, Heer M. Gut Microbiome and Space Travelers' Health: State of the Art and Possible Pro/Prebiotic Strategies for Long-Term Space Missions. Front Physiol 2020; 11:553929. [PMID: 33013480 PMCID: PMC7505921 DOI: 10.3389/fphys.2020.553929] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/14/2020] [Indexed: 12/20/2022] Open
Abstract
The upcoming exploration missions will imply a much longer duration than any of the missions flown so far. In these missions, physiological adaptation to the new environment leads to changes in different body systems, such as the cardiovascular and musculoskeletal systems, metabolic and neurobehavioral health and immune function. To keep space travelers healthy on their trip to Moon, Mars and beyond and their return to Earth, a variety of countermeasures need to be provided to maintain body functionality. From research on the International Space Station (ISS) we know today, that for instance prescribing an adequate training regime for each individual with the devices available in the respective spacecraft is still a challenge. Nutrient supply is not yet optimal and must be optimized in exploration missions. Food intake is intrinsically linked to changes in the gut microbiome composition. Most of the microbes that inhabit our body supply ecosystem benefit to the host-microbe system, including production of important resources, bioconversion of nutrients, and protection against pathogenic microbes. The gut microbiome has also the ability to signal the host, regulating the processes of energy storage and appetite perception, and influencing immune and neurobehavioral function. The composition and functionality of the microbiome most likely changes during spaceflight. Supporting a healthy microbiome by respective measures in space travelers might maintain their health during the mission but also support rehabilitation when being back on Earth. In this review we are summarizing the changes in the gut microbiome observed in spaceflight and analog models, focusing particularly on the effects on metabolism, the musculoskeletal and immune systems and neurobehavioral disorders. Since space travelers are healthy volunteers, we focus on the potential of countermeasures based on pre- and probiotics supplements.
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Affiliation(s)
- Silvia Turroni
- Unit of Microbial Ecology of Health, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Marciane Magnani
- Laboratory of Microbial Processes in Foods, Department of Food Engineering, Federal University of Paraíba, João Pessoa, Brazil
| | - Pukar Kc
- Institut National de la Santé et de la Recherche Médicale (Inserm, UMR_S 1166), Hôpital de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Philippe Lesnik
- Institut National de la Santé et de la Recherche Médicale (Inserm, UMR_S 1166), Hôpital de la Pitié-Salpêtrière, Sorbonne Université, Paris, France.,Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Hubert Vidal
- CarMeN Laboratory, INSERM, INRA, Université Claude Bernard Lyon 1, Pierre-Benite, France
| | - Martina Heer
- International University of Applied Sciences, Bad Reichenhall, Germany.,Institute of Nutritional and Food Sciences, University of Bonn, Bonn, Germany
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9
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Sandal PH, Kim D, Fiebig L, Winnard A, Caplan N, Green DA, Weber T. Effectiveness of nutritional countermeasures in microgravity and its ground-based analogues to ameliorate musculoskeletal and cardiopulmonary deconditioning-A Systematic Review. PLoS One 2020; 15:e0234412. [PMID: 32516346 PMCID: PMC7282646 DOI: 10.1371/journal.pone.0234412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
A systematic review was performed to evaluate the effectiveness of nutrition as a standalone countermeasure to ameliorate the physiological adaptations of the musculoskeletal and cardiopulmonary systems associated with prolonged exposure to microgravity. A search strategy was developed to find all astronaut or human space flight bed rest simulation studies that compared individual nutritional countermeasures with non-intervention control groups. This systematic review followed the guidelines of the Cochrane Handbook for Systematic Reviews and tools created by the Aerospace Medicine Systematic Review Group for data extraction, quality assessment of studies and effect size. To ensure adequate reporting this systematic review followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses. A structured search was performed to screen for relevant articles. The initial search yielded 4031 studies of which 10 studies were eligible for final inclusion. Overall, the effect of nutritional countermeasure interventions on the investigated outcomes revealed that only one outcome was in favor of the intervention group, whereas six outcomes were in favor of the control group, and 43 outcomes showed no meaningful effect of nutritional countermeasure interventions at all. The main findings of this study were: (1) the heterogeneity of reported outcomes across studies, (2) the inconsistency of the methodology of the included studies (3) an absence of meaningful effects of standalone nutritional countermeasure interventions on musculoskeletal and cardiovascular outcomes, with a tendency towards detrimental effects on specific muscle outcomes associated with power in the lower extremities. This systematic review highlights the limited amount of studies investigating the effect of nutrition as a standalone countermeasure on operationally relevant outcome parameters. Therefore, based on the data available from the included studies in this systematic review, it cannot be expected that nutrition alone will be effective in maintaining musculoskeletal and cardiopulmonary integrity during space flight and bed rest.
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Affiliation(s)
- Peter H. Sandal
- Space Medicine Team, European Astronaut Centre, European Space Agency, Köln, Germany
| | - David Kim
- Space Medicine Team, European Astronaut Centre, European Space Agency, Köln, Germany
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Leonie Fiebig
- Space Medicine Team, European Astronaut Centre, European Space Agency, Köln, Germany
- Institute of Biomechanics und Orthopaedics, German Sport University, Cologne, Germany
| | - Andrew Winnard
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Nick Caplan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David A. Green
- Space Medicine Team, European Astronaut Centre, European Space Agency, Köln, Germany
- Centre of Human & Applied Physiological Sciences, King’s College London, London, United Kingdom
- KBR GmbH, Köln, Germany
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, European Space Agency, Köln, Germany
- KBR GmbH, Köln, Germany
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10
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Zhang JB, Tamboli RA, Albaugh VL, Williams DB, Kilkelly DM, Grijalva CG, Shibao CA. The incidence of orthostatic intolerance after bariatric surgery. Obes Sci Pract 2020; 6:76-83. [PMID: 32128245 PMCID: PMC7042102 DOI: 10.1002/osp4.383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/22/2019] [Accepted: 10/07/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS Every year, over 200 000 individuals undergo bariatric surgery for the treatment of extreme obesity in the United States. Several retrospective studies describe the occurrence of orthostatic intolerance (OI) syndrome after bariatric surgery. However, the incidence of this syndrome remains unknown. MATERIALS AND METHODS We used a prospective, de-identified registry of 4547 patients who have undergone bariatric surgery at Vanderbilt to identify cases of new-onset OI. Structured chart reviews were conducted for all subjects who reported new-onset OI post surgery. Cases of OI were confirmed using an operational case definition developed by the Vanderbilt Autonomic Dysfunction Center, and autonomic function tests results were examined for evidence of impaired autonomic function. The cumulative incidence of post-bariatric surgery OI syndrome was estimated using a life table. RESULTS Seven hundred forty-one of 4547 (16.3%) patients included in our cohort reported new OI symptoms after surgery. After the chart review, we confirmed the presence of post-bariatric surgery OI syndrome in 85 patients, 14 with severe OI requiring pressor agents. At 5 years post surgery, follow-up is reduced to 15%; the unadjusted 5-year prevalence of OI was 1.9%. The cumulative incidence of OI syndrome adjusted for loss of follow-up was 4.2%. Most OI cases developed during weight-stable months (±5 kg). At the time of identification, 13% of OI cases showed evidence of impaired sympathetic vasoconstrictor activity. CONCLUSION OI is frequent in the bariatric population, affecting 4.2% of patients within the first 5 years postoperatively. In 13% of post-bariatric surgery OI patients, there was evidence of impaired sympathetic vasoconstriction activity.
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Affiliation(s)
- James B. Zhang
- Department of SurgeryVanderbilt University Medical CenterNashvilleTennessee
| | - Robyn A. Tamboli
- Department of SurgeryVanderbilt University Medical CenterNashvilleTennessee
| | - Vance L. Albaugh
- Department of SurgeryVanderbilt University Medical CenterNashvilleTennessee
| | - David B. Williams
- Department of SurgeryVanderbilt University Medical CenterNashvilleTennessee
| | - Donna M. Kilkelly
- Department of SurgeryVanderbilt University Medical CenterNashvilleTennessee
| | - Carlos G. Grijalva
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennessee
- Mid‐South Geriatric Research Education and Clinical CenterVA Tennessee Valley Health Care SystemNashvilleTennessee
| | - Cyndya A. Shibao
- Department of MedicineVanderbilt University Medical CenterNashvilleTennessee
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11
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Stewart JM, Boris JR, Chelimsky G, Fischer PR, Fortunato JE, Grubb BP, Heyer GL, Jarjour IT, Medow MS, Numan MT, Pianosi PT, Singer W, Tarbell S, Chelimsky TC. Pediatric Disorders of Orthostatic Intolerance. Pediatrics 2018; 141:peds.2017-1673. [PMID: 29222399 PMCID: PMC5744271 DOI: 10.1542/peds.2017-1673] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 01/18/2023] Open
Abstract
Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40% of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe the most common forms of OI in pediatrics and distinguish between chronic and acute OI. These common forms of OI include initial orthostatic hypotension (which is a frequently seen benign condition in youngsters), true orthostatic hypotension (both neurogenic and nonneurogenic), vasovagal syncope, and postural tachycardia syndrome. We also describe the influences of chronic bed rest and rapid weight loss as aggravating factors and causes of OI. Presenting signs and symptoms are discussed as well as patient evaluation and testing modalities. Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities, such as joint hypermobility, anxiety, and gastrointestinal issues. The medical management of OI is considered, which includes both nonpharmacologic and pharmacologic approaches. Finally, we discuss the prognosis and long-term implications of OI and indicate future directions for research and patient management.
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Affiliation(s)
| | | | | | | | - John E. Fortunato
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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12
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Goswami N. Falls and Fall-Prevention in Older Persons: Geriatrics Meets Spaceflight! Front Physiol 2017; 8:603. [PMID: 29075195 PMCID: PMC5641583 DOI: 10.3389/fphys.2017.00603] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/04/2017] [Indexed: 02/04/2023] Open
Abstract
This paper provides a general overview of key physiological consequences of microgravity experienced during spaceflight and of important parallels and connections to the physiology of aging. Microgravity during spaceflight influences cardiovascular function, cerebral autoregulation, musculoskeletal, and sensorimotor system performance. A great deal of research has been carried out to understand these influences and to provide countermeasures to reduce the observed negative consequences of microgravity on physiological function. Such research can inform and be informed by research related to physiological changes and the deterioration of physiological function due to aging. For example, head-down bedrest is used as a model to study effects of spaceflight deconditioning due to reduced gravity. As hospitalized older persons spend up to 80% of their time in bed, the deconditioning effects of bedrest confinement on physiological functions and parallels with spaceflight deconditioning can be exploited to understand and combat both variations of deconditioning. Deconditioning due to bed confinement in older persons can contribute to a downward spiral of increasing frailty, orthostatic intolerance, falls, and fall-related injury. As astronauts in space spend substantial amounts of time carrying out exercise training to counteract the microgravity-induced deconditioning and to counteract orthostatic intolerance on return to Earth, it is logical to suggest some of these interventions for bed-confined older persons. Synthesizing knowledge regarding deconditioning due to reduced gravitational stress in space and deconditioning during bed confinement allows for a more comprehensive approach that can incorporate aspects such as (mal-) nutrition, muscle strength and function, cardiovascular (de-) conditioning, and cardio-postural interactions. The impact of such integration can provide new insights and lead to methods of value for both space medicine and geriatrics (Geriatrics meets spaceflight!). In particular, such integration can lead to procedures that address the morbidity and the mortality associated with bedrest immobilization and in the rising health care costs associated with an aging population demographic.
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Affiliation(s)
- Nandu Goswami
- Gravitational Physiology, Aging and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria.,Department of Health Sciences, Alma Mater Europea University, Maribor, Slovenia
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13
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Christou GA, Kiortsis DN. The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope. Obes Rev 2017; 18:370-379. [PMID: 28112481 DOI: 10.1111/obr.12501] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 12/16/2022]
Abstract
Orthostatic intolerance (OI) is frequently the mechanism underlying the occurrence of noncardiac syncope (NCS) and is associated with substantial risk for injury. Body weight status appears to be a modifier of orthostatic responses and possibly influences the propensity to NCS. The majority of cross-sectional studies have found that the lower the body mass index (BMI) the greater the predisposition to OI is, accompanied with both down-regulation of sympathetic nervous system activity and up-regulation of parasympathetic nervous system activity. These changes appear to occur across the whole spectrum of BMI values from underweight to obesity, while they may be associated more strongly with central body fat than total body fat. Weight loss following bariatric surgery has been consistently found to increase OI, attributed first to the effects of weight loss per se, second to the specific type of surgical procedure and third to the potential postoperative autonomic neuropathy due to vitamin deficiency. The increased OI following bariatric surgery renders this intervention not easily tolerable for the affected individuals, mandating increased fluid and salt intake, pharmacological measures or surgical adjustments to attenuate OI. All future studies investigating orthostatic responses and NCS should implement a matching of the population arms for BMI and ideally for body fat.
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Affiliation(s)
- G A Christou
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | - D N Kiortsis
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
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14
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Bergouignan A, Stein TP, Habold C, Coxam V, O’ Gorman D, Blanc S. Towards human exploration of space: The THESEUS review series on nutrition and metabolism research priorities. NPJ Microgravity 2016; 2:16029. [PMID: 28725737 PMCID: PMC5515527 DOI: 10.1038/npjmgrav.2016.29] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 01/01/2023] Open
Abstract
Nutrition has multiple roles during space flight from providing sufficient nutrients to meet the metabolic needs of the body and to maintain good health, to the beneficial psychosocial aspects related to the meals. Nutrition is central to the functioning of the body; poor nutrition compromises all the physiological systems. Nutrition is therefore likely to have a key role in counteracting the negative effects of space flight (e.g., radiation, immune deficits, oxidative stress, and bone and muscle loss). As missions increase in duration, any dietary/nutritional deficiencies will become progressively more detrimental. Moreover, it has been recognized that the human diet contains, in addition to essential macronutrients, a complex array of naturally occurring bioactive micronutrients that may confer significant long-term health benefits. It is therefore critical that astronauts be adequately nourished during missions. Problems of nutritional origin are often treatable by simply providing the appropriate nutrients and adequate recommendations. This review highlights six key issues that have been identified as space research priorities in nutrition field: in-flight energy balance; altered feeding behavior; development of metabolic stress; micronutrient deficiency; alteration of gut microflora; and altered fluid and electrolytes balance. For each of these topics, relevance for space exploration, knowledge gaps and proposed investigations are described. Finally, the nutritional questions related to bioastronautics research are very relevant to multiple ground-based-related health issues. The potential spin-offs are both interesting scientifically and potentially of great clinical importance.
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Affiliation(s)
- Audrey Bergouignan
- Anschutz Health and Wellness Center, Division of Endocrinology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Université de Strasbourg, IPHC, Strasbourg, France
- CNRS, UMR7178, Strasbourg, France
| | - T Peter Stein
- Department of Surgery, Rowan University, Stratford, NJ, USA
| | - Caroline Habold
- Université de Strasbourg, IPHC, Strasbourg, France
- CNRS, UMR7178, Strasbourg, France
| | - Veronique Coxam
- Centre de Recherche en Nutrition Humaine d’Auvergne, Clermont-Ferrand, France
| | - Donal O’ Gorman
- Department of Health & Human Performance, Dublin City University, Dublin, Republic of Ireland
| | - Stéphane Blanc
- Université de Strasbourg, IPHC, Strasbourg, France
- CNRS, UMR7178, Strasbourg, France
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15
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Florian JP, Baisch FJ, Heer M, Pawelczyk JA. Caloric restriction diminishes the pressor response to static exercise. EXTREME PHYSIOLOGY & MEDICINE 2016; 5:2. [PMID: 26793301 PMCID: PMC4719559 DOI: 10.1186/s13728-016-0043-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/05/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Astronauts in space consume fewer calories and return to earth predisposed to orthostatic intolerance. The role that caloric deficit plays in the modulation of autonomic control of the cardiovascular system is unknown. Therefore, the purpose of this study was to determine the effects of 6° head-down bedrest (an analog of spaceflight) with a hypocaloric diet (25 % caloric restriction) (CR) on autonomic neural control during static handgrip (HG) and cold pressor (CP) tests. Nine healthy young men participated in a randomized crossover bedrest (BR) study, consisting of four, two-week interventions (hypocaloric ambulatory, hypocaloric bedrest, normocaloric ambulatory, and normocaloric bedrest), each separated by 5 months. Heart rate (HR), arterial pressure, and muscle sympathetic nerve activity (MSNA) were recorded before, during, and after HG (40 % of maximum voluntary contraction to fatigue), post-exercise muscle ischemia (forearm occlusion), and CP. Bedrest and nutritional combinations were compared using two-way ANOVA with repeated measures. RESULTS HR, MSNA, and the change in systolic blood pressure during HG were attenuated with caloric restriction, but post-intervention responses for all groups were similar during post-exercise muscle ischemia. CR was associated with a higher diastolic blood pressure during CP; however, HR was directionally opposite (i.e., increase with BR, decrease with CR). CONCLUSIONS In summary 14-day caloric/fat restriction attenuated MSNA and pressor responses during isometric exercise to fatigue but not to post-exercise muscle ischemia. This indicates that the integrity of the metaboreflex is maintained whereas the influence of the mechanoreflex and/or central command may be reduced.
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Affiliation(s)
- John P Florian
- Navy Experimental Diving Unit, 321 Bullfinch Rd., Panama City, FL 32407 USA
| | | | - Martina Heer
- DLR-Institute of Aerospace Medicine, Cologne, Germany
| | - James A Pawelczyk
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
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