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Crispim Carvalho NN, Baccin Martins VJ, da Nóbrega VA, de Arruda Neta ADCP, Cavalcante da Fonseca LA, Bandeira F, de Brito Alves JL. Effects of Preoperative Sarcopenia-Related Parameters on Cardiac Autonomic Function in Women with Obesity Following Bariatric Surgery: A One-Year Prospective Study. Nutrients 2023; 15:2656. [PMID: 37375560 DOI: 10.3390/nu15122656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES Investigate changes in blood pressure (BP) and heart rate variability (HRV) in women with and without sarcopenia-related parameters who underwent bariatric surgery (BS) during a one-year follow-up. SUBJECTS AND METHODS Women were separated into obesity (OB, n = 20) and women with obesity displaying sarcopenia-related parameters (SOP, n = 14) and evaluated before BS and 3, 6, and 12 months after BS. SOP was defined as low handgrip strength (HS) and/or low appendicular skeletal mass adjusted for weight (ASM/wt × 100, %) in the lowest quartile of the sample. ASM/wt × 100, % and HS were significantly lower in SOP than OB over a one-year follow-up of BS (p < 0.05). RESULTS There was a reduction in diastolic BP, heart rate (HR), SDHR, LF, and the LF/HF ratio (p < 0.05) and an increase in the HF band in both groups during the follow-up period (p < 0.05). SOP women had reduced root mean square differences of successive RR intervals (RMSSD) and HF band and an increased LF band and SD2/SD1 ratio compared to the OB group during the one-year follow-up (p < 0.05). ASM/wt × 100, % was negatively associated with the LF band (r = -0.24, p = 0.00) and positively associated with the HF band (r = 0.22, p = 0.01). Conversely, HS had no association with LF (r = -0.14, p = 0.09) and HF (r = 0.11, p = 0.19). ASM/wt × 100, % and HS were negatively associated with the LF/HF ratio (p < 0.05). CONCLUSIONS Women who underwent BS had an improved HRV over a one-year follow-up. However, the improvement in HRV variables was less pronounced in women with low muscle mass and/or HS during the follow-up period.
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Affiliation(s)
- Nara Nóbrega Crispim Carvalho
- Department of Nutrition, Health Sciences Center, Federal University of Paraíba, João Pessoa 58010-780, Brazil
- Department of Endocrinology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa 58050-000, Brazil
| | - Vinícius José Baccin Martins
- Department of Physiology and Pathology, Health Sciences Center, Federal University of Paraíba, João Pessoa 58010-780, Brazil
| | - Vinícius Almeida da Nóbrega
- Department of Nutrition, Health Sciences Center, Federal University of Paraíba, João Pessoa 58010-780, Brazil
| | | | | | - Francisco Bandeira
- Division of Endocrinology and Diabetes, Hospital Agamenon Magalhães, Recife 52051-380, Brazil
| | - José Luiz de Brito Alves
- Department of Nutrition, Health Sciences Center, Federal University of Paraíba, João Pessoa 58010-780, Brazil
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Alonge KM, Porte D, Schwartz MW. Distinct Roles for Brain and Pancreas in Basal and Postprandial Glucose Homeostasis. Diabetes 2023; 72:547-556. [PMID: 37146276 PMCID: PMC10130484 DOI: 10.2337/db22-0969] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/04/2023] [Indexed: 05/07/2023]
Abstract
The glucose homeostasis system ensures that the circulating glucose level is maintained within narrow physiological limits both in the fasting (or basal) state and following a nutrient challenge. Although glucose homeostasis is traditionally conceptualized as a single overarching system, evidence reviewed here suggests that basal glycemia and glucose tolerance are governed by distinct control systems. Specifically, whereas glucose tolerance appears to be determined largely by interactions between insulin secretion and insulin sensitivity, basal-state glucose homeostasis is predominated by insulin-independent mechanisms governed largely by the brain. In addition to a new perspective on how glucose homeostasis is achieved, this "dual control system" hypothesis offers a feasible and testable explanation for observations that are otherwise difficult to reconcile and sheds new light on the integration of central and peripheral metabolic control mechanisms. The implications of this model for the pathogenesis and treatment of impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes are also discussed.
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Affiliation(s)
- Kimberly M. Alonge
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, WA
| | - Daniel Porte
- Division of Endocrinology, School of Medicine, University of California San Diego, San Diego, CA
| | - Michael W. Schwartz
- Department of Medicine, University of Washington Medicine Diabetes Institute, Seattle, WA
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Mattos S, Rabello da Cunha M, Barreto Silva MI, Serfaty F, Tarvainen MP, Klein MRST, Neves MF. Effects of weight loss through lifestyle changes on heart rate variability in overweight and obese patients: A systematic review. Clin Nutr 2022; 41:2577-2586. [PMID: 36228570 DOI: 10.1016/j.clnu.2022.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/27/2022] [Accepted: 09/16/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS The effects of calorie restriction and physical activity on autonomic regulation and cardiac vagal control in overweight and obese individuals remain inconsistent. Thus, this systematic review aimed to evaluate the weight loss effects through lifestyle changes on heart rate variability (HRV) markers in overweight and obese subjects. METHODS A systematic search for studies published up to November 2021 was conducted in MEDLINE, Embase, EBSCO host and VHL REGIONAL/LILACS. The main outcomes were changes in HRV indices from pre- and post-nutritional intervention and exercise in overweight and obese individuals. This review was registered in PROSPERO: CRD42021274467. RESULTS The literature search retrieved 959 articles, of which 12 were included in this review. The intervention in nine studies was diet only, in two studies was diet and exercise, and in one study diet was compared to diet and exercise. The weight loss was greater than 10% in four studies and between 5 and 10% in three studies. Most of the studies revealed that weight loss through lifestyle changes seems to promote beneficial effects on HRV, restoring sympathovagal balance by increasing parasympathetic activity and reducing sympathetic activation. CONCLUSION This systematic review exhibited the beneficial effects of weight loss through lifestyle changes on cardiac autonomic control in overweight and obese individuals. Future investigations need standardization of HRV indices for better interpretation of autonomic function in different clinical situations.
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Affiliation(s)
- Samanta Mattos
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria Inês Barreto Silva
- Department of Applied Nutrition, Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Applied Nutrition, Nutrition School, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabiano Serfaty
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mika P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Mario Fritsch Neves
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Giovanelli L, Palombo C, Pina M, Facchetti S, Malacarne M, Pagani M, Nannipieri M, Berta R, Lucini D. Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study. J Pers Med 2022; 12:jpm12081317. [PMID: 36013266 PMCID: PMC9409827 DOI: 10.3390/jpm12081317] [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: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity is associated with an increased risk of several chronic comorbidities, which may also be determined by dysfunctional autonomic nervous system (ANS). The influence of bariatric surgery (BS) on ANS balance was explored in previous studies, but with high heterogeneity in both the assessment timing and methods employed. In the present observational study, we applied a clinical protocol which considers two subsequent phases. Twenty-nine non-diabetic obese subjects were studied at baseline (T0), after one month of lifestyle modification (prehabilitation) (phase 1-T1), and after eight months following BS (phase 2-T2). ANS regulation was assessed across the three study epochs by means of ANSI, a single composite percent-ranked proxy of autonomic balance, being free of gender and age bias, economical and simple to apply in a clinical setting. The aim of the present study was to investigate the effects of the clinical protocol based on prehabilitation and subsequent BS on the ANS regulation by means of ANSI. Potential intertwined correlations with metabolic parameters were also investigated. Notably, we observed a progressive improvement in ANS control, even by employing ANSI. Moreover, the reduction in the markers of sympathetic overactivity was found to significantly correlate with the amelioration in some metabolic parameters (fasting glucose, insulin levels, and waist circumference), as well as in stress and tiredness perception. In conclusion, this study provides convincing evidence that a unitary proxy of cardiac autonomic regulation (CAR) may reflect the progressive improvement in autonomic regulation following behavioral and surgical interventions in obese patients. Intriguingly, this might contribute to reducing cardiovascular and metabolic risk.
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Affiliation(s)
- Luca Giovanelli
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Department of Endocrine and Metabolic Medicine, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, 56126 Pisa, Italy
| | - Matteo Pina
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Simone Facchetti
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Mara Malacarne
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, 56216 Pisa, Italy
| | - Rossana Berta
- Obesity Surgery Division, Pisa University Hospital, 56216 Pisa, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Correspondence: ; Tel.: +3902-619-1128-08
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Ca 2+ mishandling and mitochondrial dysfunction: a converging road to prediabetic and diabetic cardiomyopathy. Pflugers Arch 2022; 474:33-61. [PMID: 34978597 PMCID: PMC8721633 DOI: 10.1007/s00424-021-02650-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/16/2022]
Abstract
Diabetic cardiomyopathy is defined as the myocardial dysfunction that suffers patients with diabetes mellitus (DM) in the absence of hypertension and structural heart diseases such as valvular or coronary artery dysfunctions. Since the impact of DM on cardiac function is rather silent and slow, early stages of diabetic cardiomyopathy, known as prediabetes, are poorly recognized, and, on many occasions, cardiac illness is diagnosed only after a severe degree of dysfunction was reached. Therefore, exploration and recognition of the initial pathophysiological mechanisms that lead to cardiac dysfunction in diabetic cardiomyopathy are of vital importance for an on-time diagnosis and treatment of the malady. Among the complex and intricate mechanisms involved in diabetic cardiomyopathy, Ca2+ mishandling and mitochondrial dysfunction have been described as pivotal early processes. In the present review, we will focus on these two processes and the molecular pathway that relates these two alterations to the earlier stages and the development of diabetic cardiomyopathy.
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An Z, Wang H, Mokadem M. Role of the Autonomic Nervous System in Mechanism of Energy and Glucose Regulation Post Bariatric Surgery. Front Neurosci 2021; 15:770690. [PMID: 34887725 PMCID: PMC8649921 DOI: 10.3389/fnins.2021.770690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/15/2021] [Indexed: 01/06/2023] Open
Abstract
Even though lifestyle changes are the mainstay approach to address obesity, Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most effective and durable treatments facing this pandemic and its associated metabolic conditions. The traditional classifications of bariatric surgeries labeled them as “restrictive,” “malabsorptive,” or “mixed” types of procedures depending on the anatomical rearrangement of each one of them. This conventional categorization of bariatric surgeries assumed that the “restrictive” procedures induce their weight loss and metabolic effects by reducing gastric content and therefore having a smaller reservoir. Similarly, the “malabsorptive” procedures were thought to induce their main energy homeostatic effects from fecal calorie loss due to intestinal malabsorption. Observational data from human subjects and several studies from rodent models of bariatric surgery showed that neither of those concepts is completely true, at least in explaining the multiple metabolic changes and the alteration in energy balance that those two surgeries induce. Rather, neuro-hormonal mechanisms have been postulated to underly the physiologic effects of those two most performed bariatric procedures. In this review, we go over the role the autonomic nervous system plays- through its parasympathetic and sympathetic branches- in regulating weight balance and glucose homeostasis after SG and RYGB.
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Affiliation(s)
- Zhibo An
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States
| | - Haiying Wang
- Department of Physiology, Basic Medical School of Jining Medical University, Jining, China
| | - Mohamad Mokadem
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.,Fraternal Order of Eagles Diabetes Research Center, The University of Iowa, Iowa City, IA, United States.,Obesity Research and Education Initiative, The University of Iowa, Iowa City, IA, United States.,Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States
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7
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Benjamim CJR, Pontes YMDM, de Sousa Junior FW, Porto AA, Bueno Júnior CR, Marcelino da Silva AA, Ferro Cavalcante TC, Garner DM, Valenti VE. Does bariatric surgery improve cardiac autonomic modulation assessed by heart rate variability? A systematic review. Surg Obes Relat Dis 2021; 17:1497-1509. [PMID: 33958294 DOI: 10.1016/j.soard.2021.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/04/2021] [Accepted: 03/20/2021] [Indexed: 11/17/2022]
Abstract
Our study aimed to explore the influence of bariatric surgery (BS) on heart rate (HR) variability (HRV) through a systematic review. Manuscripts were selected based on electronic searches of the MEDLINE, EMBASE, and CINAHL databases from the inception of each database up to year 2020, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Searching of these studies was systematized using the Population Intervention Comparison Outcome Study Design strategy. We selected randomized and nonrandomized controlled trials and cohorts from prospective studies that reported the influence of BS on HRV. We assessed the quality rating using the Black and Downs questionnaire. Following the screening and eligibility stages, 14 studies were included in the review. All studies agreed that BS promotes an increase in parasympathetic HR control and HRV and a decrease in HR. Yet the literature does not provide evidence that these outcomes are directly caused by the surgical procedure. There is limited evidence to support that patients with type 2 diabetes have greater improvement in HRV as an interim measure, to individuals without. The decrease in insulin resistance was correlated with the increase in HRV in some studies, but, other studies are unsupportive of this outcome. Improvements in 2 metabolic parameters (e.g., leptin, N-terminal pro B-type natriuretic peptide) were connected with superior increases in HRV. This review demonstrated that BS promotes an increase in HRV, indicating improved autonomic control of HR.
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Affiliation(s)
- Cicero Jonas R Benjamim
- Development, Nutrition, Phytotherapy and Hygiene Research Group, University of Pernambuco, Petrolina, Brazil; Autonomic Nervous System Center, Sao Paulo State University, Marilia, Brazil
| | - Yasmim Mota de M Pontes
- Physiological and Collective Sciences Nucleus, School of Juazeiro do Norte, Juazeiro do Norte, Brazil
| | | | - Andrey Alves Porto
- Autonomic Nervous System Center, Sao Paulo State University, Marilia, Brazil; Department of Physical Therapy, Faculty of Sciences and Technologies, UNESP, Presidente Prudente, Brazil
| | - Carlos Roberto Bueno Júnior
- Ribeirão Preto Medical School, Department of Medical Clinic, University of São Paulo, Ribeirão Preto, Brazil
| | - Amanda A Marcelino da Silva
- Development, Nutrition, Phytotherapy and Hygiene Research Group, University of Pernambuco, Petrolina, Brazil
| | - Taisy C Ferro Cavalcante
- Development, Nutrition, Phytotherapy and Hygiene Research Group, University of Pernambuco, Petrolina, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, United Kingdom
| | - Vitor E Valenti
- Autonomic Nervous System Center, Sao Paulo State University, Marilia, Brazil.
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8
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Snacking on Whole Almonds for Six Weeks Increases Heart Rate Variability during Mental Stress in Healthy Adults: A Randomized Controlled Trial. Nutrients 2020; 12:nu12061828. [PMID: 32575387 PMCID: PMC7353422 DOI: 10.3390/nu12061828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
Cardiac autonomic regulation can be indirectly measured by heart rate variability (HRV). Low HRV, which can be induced by mental stress, is a predictor of risk of sudden cardiac death. Few studies have investigated cause-and-effect relationships between diet and HRV. Nut consumption is associated with CVD risk reduction, but the impact on HRV, particularly in response to stress, is unclear. Men and women (30–70 y) with above average risk of developing CVD were randomly assigned in a 6-week randomized, controlled, parallel arm trial to consume either whole almond or isocaloric control snacks (20% of daily estimated energy requirement). Control snacks contained the average nutrient profile of UK snacks. Five-minute periods of supine heart rate (HR) and HRV were measured at resting and during mental stress (Stroop color-word test) at baseline and six weeks. High frequency (HF) power, which reflects parasympathetic regulation of HR, was increased following almonds during the mental stress task relative to control (mean difference between groups 124 ms2; 95% CI 11, 237; p = 0.031, n = 105), but other indices were unaffected. Snacking on whole almonds instead of typical snacks may reduce risk of CVD partly by ameliorating the suppression of HRV during periods of mental stress.
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Katsogiannos P, Kamble PG, Wiklund U, Sundbom M, Espes D, Hammar U, Karlsson FA, Pereira MJ, Eriksson JW. Rapid changes in neuroendocrine regulation may contribute to reversal of type 2 diabetes after gastric bypass surgery. Endocrine 2020; 67:344-353. [PMID: 31983031 PMCID: PMC7026226 DOI: 10.1007/s12020-020-02203-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/13/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the role of hormones and the autonomic nervous system in the rapid remission of diabetes after Roux-en-Y Gastric Bypass (RYGB). RESEARCH DESIGN AND METHODS Nineteen obese patients with type 2 diabetes, 7 M/12 F, were randomized (2:1) to RYGB or standard-of-care medical treatment (control). At baseline and 4 and 24 weeks post surgery, fasting blood sampling, OGTT, intravenous arginine challenge, and heart-rate variability (HRV) assessments were performed. RESULTS At both 4 and 24 weeks post-RYGB the following effects were found: arginine-stimulated insulin secretion was reduced. GLP-1, GIP, and glucagon rise during OGTT was enhanced. IGF-1 and GH levels increased. In addition, total HRV and spectral components PLF (power of low frequency) and PHF (power of high frequency) increased. At 4 weeks, morning cortisol was lower than baseline and 24 weeks. At 24 weeks, NEFA levels during OGTT, and the PLF/PHF ratio decreased. None of these changes were seen in the control group. CONCLUSIONS There were rapid changes within 4 weeks after RYGB: signs of enhanced parasympathetic nerve activity, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose. The findings suggest that neurohormonal mechanisms can contribute to the rapid improvement of insulin resistance and glycemia following RYGB in type 2 diabetes.
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Affiliation(s)
- Petros Katsogiannos
- Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Prasad G Kamble
- Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Urban Wiklund
- Radiation Sciences, Biomedical Engineering & Informatics, Umeå University, Umeå, Sweden
| | | | - Daniel Espes
- Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Ulf Hammar
- Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - F Anders Karlsson
- Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Maria J Pereira
- Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Jan W Eriksson
- Department of Medical Science, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden.
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Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JPH. Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review. Diabetes Ther 2019; 10:1995-2021. [PMID: 31552598 PMCID: PMC6848658 DOI: 10.1007/s13300-019-00693-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a major complication of type 1 and type 2 diabetes mellitus (T1DM and T2DM). The increased morbidity, cardiovascular and all-cause mortality associated with CAN is established from numerous epidemiological studies. However, CAN is increasingly recognised in people with prediabetes (pre-DM) and the metabolic syndrome (MetS) with a reported prevalence up to 11% and 24% respectively. CAN is associated with components of MetS including hypertension and obesity, predating hyperglycaemia. The aetiology of CAN is multifactorial and there is a reciprocal relationship with insulin resistance and MetS. Obstructive sleep apnoea (OSA) is also associated with CAN possibly through MetS and an independent mechanism. An estimated global prevalence of the impaired glucose tolerance (IGT) form of pre-DM of 587 million people by 2045 means CAN will become a major clinical problem. CAN is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Screening for CAN in pre-DM using risk scores with analysis of heart rate variability (HRV) or Sudoscan is important to allow earlier treatment at a reversible stage. The link between obesity and CAN highlights the therapeutic potential of lifestyle interventions including diet and physical activity to reverse MetS and prevent CAN. Weight loss achieved using these dietary and exercise lifestyle interventions improves the sympathetic and parasympathetic HRV indices of cardiac autonomic function. Further research is needed to identify high-risk populations of people with pre-DM or obesity that might benefit from targeted pharmacotherapy including metformin, sodium/glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) analogues. Bariatric surgery also improves HRV through weight loss which might also prevent CAN in severe obesity. This article reviews the literature on CAN in obesity, pre-DM and MetS, to help determine a rationale for screening, early intervention treatment and formulate future research questions in this highly prevalent condition.
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Affiliation(s)
| | | | - Uazman Alam
- Diabetes and Neuropathy Research, Department of Eye and Vision Sciences and Pain Research Institute, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
- Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
| | - Daniel J Cuthbertson
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Lundqvist MH, Almby K, Abrahamsson N, Eriksson JW. Is the Brain a Key Player in Glucose Regulation and Development of Type 2 Diabetes? Front Physiol 2019; 10:457. [PMID: 31133864 PMCID: PMC6524713 DOI: 10.3389/fphys.2019.00457] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
Ever since Claude Bernards discovery in the mid 19th-century that a lesion in the floor of the third ventricle in dogs led to altered systemic glucose levels, a role of the CNS in whole-body glucose regulation has been acknowledged. However, this finding was later overshadowed by the isolation of pancreatic hormones in the 20th century. Since then, the understanding of glucose homeostasis and pathology has primarily evolved around peripheral mechanism. Due to scientific advances over these last few decades, however, increasing attention has been given to the possibility of the brain as a key player in glucose regulation and the pathogenesis of metabolic disorders such as type 2 diabetes. Studies of animals have enabled detailed neuroanatomical mapping of CNS structures involved in glucose regulation and key neuronal circuits and intracellular pathways have been identified. Furthermore, the development of neuroimaging techniques has provided methods to measure changes of activity in specific CNS regions upon diverse metabolic challenges in humans. In this narrative review, we discuss the available evidence on the topic. We conclude that there is much evidence in favor of active CNS involvement in glucose homeostasis but the relative importance of central vs. peripheral mechanisms remains to be elucidated. An increased understanding of this field may lead to new CNS-focusing pharmacologic strategies in the treatment of type 2 diabetes.
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Affiliation(s)
| | - Kristina Almby
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Jan W Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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12
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Spallone V. Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet. Diabetes Metab J 2019; 43:3-30. [PMID: 30793549 PMCID: PMC6387879 DOI: 10.4093/dmj.2018.0259] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 12/15/2022] Open
Abstract
The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening. CAN assessment allows for treatment of its manifestations, cardiovascular risk stratification, and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, whereas multifactorial intervention might be effective in T2DM. Lifestyle intervention improves autonomic function mostly in pre-diabetes. While there is no conclusive evidence for a disease-modifying therapy, treatment of CAN manifestations is available. The modulation of autonomic function by SGLT2i represents a promising research field with possible clinical relevance.
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Affiliation(s)
- Vincenza Spallone
- Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Ma J, Vella A. What Has Bariatric Surgery Taught Us About the Role of the Upper Gastrointestinal Tract in the Regulation of Postprandial Glucose Metabolism? Front Endocrinol (Lausanne) 2018; 9:324. [PMID: 29997575 PMCID: PMC6028568 DOI: 10.3389/fendo.2018.00324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
The interaction between the upper gastrointestinal tract and the endocrine system is important in the regulation of metabolism and of weight. The gastrointestinal tract has a heterogeneous cellular content and comprises a variety of cells that elaborate paracrine and endocrine mediators that collectively form the entero-endocrine system. The advent of therapy that utilizes these pathways as well as the association of bariatric surgery with diabetes remission has (re-)kindled interest in the role of the gastrointestinal tract in glucose homeostasis. In this review, we will use the changes wrought by bariatric surgery to provide insights into the various gut-pancreas interactions that maintain weight, regulate satiety, and limit glucose excursions after meal ingestion.
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Affiliation(s)
- Jing Ma
- Division of Endocrinology and Metabolism, Shanghai Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic College of Medicine, Rochester, NY, United States
| | - Adrian Vella
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic College of Medicine, Rochester, NY, United States
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14
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Effect of renal sympathetic denervation on hepatic glucose metabolism and blood pressure in a rat model of insulin resistance. J Hypertens 2017; 34:2465-2474. [PMID: 27512967 DOI: 10.1097/hjh.0000000000001087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Hypertension and diabetes are associated with impaired glucose metabolism and insulin resistance. Chronic activation of the sympathetic nervous system may contribute to either condition. The purpose of this study was to investigate the effect of renal denervation on glucose kinetics and insulin signal pathways in high-fat diet (HFD)-fed rats. METHODS We examined the effects of renal denervation on glucose kinetics and insulin sensitivity in HFD-fed rats with a hyperinsulinemic-euglycemic clamp technique combined with [3-H] glucose and [U-C]-lactate as a tracer. We also analyzed in vivo the flux through glucose-6-phosphatase and the relative contribution of gluconeogenesis and glycogenolysis in renal denervation rats. In addition, western blotting was used to identify the activities of insulin signaling proteins. RESULTS Renal denervation in HFD-fed rats markedly decreased blood pressure and hepatic glucose production. Hepatic glucose production reduction in renal-denervation-treated rats includes decrease in glycogenolysis by 18.2% for left renal denervation or 31.9% for bilateral renal denervation and decrease in gluconeogenesis by 16.3% for left renal denervation or 42.8% for bilateral renal denervation. These changes were accompanied by decreased hepatic expression of glucose-6-phosphatase and phosphoenolpyruvate carboxykinase. Importantly, renal denervation increased phosphorylation of insulin receptors, insulin receptor substrate-1 and Akt kinase in HFD-fed rats. CONCLUSION These data corroborate the notion that renal denervation potentiates hepatic insulin sensitivity.
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15
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Chou CC, Ho CT, Lee HL, Chu Y, Yen TH, Wen MS, Lin SF, Lee CH, Chang PC. Roles of impaired intracellular calcium cycling in arrhythmogenicity of diabetic mouse model. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1087-1095. [PMID: 28842915 DOI: 10.1111/pace.13166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/03/2017] [Accepted: 07/14/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetes mellitus is associated an increased risk of ventricular arrhythmias (VAs), but the underlying electrophysiological mechanisms are not fully explored. This study was aimed to test whether dynamic factors and Cai handling play roles in arrhythmogenesis of a diabetic animal model. METHODS We used 26 db/db type 2 diabetes mice and 28 control mice in this study. VA inducibility was evaluated in vivo under isoflurane general anesthesia. The intracellular Ca2+ (Cai ) and membrane voltage (Vm ) signals of the Langendorff-perfused mouse hearts were simultaneously recorded using the optical mapping technique. Action potential duration (APD), Cai dynamics conduction velocity (CV), and arrhythmogenic alternans were analyzed. Western blot was conducted to examine expressions of calcium handling and associated ion channels proteins. RESULTS The diabetic db/db mice showed significantly increased VA inducibility and severity. Longer APD and Cai transient duration and slower Cai decay and CV in the db/db mice than these in the control ones were observed. Dynamic pacing showed increased incidence of spatially discordant alternans leading to more VA inducibility in the db/db mice. Western blot analyses revealed increased phosphorylated-Ca2+ /calmodulin-dependent protein kinase II protein expression and decreased ryanodine receptor protein expression, which probably underlay the molecular mechanisms of enhanced arrhythmogenicity in db/db mice. CONCLUSIONS The type 2 diabetic mouse hearts show impaired repolarization, Cai handling homeostasis, and cardiac conduction reserve, leading to vulnerability of spatially discordant alternans development and induction of VA. Altered Cai -handling protein expressions probably underlie the molecular mechanisms of arrhythmogenicity in the type 2 diabetes animal model.
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Affiliation(s)
- Chung-Chuan Chou
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Te Ho
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yen Chu
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Thoracic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzung-Hai Yen
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Shien Wen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shien-Fong Lin
- Institute of Biomedical Engineering, National Chiao Tung University, Hsin Chu, Taiwan
| | - Cheng-Hung Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Cheng Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
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Guarino D, Nannipieri M, Iervasi G, Taddei S, Bruno RM. The Role of the Autonomic Nervous System in the Pathophysiology of Obesity. Front Physiol 2017; 8:665. [PMID: 28966594 PMCID: PMC5606212 DOI: 10.3389/fphys.2017.00665] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/22/2017] [Indexed: 12/18/2022] Open
Abstract
Obesity is reaching epidemic proportions globally and represents a major cause of comorbidities, mostly related to cardiovascular disease. The autonomic nervous system (ANS) dysfunction has a two-way relationship with obesity. Indeed, alterations of the ANS might be involved in the pathogenesis of obesity, acting on different pathways. On the other hand, the excess weight induces ANS dysfunction, which may be involved in the haemodynamic and metabolic alterations that increase the cardiovascular risk of obese individuals, i.e., hypertension, insulin resistance and dyslipidemia. This article will review current evidence about the role of the ANS in short-term and long-term regulation of energy homeostasis. Furthermore, an increased sympathetic activity has been demonstrated in obese patients, particularly in the muscle vasculature and in the kidneys, possibily contributing to increased cardiovascular risk. Selective leptin resistance, obstructive sleep apnea syndrome, hyperinsulinemia and low ghrelin levels are possible mechanisms underlying sympathetic activation in obesity. Weight loss is able to reverse metabolic and autonomic alterations associated with obesity. Given the crucial role of autonomic dysfunction in the pathophysiology of obesity and its cardiovascular complications, vagal nerve modulation and sympathetic inhibition may serve as therapeutic targets in this condition.
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Affiliation(s)
- Daniela Guarino
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy.,Institute of Clinical Physiology of CNRPisa, Italy.,Scuola Superiore Sant'AnnaPisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
| | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
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Putiri AL, Close JR, Lilly HR, Guillaume N, Sun GC. Qigong Exercises for the Management of Type 2 Diabetes Mellitus. MEDICINES (BASEL, SWITZERLAND) 2017; 4:medicines4030059. [PMID: 28930273 PMCID: PMC5622394 DOI: 10.3390/medicines4030059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/08/2017] [Indexed: 04/13/2023]
Abstract
Background: The purpose of this article is to clarify and define medical qigong and to identify an appropriate study design and methodology for a large-scale study looking at the effects of qigong in patients with type 2 diabetes mellitus (T2DM), specifically subject enrollment criteria, selection of the control group and study duration. Methods: A comprehensive literature review of English databases was used to locate articles from 1980-May 2017 involving qigong and T2DM. Control groups, subject criteria and the results of major diabetic markers were reviewed and compared within each study. Definitions of qigong and its differentiation from physical exercise were also considered. Results: After a thorough review, it was found that qigong shows positive effects on T2DM; however, there were inconsistencies in control groups, research subjects and diabetic markers analyzed. It was also discovered that there is a large variation in styles and definitions of qigong. Conclusions: Qigong exercise has shown promising results in clinical experience and in randomized, controlled pilot studies for affecting aspects of T2DM including blood glucose, triglycerides, total cholesterol, weight, BMI and insulin resistance. Due to the inconsistencies in study design and methods and the lack of large-scale studies, further well-designed randomized control trials (RCT) are needed to evaluate the 'vital energy' or qi aspect of internal medical qigong in people who have been diagnosed with T2DM.
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Affiliation(s)
- Amy L Putiri
- Institute of Qigong and Integrative Medicine (IQ & IM), 10127 Main Place, Suite B, Bothell, WA 98011, USA.
| | - Jacqueline R Close
- Institute of Qigong and Integrative Medicine (IQ & IM), 10127 Main Place, Suite B, Bothell, WA 98011, USA.
- Seattle Healing Acupuncture, LLC, 1307 N 45th Street, Suite 204, Seattle, WA 98103, USA.
| | - Harold Ryan Lilly
- Institute of Qigong and Integrative Medicine (IQ & IM), 10127 Main Place, Suite B, Bothell, WA 98011, USA.
| | - Nathalie Guillaume
- Institute of Qigong and Integrative Medicine (IQ & IM), 10127 Main Place, Suite B, Bothell, WA 98011, USA.
- Healing Happy Hour, 930 Grand Concourse, Ground FL, New York, NY 10451, USA.
| | - Guan-Cheng Sun
- Institute of Qigong and Integrative Medicine (IQ & IM), 10127 Main Place, Suite B, Bothell, WA 98011, USA.
- Bastyr University Research Institute, 14500 Juanita Dr. NE, Kenmore, WA 98028, USA.
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18
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When to eat? The influence of circadian rhythms on metabolic health: are animal studies providing the evidence? Nutr Res Rev 2016; 29:180-193. [PMID: 27364352 DOI: 10.1017/s095442241600010x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As obesity and metabolic diseases rise, there is need to investigate physiological and behavioural aspects associated with their development. Circadian rhythms have a profound influence on metabolic processes, as they prepare the body to optimise energy use and storage. Moreover, food-related signals confer temporal order to organs involved in metabolic regulation. Therefore food intake should be synchronised with the suprachiasmatic nucleus (SCN) to elaborate efficient responses to environmental challenges. Human studies suggest that a loss of synchrony between mealtime and the SCN promotes obesity and metabolic disturbances. Animal research using different paradigms has been performed to characterise the effects of timing of food intake on metabolic profiles. Therefore the purpose of the present review is to critically examine the evidence of animal studies, to provide a state of the art on metabolic findings and to assess whether the paradigms used in rodent models give the evidence to support a 'best time' for food intake. First we analyse and compare the current findings of studies where mealtime has been shifted out of phase from the light-dark cycle. Then, we analyse studies restricting meal times to different moments within the active period. So far animal studies correlate well with human studies, demonstrating that restricting food intake to the active phase limits metabolic disturbances produced by high-energy diets and that eating during the inactive/sleep phase leads to a worse metabolic outcome. Based on the latter we discuss the missing elements and possible mechanisms leading to the metabolic consequences, as these are still lacking.
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19
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Zeng S, Chen Q, Wang XW, Hong K, Li JX, Li P, Cheng XS, Su H. Longer rewarming time in finger cooling test in association with HbA1c level in diabetics. Microvasc Res 2016; 107:72-5. [PMID: 27211911 DOI: 10.1016/j.mvr.2016.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess if rewarming time in finger cooling test (FCT) as an indicator of microvascular dysfunction is abnormal in patients with type 2 diabetes mellitus (T2DM). METHODS Forty-three T2DM patients and 48 healthy controls with similarly distributed baseline demographic, clinical and laboratory parameters were subjected to FCT involving 60-second index finger immersion into water at 4°C. Finger temperature was measured before FCT (baseline-T), immediately after cooling stimulus (T0), and at one-minute intervals until baseline-T recovery. Temperature decline amplitude was calculated as the difference between T0 and baseline-T, and rewarming time as time elapsed from T0 to baseline-T recovery. RESULTS T2DM patients compared with healthy controls had statistically similar baseline-T, significantly larger temperature decline amplitude, significantly lower T0, and significantly longer rewarming time. In T2DM patients, rewarming time positively correlated with T2DM duration (r=0.513, p<0.001) and glycated hemoglobin (HbA1c) level (r=0.446, p=0.003), which also were its independent predictors in multivariate regression analysis. CONCLUSIONS Patients with T2DM display abnormal FCT results suggestive of microvascular dysfunction, with T2DM duration and HbA1c level independently predicting rewarming time.
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Affiliation(s)
- Shan Zeng
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Qi Chen
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiang-Wen Wang
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Kui Hong
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Molecular Medicine, Jiangxi 330006, China
| | - Ju-Xiang Li
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Ping Li
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiao-Shu Cheng
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Hai Su
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
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20
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Casellini CM, Parson HK, Hodges K, Edwards JF, Lieb DC, Wohlgemuth SD, Vinik AI. Bariatric Surgery Restores Cardiac and Sudomotor Autonomic C-Fiber Dysfunction towards Normal in Obese Subjects with Type 2 Diabetes. PLoS One 2016; 11:e0154211. [PMID: 27137224 PMCID: PMC4854471 DOI: 10.1371/journal.pone.0154211] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/11/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim was to evaluate the impact of bariatric surgery on cardiac and sudomotor autonomic C-fiber function in obese subjects with and without Type 2 diabetes mellitus (T2DM), using sudorimetry and heart rate variability (HRV) analysis. METHOD Patients were evaluated at baseline, 4, 12 and 24 weeks after vertical sleeve gastrectomy or Roux-en-Y gastric bypass. All subjects were assessed using SudoscanTM to measure electrochemical skin conductance (ESC) of hands and feet, time and frequency domain analysis of HRV, Neurologic Impairment Scores of lower legs (NIS-LL), quantitative sensory tests (QST) and sural nerve conduction studies. RESULTS Seventy subjects completed up to 24-weeks of follow-up (24 non-T2DM, 29 pre-DM and 17 T2DM). ESC of feet improved significantly towards normal in T2DM subjects (Baseline = 56.71±3.98 vs 12-weeks = 62.69±3.71 vs 24-weeks = 70.13±2.88, p<0.005). HRV improved significantly in T2DM subjects (Baseline sdNN (sample difference of the beat to beat (NN) variability) = 32.53±4.28 vs 12-weeks = 44.94±4.18 vs 24-weeks = 49.71±5.19, p<0,001 and baseline rmsSD (root mean square of the difference of successive R-R intervals) = 23.88±4.67 vs 12-weeks = 38.06±5.39 vs 24-weeks = 43.0±6.25, p<0.0005). Basal heart rate (HR) improved significantly in all groups, as did weight, body mass index (BMI), percent body fat, waist circumference and high-density lipoprotein (HDL). Glycated hemoglobin (HbA1C), insulin and HOMA2-IR (homeostatic model assessment) levels improved significantly in pre-DM and T2DM subjects. On multiple linear regression analysis, feet ESC improvement was independently associated with A1C, insulin and HOMA2-IR levels at baseline, and improvement in A1C at 24 weeks, after adjusting for age, gender and ethnicity. Sudomotor function improvement was not associated with baseline weight, BMI, % body fat or lipid levels. Improvement in basal HR was also independently associated with A1C, insulin and HOMA2-IR levels at baseline. CONCLUSION This study shows that bariatric surgery can restore both cardiac and sudomotor autonomic C-fiber dysfunction in subjects with diabetes, potentially impacting morbidity and mortality.
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Affiliation(s)
- Carolina M. Casellini
- Strelitz Diabetes Center for Endocrine and Metabolic Disorders and the Neuroendocrine Unit, Department of Medicine; Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Henri K. Parson
- Strelitz Diabetes Center for Endocrine and Metabolic Disorders and the Neuroendocrine Unit, Department of Medicine; Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Kim Hodges
- Strelitz Diabetes Center for Endocrine and Metabolic Disorders and the Neuroendocrine Unit, Department of Medicine; Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Joshua F. Edwards
- Strelitz Diabetes Center for Endocrine and Metabolic Disorders and the Neuroendocrine Unit, Department of Medicine; Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - David C. Lieb
- Strelitz Diabetes Center for Endocrine and Metabolic Disorders and the Neuroendocrine Unit, Department of Medicine; Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Stephen D. Wohlgemuth
- Sentara Comprehensive Weight Loss Solutions, Sentara Medical Group, Norfolk, Virginia, United States of America
| | - Aaron I. Vinik
- Strelitz Diabetes Center for Endocrine and Metabolic Disorders and the Neuroendocrine Unit, Department of Medicine; Eastern Virginia Medical School, Norfolk, Virginia, United States of America
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Ziegler D, Strom A, Nowotny B, Zahiragic L, Nowotny PJ, Carstensen-Kirberg M, Herder C, Roden M. Effect of Low-Energy Diets Differing in Fiber, Red Meat, and Coffee Intake on Cardiac Autonomic Function in Obese Individuals With Type 2 Diabetes. Diabetes Care 2015; 38:1750-7. [PMID: 26070589 DOI: 10.2337/dc15-0466] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The autonomic nervous system (ANS) regulates both the cardiovascular system and energy balance and is disturbed in diabetes and obesity. The effect of different approaches of caloric restriction on ANS function has not been assessed in individuals with diabetes. Thus, we sought to determine whether low-energy diets differing in fiber, red meat, and coffee intake exert differential effects on cardiac autonomic function. RESEARCH DESIGN AND METHODS In this randomized parallel-group pilot trial, obese patients with type 2 diabetes were randomly allocated to consume either a diet high in cereal fiber, free of red meat, and high in coffee (n = 13) or a diet low in fiber, high in red meat, and coffee free (n = 15) over 8 weeks. Eight measures of heart rate variability (HRV) indicating vagal and/or sympathetic modulation over 3 h and inflammatory markers were determined during a hyperinsulinemic-euglycemic clamp. RESULTS After 8 weeks, both dietary interventions resulted in a mean weight loss of 5-6 kg, a mean decline in heart rate of 4-6 bpm, and improvement in vagally mediated HRV. However, the changes in HRV parameters from baseline to 8 weeks did not differ between the groups. In the entire study cohort, incremental HRV from baseline to 8 weeks was associated with enhanced oxidative glucose utilization (P < 0.05), but not with insulin sensitivity and inflammatory markers. CONCLUSIONS In obese patients with type 2 diabetes, energy restriction per se over 8 weeks contributed to improved cardiac vagal function in relation to improved oxidative glucose utilization. This preliminary finding should be verified in a confirmatory trial.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Lejla Zahiragic
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Peter J Nowotny
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Maren Carstensen-Kirberg
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
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Cabiddu R, Trimer R, Borghi-Silva A, Migliorini M, Mendes RG, Oliveira Jr. AD, Costa FSM, Bianchi AM. Are Complexity Metrics Reliable in Assessing HRV Control in Obese Patients During Sleep? PLoS One 2015; 10:e0124458. [PMID: 25893856 PMCID: PMC4404104 DOI: 10.1371/journal.pone.0124458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 03/03/2015] [Indexed: 11/30/2022] Open
Abstract
Obesity is associated with cardiovascular mortality. Linear methods, including time domain and frequency domain analysis, are normally applied on the heart rate variability (HRV) signal to investigate autonomic cardiovascular control, whose imbalance might promote cardiovascular disease in these patients. However, given the cardiac activity non-linearities, non-linear methods might provide better insight. HRV complexity was hereby analyzed during wakefulness and different sleep stages in healthy and obese subjects. Given the short duration of each sleep stage, complexity measures, normally extracted from long-period signals, needed be calculated on short-term signals. Sample entropy, Lempel-Ziv complexity and detrended fluctuation analysis were evaluated and results showed no significant differences among the values calculated over ten-minute signals and longer durations, confirming the reliability of such analysis when performed on short-term signals. Complexity parameters were extracted from ten-minute signal portions selected during wakefulness and different sleep stages on HRV signals obtained from eighteen obese patients and twenty controls. The obese group presented significantly reduced complexity during light and deep sleep, suggesting a deficiency in the control mechanisms integration during these sleep stages. To our knowledge, this study reports for the first time on how the HRV complexity changes in obesity during wakefulness and sleep. Further investigation is needed to quantify altered HRV impact on cardiovascular mortality in obesity.
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Affiliation(s)
- Ramona Cabiddu
- DEIB, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
- * E-mail:
| | - Renata Trimer
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Matteo Migliorini
- DEIB, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Renata G. Mendes
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | | | - Anna M. Bianchi
- DEIB, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
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Altaf QA, Barnett AH, Tahrani AA. Novel therapeutics for type 2 diabetes: insulin resistance. Diabetes Obes Metab 2015; 17:319-34. [PMID: 25308775 DOI: 10.1111/dom.12400] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/23/2014] [Accepted: 10/04/2014] [Indexed: 12/19/2022]
Abstract
Insulin resistance (IR) plays an important role in the pathogenesis of type 2 diabetes (T2D) and cardiovascular disease. Hence improving IR is a major target of treatment in patients with T2D. Obesity and lack of exercise are major causes of IR. However, recent evidence implicates sleep disorders and disorders of the circadian rhythm in the pathogenesis of IR. Weight loss and lifestyle changes are the cornerstone and most effective treatments of IR, but adherence and patient's acceptability are poor. Bariatric surgery results in significant and sustainable long-term weight loss associated with beneficial impact on IR and glucose metabolism, making this an attractive treatment option for patients with T2D. Currently available pharmacological options targeting IR (such as metformin and thiazolidinediones) do not maintain glycaemic measures within targets long term and can be associated with significant side effects. Over the last two decades, many pharmacological agents targeting different aspects of the insulin signalling pathway were developed to improve IR, but only a minority reached clinical trials. Such treatments need to be specific and reversible as many of the components of the insulin signalling pathway are involved in other cellular functions such as apoptosis. Recent evidence highlighted the role of circadian rhythm and sleep-related disorders in the pathogenesis of IR. In this article, we review the latest developments in the pharmacological and non-pharmacological interventions targeting IR including bariatric surgery. We will also review the role of circadian rhythm and sleep-related disorders in the development and treatment of IR.
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Affiliation(s)
- Q-A Altaf
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK; Centre of Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UK
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Seravalle G, Colombo M, Perego P, Giardini V, Volpe M, Dell'Oro R, Mancia G, Grassi G. Long-term sympathoinhibitory effects of surgically induced weight loss in severe obese patients. Hypertension 2014; 64:431-7. [PMID: 24866140 DOI: 10.1161/hypertensionaha.113.02988] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Weight loss improves insulin sensitivity and exerts sympathomodulatory effects. No data, however, are available on the effects of the weight loss induced by vertical sleeve gastrectomy on sympathetic neural drive, insulin sensitivity, and their reciprocal cross talks. In 10 severe obese hypertensives (age, 54.0±2.3 years [mean±SEM]), we measured sphygmomanometric blood pressure, heart rate, body mass index, homeostatic model assessment index, plasma leptin, muscle sympathetic nerve traffic (microneurography), and baroreflex sensitivity (vasoactive drug technique). Measurements were performed 2 to 3 days before surgery and repeated 6 and 12 months after the procedure. Ten matched hypertensive obeses not undergoing gastrectomy served as controls. Six months after bariatric surgery, a significant (P<0.05) reduction in body mass index (-9.1±1.4 kg/m(2)), sphygmomanometric systolic blood pressure (-10.2±4.5 mm Hg), heart rate (-11.0±2.4 bpm), homeostatic model assessment index (-3-3±1.3 AU), plasma leptin (-53.6±8.8 μg/L), and muscle sympathetic nerve traffic (-15.0±3.4 bursts/100 heart beats) was observed. The weight loss, the plasma leptin reduction, and the sympathetic inhibition were maintained after 12 months, whereas homeostatic model assessment index showed a tendency to return toward presurgery values. A significant improvement in baroreflex control of sympathetic nerve traffic was observed both 6 (+32.1%; P<0.05) and 12 months (+60.7%; P<0.01) after gastrectomy. No significant changes in the above-mentioned variables were detected in the control group. These data provide evidence that massive weight loss induced by sleeve gastrectomy triggers profound sympathoinhibitory effects, associated with a stable and significant reduction in plasma leptin levels, whereas the improvement in insulin sensitivity was attenuated with time and unrelated to the sympathoinhibition.
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Affiliation(s)
- Gino Seravalle
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| | - Manuela Colombo
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| | - Paolo Perego
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| | - Vittorio Giardini
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| | - Marco Volpe
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| | - Raffaella Dell'Oro
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| | - Giuseppe Mancia
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| | - Guido Grassi
- From the Istituto Auxologico Italiano, Milan, Italy (G.S., G.M.); Clinica Medica, Department of Health Science (M.C., M.V., R.D., G.G.) and Chirurgia II (P.P., V.G.), University of Milano-Bicocca, Monza, Italy; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy (G.M., G.G.); and IRCCS Multimedica, Sesto San Giovanni, Milan, Italy (G.G.).
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