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Gonçalves Teixeira B, Paciência I, Cavaleiro Rufo J, Mendes F, Farraia M, Padrão P, Moreira P, Moreira A. The Influence of Obesity in the Autonomic Nervous System Activity in School-Aged Children in Northern Portugal: A Cross-Sectional Study. ACTA MEDICA PORT 2023; 36:317-325. [PMID: 37130573 DOI: 10.20344/amp.17144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/19/2022] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Obesity is one of the most prevalent chronic diseases in childhood, being an important public health issue. Excessive weight has been associated with autonomic dysfunction but the evidence in children is scarce. Therefore, the aim of this study was to assess the effect of overweight and obesity on the autonomic nervous system activity, in children. MATERIAL AND METHODS Data from a cross-sectional study of 1602 children, aged 7 to 12 years, was used and 858 children were included in the analysis. Body mass index was calculated and classified according to criteria of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF). Body composition was characterized by bioelectrical impedance. Linear regression models were used to determine the association between body mass index, body composition and the autonomic nervous system activity, assessed by pupillometry. RESULTS Average dilation velocity was higher among children with obesity, according to the CDC and percentage of body fat criteria (β = 0.053, 95% CI = 0.005 to 0.101 and β = 0.063, 95% CI = 0.016 to 0.109, respectively). The same trend was observed for WHO and IOTF criteria (β = 0.045, 95% CI = -0.001 to 0.091, and β = 0.055, 95% CI = -0.001 to 0.111, respectively). CDC and WHO body mass index z-scores were also positively associated with the values of average dilation velocity (rs = 0.030, p = 0.048; and rs = 0.027, p = 0.042, respectively). CONCLUSION Our findings suggest an association between body mass and changes in the autonomic activity, Moreover, this study provides proof of concept for interventions targeting the prevention/treatment of obesity in children that may offer some benefit in re-establishing the balance of the autonomic nervous system, and subsequently preventing the consequences associated with the autonomic nervous system dysfunction.
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Affiliation(s)
| | - Inês Paciência
- Serviço de Imunologia Básica e Clínica. Departamento de Patologia. Faculdade de Medicina da Universidade do Porto. Centro Hospitalar Universitário de São João. Porto; EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto. Portugal
| | - João Cavaleiro Rufo
- Serviço de Imunologia Básica e Clínica. Departamento de Patologia. Faculdade de Medicina da Universidade do Porto. Centro Hospitalar Universitário de São João. Porto; EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto. Portugal
| | - Francisca Mendes
- Serviço de Imunologia Básica e Clínica. Departamento de Patologia. Faculdade de Medicina da Universidade do Porto. Centro Hospitalar Universitário de São João. Porto; EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto. Portugal
| | - Mariana Farraia
- Serviço de Imunologia Básica e Clínica. Departamento de Patologia. Faculdade de Medicina da Universidade do Porto. Centro Hospitalar Universitário de São João. Porto; EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto. Portugal
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação. Universidade do Porto. Porto; EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto. Portugal
| | - Pedro Moreira
- Faculdade de Ciências da Nutrição e Alimentação. Universidade do Porto. Porto; EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto. Portugal
| | - André Moreira
- Serviço de Imunologia Básica e Clínica. Departamento de Patologia. Faculdade de Medicina da Universidade do Porto. Centro Hospitalar Universitário de São João. Porto; EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto. Portugal
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Anthropometric Determinants of Respiratory Sinus Arrhythmia in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010566. [PMID: 35010824 PMCID: PMC8744931 DOI: 10.3390/ijerph19010566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022]
Abstract
Background: The study was conducted to investigate the implications of anthropometry in school-aged children on the degree of respiratory sinus arrhythmia observed in clinical settings. Methods: In a cohort study, 626 healthy children (52% male) aged 10.8 ± 0.5 years attending primary school in a single town underwent a 12-lead electrocardiogram coupled with measurements of height, weight and blood pressure. Indices of respiratory sinus arrhythmia (pvRSA, RMSSD, RMSSDc) were derived from semi-automatic measurements of RR intervals. Height, weight, BMI, blood pressure as well as waist and hip circumferences were compared between subjects with rhythmic heart rate and respiratory sinus arrhythmia, and correlations between indices of sinus arrhythmia and anthropometry were investigated. Results: Respiratory sinus arrhythmia was recognized in 43% of the participants. Subjects with sinus arrhythmia had lower heart rate (p < 0.001), weight (p = 0.009), BMI (p = 0.005) and systolic (p = 0.018) and diastolic (p = 0.004) blood pressure. There were important inverse correlations of heart rate and indices of sinus arrhythmia (r = −0.52 for pvRSA and r = −0.58 for RMSSD), but not the anthropometry. Conclusion: Lower prevalence of respiratory sinus arrhythmia among children with overweight and obesity is a result of higher resting heart rate observed in this population.
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Speer KE, Koenig J, Telford RM, Olive LS, Mara JK, Semple S, Naumovski N, Telford RD, McKune AJ. Relationship between heart rate variability and body mass index: A cross-sectional study of preschool children. Prev Med Rep 2021; 24:101638. [PMID: 34976689 PMCID: PMC8684011 DOI: 10.1016/j.pmedr.2021.101638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/02/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022] Open
Abstract
Heart rate variability and BMI are inversely related in preschool children. One unit increase in BMI resulted in a reduction in RMSSD(ln) of 0.06% Age, sex and physical activity levels did not influence this relationship.
Reduced heart rate variability (HRV) is associated with overweight and obesity in adults. However, little is known about this relationship in early childhood. We investigated the relationship between resting vagally-mediated HRV and body mass index (BMI) in Australian preschool children. Children were recruited from 13 non-government early learning centres located in Queensland and New South Wales, Australia. From this population-based sample, data from 146 healthy children (58 females) between 3 and 5 years of age (mean age 4.35 ± 0.44 years) were analysed. BMI was calculated from child body weight and height. Physical activity was recorded using an Actigraph wGT3x accelerometer worn at the waist of participants over 3 consecutive days. A Polar H10 chest strap measured seated, resting RR intervals for the calculation of HRV with the root mean square of successive differences (RMSSD) reflecting vagally-mediated activity. The relationship between HRV and BMI was analysed using a linear mixed model adjusted for age, sex and physical activity. Analysis revealed that RMSSD (ln) demonstrated a significant inverse relationship with BMI (β = -0.06; 95% CI = -0.12 – −0.01; p = 0.032), and the model accounted for 23% of the variance in RMSSD (ln). Notably, a one unit increase in BMI resulted in a reduction in RMSDD (ln) of 0.06. This investigation demonstrated evidence for a significant inverse linear relationship between vagally-mediated HRV and BMI in 3 – 5-year-old Australian children, similar to that of adults. Furthermore, this relationship was independent of age, sex and physical activity levels. Results may indicate that the cardiometabolic health of preschool children is, in part, influenced by the relationship between vagally-mediated HRV and weight status.
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Affiliation(s)
- Kathryn E Speer
- Faculty of Health, Discipline of Sport and Exercise Science/University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise/University of Canberra, Canberra, ACT, Australia
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Rohan M Telford
- Research Institute for Sport and Exercise/University of Canberra, Canberra, ACT, Australia
| | - Lisa S Olive
- Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jocelyn K Mara
- Faculty of Health, Discipline of Sport and Exercise Science/University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise/University of Canberra, Canberra, ACT, Australia
| | - Stuart Semple
- Faculty of Health, Discipline of Sport and Exercise Science/University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise/University of Canberra, Canberra, ACT, Australia
| | - Nenad Naumovski
- Faculty of Health, University of Canberra, Discipline of Nutrition and Dietetics/University of Canberra, Canberra, ACT, Australia.,Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT, Australia.,Department of Nutrition and Dietetics, Harokopio University, Athens 17671, Greece
| | - Richard D Telford
- Research Institute for Sport and Exercise/University of Canberra, Canberra, ACT, Australia
| | - Andrew J McKune
- Faculty of Health, Discipline of Sport and Exercise Science/University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise/University of Canberra, Canberra, ACT, Australia.,Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences/ University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Lubocka P, Sabiniewicz R. Respiratory Sinus Arrhythmia in Children-Predictable or Random? Front Cardiovasc Med 2021; 8:643846. [PMID: 34095247 PMCID: PMC8172810 DOI: 10.3389/fcvm.2021.643846] [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: 12/21/2020] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Respiratory sinus arrhythmia (RSA) is associated with better health in children. Aim: The study was conducted to analyze the trajectory of RSA in 10-year-olds. Methods: A follow-up study on 120 healthy children (62 boys) aged 10.7 ± 0.5 years consisted of a standard 12-lead electrocardiogram, measurements of height, weight and blood pressure. The protocol was repeated after 3 years. Assessment of RSA based on semi-automatic measurements of RR intervals included: the difference between the longest and shortest RR interval duration (pvRSA), the root mean square of differences between successive RR intervals (RMSSD), the standard deviation of the RR interval length (SDNN) and their equivalents corrected for heart rate (RMSSDc and SDNNc). Results: A the first visit 61.7% of children presented with RSA; 51.7% 3 years later. 23.3% of them had RSA only on the first examination; 13.3% only on the second one. The pvRSA, RMSSD, and SDNN measured in 2019 did not differ significantly from their 2016 equivalents (p > 0.05). The decline in RSA defined by RMSSD was noted in 52.5% of children and in 54.2% when defined by SDNN. The corrected values decreased in 68.3 and 64.2% of the participants for RMSSDc and SDNNc, respectively. The students with RSA at both visits had lower heart rate (p < 0.001) and systolic blood pressure (p = 0.010) compared to those with rhythmic electrocardiograms. Conclusions: RSA in children is changeable, though its measurable indices should be adjusted to heart rate.
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Affiliation(s)
- Paulina Lubocka
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
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Gąsior JS, Zamunér AR, Silva LEV, Williams CA, Baranowski R, Sacha J, Machura P, Kochman W, Werner B. Heart Rate Variability in Children and Adolescents with Cerebral Palsy-A Systematic Literature Review. J Clin Med 2020; 9:jcm9041141. [PMID: 32316278 PMCID: PMC7230809 DOI: 10.3390/jcm9041141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/04/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiac autonomic dysfunction has been reported in patients with cerebral palsy (CP). The aim of this study was to assess the existing literature on heart rate variability (HRV) in pediatric patients with CP and a special attention was paid to the compliance of the studies with the current HRV assessment and interpretation guidelines. A systematic review was performed in PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases searched for English language publications from 1996 to 2019 using Medical Subject Headings (MeSH) terms “heart rate variability” and “cerebral palsy” in conjunction with additional inclusion criteria: studies limited to humans in the age range of 0–18 years and empirical investigations. Out of 47 studies, 12 were included in the review. Pediatric patients with CP presented a significantly higher resting heart rate and reduced HRV, different autonomic responses to movement stimuli compared to children with normal development, but also reduced HRV parameters in the children dependent on adult assistance for mobility compared to those generally independent. None of the included studies contained the necessary details concerning RR intervals acquisition and HRV measurements as recommended by the guidelines. Authors of HRV studies should follow the methodological guidelines and recommendations on HRV measurement, because such an approach may allow a direct comparison of their results.
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Affiliation(s)
- Jakub S. Gąsior
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, 26-600 Radom, Poland
- Correspondence: ; Tel.: +48-793-199-222
| | | | - Luiz Eduardo Virgilio Silva
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil;
| | - Craig A. Williams
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK;
| | - Rafał Baranowski
- Department of Heart Rhythm Disorders, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland;
- Department of Cardiology, University Hospital in Opole, University of Opole, 45-401 Opole, Poland
| | - Paulina Machura
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-950 Warsaw, Poland;
| | - Wacław Kochman
- Clinical Department of Cardiology at Bielanski Hospital, National Institute of Cardiology, 01-809 Warsaw, Poland;
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Doom JR, Lumeng JC, Sturza J, Kaciroti N, Vazquez DM, Miller AL. Longitudinal associations between overweight/obesity and stress biology in low-income children. Int J Obes (Lond) 2019; 44:646-655. [PMID: 31477784 PMCID: PMC7050333 DOI: 10.1038/s41366-019-0447-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/01/2019] [Accepted: 07/22/2019] [Indexed: 01/22/2023]
Abstract
Background/Objectives Associations between overweight and altered stress biology have been reported cross-sectionally during childhood, but it is unclear whether overweight precedes altered stress biology or if altered stress biology predicts greater likelihood of overweight over time. The current longitudinal study investigates associations between overweight/obesity, salivary alpha amylase and cortisol morning intercept, diurnal slope, and reactivity to social stress in a cohort of low-income children during preschool and middle childhood. Subjects/Methods Children were recruited through Head Start and were observed and followed into middle childhood (N = 257; M = 8.0 years). Height and weight were measured at both time points. Saliva samples were collected across the day and in response to a social challenge at both ages for alpha amylase and cortisol determination. Results Cross-lagged panel analyses indicated that overweight/obesity at preschool predicted lower morning alpha amylase (β = −0.18, 95% CI: −0.34, −0.03; p = .023), lower morning cortisol (β = −0.22, 95% CI: −0.38, −0.06; p = .006), lower sAA diurnal slope (β = −0.18, 95% CI: −0.34, −0.03; p = .021), and lower cortisol stress reactivity (β = −0.19, 95% CI: −0.35, −0.02; p = .031) in middle childhood. Lower alpha amylase reactivity at preschool was the only biological factor that predicted higher likelihood of overweight/obesity at middle childhood (β = −0.20, 95% CI: −0.38, −0.01; p = .035). Conclusions These findings suggest that overweight/obesity may be driving changes in stress biology across early to middle childhood, particularly in down-regulation of morning levels of stress hormones, diurnal sAA slope, and cortisol reactivity to stress, rather than stress biology driving overweight/obesity.
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Affiliation(s)
- Jenalee R Doom
- Department of Psychology, University of Denver, Denver, CO, USA. .,Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA. .,Center for Human Growth & Development, University of Michigan, Ann Arbor, MI, USA.
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Human Growth & Development, University of Michigan, Ann Arbor, MI, USA.,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Human Growth & Development, University of Michigan, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Center for Human Growth & Development, University of Michigan, Ann Arbor, MI, USA.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Delia M Vazquez
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Human Growth & Development, University of Michigan, Ann Arbor, MI, USA
| | - Alison L Miller
- Center for Human Growth & Development, University of Michigan, Ann Arbor, MI, USA.,Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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da Silva CF, Burgos MS, da Silva PT, Burgos LT, Welser L, Sehn AP, Horta JA, de Mello ED, Reuter CP. Relationship between Cardiometabolic Parameters and Elevated Resting and Effort Heart Rate in Schoolchildren. Arq Bras Cardiol 2017; 109:191-198. [PMID: 28746520 PMCID: PMC5586225 DOI: 10.5935/abc.20170103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/07/2017] [Accepted: 03/03/2017] [Indexed: 11/20/2022] Open
Abstract
Background Little has been studied on heart rate and its relationship with metabolic disorders. Objective To identify possible association between heart rate (HR) and metabolic disorders in children and adolescents. Methods This cross-sectional study evaluated 2.098 subjects, aged between 7 and 17 years. The variables evaluated were: HR, systolic (SBP) and diastolic blood pressure (DBP), pulse pressure (PP), double-product (DP), myocardial oxygen consumption (mVO2), lipids, glucose and uric acid levels, body mass index (BMI) and waist circumference (WC). The values of HR at rest and effort were divided into quartiles. The association between continuous values of HR and cardiometabolic indicators was tested by linear regression. Results LDL cholesterol presented a significantly higher mean (p = 0.003) in schoolchildren with resting HR greater or equal to 91 bpm, compared to students with less than 75 bpm. Compared with the quartiles of effort HR, SBP, DBP, glucose and uric acid presented high values when HR was greater or equal than 185 bpm. SBP, glucose and HDL cholesterol demonstrated a significant association with resting HR. Uric acid was observed as a predictor of increased effort HR. Conclusion Schoolchildren with a higher resting HR have higher mean of LDL cholesterol. For effort HR, there was an increase in blood pressure, glucose and uric acid levels. Uric acid has been shown to be a predictor of elevated effort HR.
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Affiliation(s)
| | | | | | | | - Letícia Welser
- Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS -
Brazil
| | - Ana Paula Sehn
- Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS -
Brazil
| | - Jorge André Horta
- Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS -
Brazil
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Hursh BE, Fazeli MS, Wang S, Marchant EA, Woo P, Elango R, Lavoie PM, Chanoine JP, Collet JP. Cardiac Autonomic Function at Baseline and under Stress and Its Relationship to Circulatory Markers of Inflammation in Obese Compared to Nonobese Children: A Pilot Study. Horm Res Paediatr 2017; 85:339-46. [PMID: 27105080 DOI: 10.1159/000445685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The autonomic nervous system (ANS) provides neurogenic control of inflammatory reactions. ANS changes in obesity may result in inflammation. This study sought to gain insight into cardiac autonomic dysfunction and inflammation in childhood obesity, and to gather pilot data on the potential relationship between altered ANS and inflammation. METHODS Fifteen obese children and adolescents without metabolic complications and 15 nonobese controls underwent heart rate variability and impedance cardiography testing during rest, mental stress, and physical stress. Inflammatory cytokines and immune reactivity were measured. RESULTS There was no statistically significant difference between groups in cardiac ANS testing at rest or in response to stress. Median high-sensitivity C-reactive protein (hsCRP) was higher in the obese group [obese 2.6 mg/l (IQR 1.6-11.9); nonobese 0.3 mg/l (IQR 0.2-0.7); p < 0.001]. Interleukin-6 and tumour necrosis factor-α were similar between groups. Immune reactivity testing (in vitro Toll-like receptor stimulation) revealed a strong, but comparable, inflammatory response in both groups. CONCLUSIONS Obese children and adolescents without metabolic complications did not have cardiac ANS dysfunction. While hsCRP was elevated, systemic cytokines were not raised. Compared to prior studies, which often focused on children with obesity and its complications, it is encouraging that obese children without metabolic complications may not yet have autonomic dysfunction.
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Affiliation(s)
- Brenden E Hursh
- Endocrinology and Diabetes Unit, BC Children's Hospital, The University of British Columbia, Vancouver, B.C., Canada
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Franco RL, Privett SH, Bowen MK, Acevedo EO, Arrowood JA, Wickham EP, Evans RK. Sympathetic Activity Assessed during Exercise Recovery in Young Obese Females. J Pediatr 2015; 167:378-83.e1. [PMID: 26003997 PMCID: PMC4516681 DOI: 10.1016/j.jpeds.2015.04.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/16/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate differences in sympathetic activity, as assessed by an exercise recovery index (ERI; heart rate/oxygen consumption [VO2] plateau), between black and white obese female adolescents. An additional aim was to determine the association of ERI with insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]), cardiovascular fitness per fat-free mass (VO2 per fat-free mass), systolic blood pressure (SBP), and percent body fat (%FAT) in both black and white obese adolescents. STUDY DESIGN Sixty-one females volunteered to participate in this study. HOMA-IR, SBP, and %FAT were assessed during resting conditions in black (n = 49, 13.7 ± 1.6 years, 38.1 ± 6.1 kg/m(2)) and white (n = 12, 13.3 ± 2.2 years, 34.3 ± 4.9 kg/m(2)) obese adolescents. An ERI was calculated during a 5-minute passive recovery period immediately following a graded treadmill exercise test to exhaustion. RESULTS The ERI was significantly greater in black compared with white obese adolescent females (29.8 ± 6.4 vs 24.1 ± 3.1 bpm·mLO2(-1)·min(-1), P = .004). Using multiple linear regression modeling, there was a significant independent association between ERI and VO2 per fat-free mass (r = -0.310, P = .027) and %FAT (r = 0.326, P = .020) in black obese adolescents after controlling for HOMA-IR and SBP. CONCLUSIONS These results suggest that black obese adolescent females have greater sympathetic activity, as assessed by an ERI, than white obese adolescent females. These findings support the need for weight management efforts aimed at both reducing %FAT and improving fitness in obese adolescents, specifically black females. TRIAL REGISTRATION Registered with Clinicaltrials.gov: NCT00562293.
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Affiliation(s)
- R. Lee Franco
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - Stacey H. Privett
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - Mary K. Bowen
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - Edmund O. Acevedo
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
| | - James A. Arrowood
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, 1001 East Broad Street, Suite 405, Richmond, VA, USA 23298-0036
| | - Edmond P. Wickham
- Departments of Internal Medicine and Pediatrics, Division of Endocrinology and Metabolism, School of Medicine, Virginia Commonwealth University, 10001 East Broad Street, Suite 405, Richmond, VA, USA 23298-0036
| | - Ronald K. Evans
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, 1020 West Grace Street, Suite 111, Richmond, VA, USA 23284-3021
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Rodríguez-Colón SM, He F, Bixler EO, Fernandez-Mendoza J, Vgontzas AN, Calhoun S, Zheng ZJ, Liao D. Metabolic syndrome burden in apparently healthy adolescents is adversely associated with cardiac autonomic modulation--Penn State Children Cohort. Metabolism 2015; 64:626-32. [PMID: 25684658 PMCID: PMC4372460 DOI: 10.1016/j.metabol.2015.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/22/2015] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reduced cardiac autonomic modulation (CAM) has been associated with metabolic syndrome (MetS) in adults. However, the association between MetS component cluster and CAM has not been examined in adolescents. METHODS We conducted a cross-sectional analysis using data from the Penn State Child Cohort follow-up examination. CAM was assessed by heart rate variability (HRV) analysis of 39-h RR intervals, including frequency (high frequency, HF; low frequency, LF; and LF/HF ratio) and time (SDNN, standard deviation of all RR intervals; RMSSD, square root of the mean of the sum of the squares of differences between adjacent RR intervals; and HR, heart rate) domain variables. To assess the MetS burden, we used continuous MetS score (cMetS)--sum of the age and sex-adjusted standardized residual (Z-score) of five established MetS components. Linear mixed-effect models were used to analyze the association between cMetS and CAM in the entire population and stratified by gender. RESULTS After adjusting for age, sex, and race, cMetS was significantly associated with reduced HRV and higher HR. With 1 standard deviation increase in cMetS, there was a significant decrease in HF (-0.10 (SE = 0.02)), LF (-0.07 (SE = 0.01)), SDNN (-1.97 (SE = 0.50)), and RMSSD (-1.70 (SE = 0.72)), and increase in LF/HF (0.08 (SE = 0.02)) and HR (1.40 (SE = 0.26)). All cMetS components, with the exception of high-density lipoprotein (HDL), were associated with significantly decreased HRV and increased HR. High blood pressure (MAP) and triglyceride (TG) levels were also associated with an increase in LF/HF and decrease in RMSSD. An increase in high-density lipoprotein was only associated with higher LF and SDNN. Moreover, cMetS and HRV associations were more pronounced in males than in females. The associations between HRV and. MAP, TG, and HDL were more pronounced in females. CONCLUSIONS cMetS score is associated with lower HRV, suggesting an adverse impact on CAM, even in apparently healthy adolescents.
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Affiliation(s)
- Sol M Rodríguez-Colón
- Department of Public Health Sciences Penn State University College of Medicine, Hershey, PA, 17033.
| | - Fan He
- Department of Public Health Sciences Penn State University College of Medicine, Hershey, PA, 17033.
| | - Edward O Bixler
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Julio Fernandez-Mendoza
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Alexandros N Vgontzas
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Susan Calhoun
- Sleep Research &Treatment Center, Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, 17033.
| | - Zhi-Jie Zheng
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
| | - Duanping Liao
- Department of Public Health Sciences Penn State University College of Medicine, Hershey, PA, 17033.
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Santos-Magalhaes AF, Aires L, Martins C, Silva G, Teixeira AM, Mota J, Rama L. Heart rate variability, adiposity, and physical activity in prepubescent children. Clin Auton Res 2015; 25:169-78. [PMID: 25820790 DOI: 10.1007/s10286-015-0277-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 12/04/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed at examining the associations between weight status, body fat mass, and heart rate variability in prepubescent children, adjusting for physical activity levels. METHODS A cross-sectional investigation in which a total of 50 Caucasian pre-pubertal children (21 normal weight; 8 overweight; 21 obese), aged 6-10 years (8.33 ± 1.14), including both boys (n = 24) and girls (n = 26), were recruited from local schools. Total body fat and trunk fat were evaluated through dual-energy X-ray absorptiometry. Free-living physical activity levels were evaluated by accelerometer. Short-term heart rate variability acquisition was performed; time- and frequency-domain parameters were analysed. Logarithmic transformations of the low-frequency (LnLFnu), high-frequency (LnHFnu) normalized units and low-frequency/high-frequency (LnLFnu/HFnu) ratio were computed. RESULTS Adjusting for age, Tanner stage, and moderate to vigorous physical activity levels, obese children compared to normal weight children showed a significant decreased LnHfnu (3.8 ± 0.2 vs 4.1 ± 0.2 %) and both higher LnLFnu (4.0 ± 0.4 vs 3.7 ± 0.3 %) and LnLFnu/LnHFnu ratio (1.1 ± 0.1 vs 0.9 ± 0.1). LnHFnu showed significant negative correlation with waist circumference (r = -0.598; P = 0.000), total body fat (r = -0.409; P = 0.011) and trunk fat (r = -0.472; P = 0.003). Both LnLFnu and LnLFnu/LnHFnu ratio showed positive correlations with waist circumference (r = 0.455; r = 0.513) and trunk fat (r = 0.370; r = 0.415). CONCLUSIONS A higher amount of body fat mass, particularly central fat, was shown to be related to decreased parasympathetic modulation in time-domain heart rate variability. This finding highlights the potential cardiovascular risk that excessive fat mass may represent even at very young age.
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12
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Salivary alpha amylase diurnal pattern and stress response are associated with body mass index in low-income preschool-aged children. Psychoneuroendocrinology 2015; 53:40-8. [PMID: 25588701 PMCID: PMC4336565 DOI: 10.1016/j.psyneuen.2014.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/08/2014] [Accepted: 12/15/2014] [Indexed: 11/24/2022]
Abstract
Physiological stress responses are proposed as a pathway through which stress can "get under the skin" and lead to health problems, specifically obesity. We tested associations of salivary alpha amylase (sAA) diurnal patterns and stress responses with body mass index (BMI) in young, low-income children (51% male; 54% non-Hispanic white). Diurnal saliva samples were collected three times per day across three days for 269 children (M age 50.8 months, SD 6.3). Individual sAA intercept and slope values were calculated using random effect models to represent morning sAA levels and rate of sAA change across the day. A subset of children (n=195; M age 56.6 months, SD 6.9) participated in a lab-based behavioral stress protocol. Area under the curve increase (AUCI) across four timepoints was calculated to represent increase in sAA output during stress elicitation. Children were weighed and height measured and BMI z-score was calculated. Linear regression was used to evaluate associations of sAA intercept, sAA slope, and sAA AUCI with BMI z-score, controlling for child age, sex, and race/ethnicity; maternal weight status; and family income-to-needs ratio. Diurnal and stress-response sAA patterns were related to child adiposity: for each 1-standard deviation unit (SDU) decrease in morning sAA level, the child's BMI z-score increased by 0.11 (SE 0.05) SDU's (p<.04); for each 1-SDU increase in sAA slope across the day, the child's BMI z-score increased by 0.12 (SE 0.05) SDU's (p<.03); and for each 1-SDU decrease in sAA AUCI during the stress elicitation, the child's BMI z-score increased by 0.14 (SE 0.06) SDU's (p<.03). Blunted stress responses and atypical diurnal patterns of sAA have been found following exposure to chronic life stressors such as poverty. Findings suggest that associations of stress, sAA, and elevated body mass index may develop very early in the lifespan.
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Liao D, Rodríguez-Colón SM, He F, Bixler EO. Childhood obesity and autonomic dysfunction: risk for cardiac morbidity and mortality. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:342. [PMID: 25143120 DOI: 10.1007/s11936-014-0342-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OPINION STATEMENT The epidemic of childhood obesity is becoming a major predictor for risk of cardiovascular diseases (CVD) and mortality during adulthood. Alterations in the morphology of the heart due to obesity could be a predictor for the dysfunction of cardiac autonomic modulation (CAM). A number of epidemiologic studies have evaluated the effect of obesity and CAM in children, finding that obesity impaired the balance of CAM toward a sympathetic overflow and reduced parasympathetic modulation, a significant predictor of CVD morbidity and mortality in adults. Lifestyle modifications, for example long-term exercise programs, have been shown to improve CAM in the obese. This review discusses the recent evidence on childhood and adolescent obesity and its impact on CAM, as well as how early lifestyle changes could help improve CAM, which may in turn reduce the burden of CVD in adults.
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Affiliation(s)
- Duanping Liao
- Department of Public Health Sciences, Penn State University College of Medicine, 90 Hope Drive, Suite 2000/A210, PO Box 855, Hershey, PA, 17033, USA,
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Alkon A, Harley KG, Neilands TB, Tambellini K, Lustig RH, Boyce WT, Eskenazi B. Latino children's body mass index at 2-3.5 years predicts sympathetic nervous system activity at 5 years. Child Obes 2014; 10:214-24. [PMID: 24745554 PMCID: PMC4038992 DOI: 10.1089/chi.2013.0063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To understand whether the relationship between young children's autonomic nervous system (ANS) responses predicted their BMI, or vice versa, the association between standardized BMI (zBMI) at 2, 3.5, and 5 years of age and ANS reactivity at 3.5-5 years of age, and whether zBMI predicts later ANS reactivity or whether early ANS reactivity predicts later zBMI, was studied. METHODS Low-income, primarily Latino children (n=112) were part of a larger cohort study of mothers recruited during early pregnancy. Study measures included maternal prenatal weight, children's health behaviors (i.e., time watching television, fast food consumption, and time playing outdoors), children's height and weight at 2, 3.5, and 5 years, and children's ANS reactivity at 3.5 and 5 years. ANS measures of sympathetic nervous system (i.e., pre-ejection period) and parasympathetic nervous system (i.e., respiratory sinus arrhythmia) activity were monitored during rest and four challenges. Reactivity was calculated as the difference between mean challenge response and rest. Structural equation models analyzed the relationship between children's zBMI at 2, 3.5, and 5 years and ANS reactivity at 3.5 and 5 years, adjusting for mother's BMI, children's behaviors, and changes in height. RESULTS There was no association between zBMI and ANS cross-sectionally. Children with high zBMI at 2 or 3.5 years or large zBMI increases from 2 to 3.5 years of age had decreased sympathetic activity at 5 years. Neither sympathetic nor parasympathetic reactivity at 3.5 years predicted later zBMI. CONCLUSIONS Increased zBMI early in childhood may dampen young children's SNS responses later in life.
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Affiliation(s)
- Abbey Alkon
- School of Nursing, University of California, San Francisco, San Francisco, CA
| | - Kim G. Harley
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention, University of California, San Francisco, San Francisco, CA
| | - Katelyn Tambellini
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Robert H. Lustig
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, San Francisco, CA
| | - W. Thomas Boyce
- Division of Developmental and Behavioral Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, Berkeley, CA
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Parasympathetic cardiac activity is associated with cardiorespiratory fitness in overweight and obese adolescents. Pediatr Cardiol 2014; 35:684-90. [PMID: 24272169 DOI: 10.1007/s00246-013-0838-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate the association between cardiac parasympathetic activity and cardiorespiratory fitness, insulin, and hemodynamic profile in overweight and obese adolescent girls and boys (aged 12-16 years). Data were taken from the Multidisciplinary Obesity Treatment Program. Only post-intervention measurements are presented herein. Body composition, cardiorespiratory fitness, blood pressure, and metabolic profile (insulin and glucose profile) of adolescents were assessed. Cardiac parasympathetic activity was determined by resting heart rate variability, which was analyzed using a heart rate monitor. Greater parasympathetic cardiac activity was associated with higher levels of cardiorespiratory fitness in both girls and boys (0.375 ≤ r ≤ 0.900), while the sympathetic-vagal balance was negatively related to maximal oxygen uptake (VO2max) in girls (r = 0.478). An association between lower parasympathetic activity and insulin resistance was noted in girls (mean of R-R intervals [RRmean] and homeostasis model assessment insulin-resistance index [HOMA-IR]: r = -0.678), while greater systolic blood pressure (SBP) and lower parasympathetic activity were associated in both sexes (RRmean and SBP: r = -0.526; high frequency [HF (nu)] and SBP: r = -0.754). In conclusion, autonomic nervous system activity was associated with cardiorespiratory fitness, insulin resistance, and SBP in overweight and obese adolescents. The identification of these potential relationships assists with the establishment of future long-term exercise interventions that evaluate the improvements in parasympathetic nervous system activity, in addition to metabolic profile and cardiorespiratory fitness in overweight and obese adolescents.
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Baum P, Petroff D, Classen J, Kiess W, Blüher S. Dysfunction of autonomic nervous system in childhood obesity: a cross-sectional study. PLoS One 2013; 8:e54546. [PMID: 23358101 PMCID: PMC3554723 DOI: 10.1371/journal.pone.0054546] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/14/2012] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the distribution of autonomic nervous system (ANS) dysfunction in overweight and obese children. METHODS Parasympathetic and sympathetic ANS function was assessed in children and adolescents with no evidence of impaired glucose metabolism by analysis of heart rate variability (low frequency power ln(LF), high frequency power, ln(HF); ln(LF/HF) ratio, ratio of longest RR interval during expiration to shortest interval during inspiration (E/I ratio), root mean square of successive differences (RMSSD); sympathetic skin response (SSR); and quantitative pupillography (pupil diameter in darkness, light reflex amplitude, latency, constriction velocity, re-dilation velocity). The relationship of each ANS variable to the standard deviation score of body mass index (BMI-SDS) was assessed in a linear model considering age, gender and pubertal stage as co-variates and employing an F-statistic to compare the fit of nested models. Group comparisons between normal weight and obese children as well as an analysis of dependence on insulin resistance (as indexed by the Homeostasis Model Assessment of Insulin Resistance, HOMA-IR) were performed for parameters shown to correlate with BMI-SDS. Statistical significance was set at 5%. RESULTS Measurements were performed in 149 individuals (mean age 12.0 y; 90 obese 45 boys; 59 normal weight, 34 boys). E/I ratio (p = 0.003), ln(HF) (p = 0.03), pupil diameter in darkness (p = 0.01) were negatively correlated with BMI-SDS, whereas ln(LF/HF) was positively correlated (p = 0.05). Early re-dilation velocity was in trend negatively correlated to BMI-SDS (p = 0.08). None of the parameters that depended significantly on BMI-SDS was found to be significantly correlated with HOMA-IR. CONCLUSION These findings demonstrate extended ANS dysfunction in obese children and adolescents, affecting several organ systems. Both parasympathetic activity and sympathetic activity are reduced. The conspicuous pattern of ANS dysfunction raises the possibility that obesity may give rise to dysfunction of the peripheral autonomic nerves resembling that observed in normal-weight diabetic children and adolescents.
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Affiliation(s)
- Petra Baum
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Women and Child Health, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Women and Child Health, University Hospital for Children and Adolescents, Leipzig, Germany
- * E-mail:
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