Skip to main content
SpringerLink
Log in

Effect of weight loss on sympatho-vagal balance in subjects with grade-3 obesity: restrictive surgery versus hypocaloric diet

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Few and mostly uncontrolled studies indicate that weight loss improves heart rate variability (HRV) in grade-3 obesity. The aim of this study was to compare in grade-3 obesity surgery and hypocaloric diet on clinical and metabolic variables and on autonomic indices of HRV. Twenty-four subjects (body mass index, BMI 45.5 ± 9.13 kg/m2) underwent surgery (n = 12, gastric banding, LAGB) or received hypocaloric diet (n = 12, 1,000–1,200 kg/day). Clinical [BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate] and metabolic variables [glucose, cholesterol, HDL- and LDL-cholesterol, triglycerides, AST and ALT transaminases] and 24-h Holter electrocardiographic-derived HRV parameters [R–R interval, standard deviation of R–R intervals (SDNN); low/high-frequency (LF/HF) ratio, and QT interval] were measured at baseline and after 6 months. The two groups were identical at baseline. BMI (−7.5 ± 3.57 kg/m2, mean ± SD), glucose (−24.1 ± 26.77 mg/dL), SBP (−16.7 ± 22.19 mmHg) and DBP (−6.2 ± 8.56 mmHg) decreased in LAGB subjects (p < 0.05) and remained unchanged in controls. At 6 months, SDNN increased in LAGB subjects (+25.0 ± 37.19 ms, p < 0.05) and LF/HF ratio diminished (2.9 ± 1.84 vs. 4.9 ± 2.78; p = 0.01), with no change in controls; LF (daytime) and HF (24 h and daytime) increased in LAGB subjects, with no change in controls. Decrease in BMI correlated with SBP and DBP decrease (p < 0.05), and DBP decrease correlated with HR decrease (p < 0.05) and QT shortening (p < 0.05). Weight loss is associated with improvement of glucose metabolism, of blood pressure, and with changes in time and frequency domain parameters of HRV; all these changes indicate recovery of a more physiological autonomic control, with increase in parasympathetic and reduction in sympathetic indices of HRV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS (2002) Obesity and the risk of heart failure. N Engl J Med 347:305–313

    Article  PubMed  Google Scholar 

  2. Prospective Studies Collaboration, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373:1083–1096

    Article  PubMed  Google Scholar 

  3. Alvarez GE, Beske SD, Ballard TP, Davy KP (2002) Sympathetic neural activation in visceral obesity. Circulation 106:2533–2536

    Article  PubMed  Google Scholar 

  4. Alvarez GE, Ballard TP, Beske SD, Davy KP (2004) Subcutaneous obesity is not associated with sympathetic neural activation. Am J Physiol Heart Circ Physiol 287:H414–H418

    Article  PubMed  CAS  Google Scholar 

  5. Wasmund SL, Owan T, Yanowitz FG, Adams TD, Hunt SC, Hamdan MH, Litwin SE (2011) Improved heart rate recovery after marked weight loss induced by gastric bypass surgery: two-year follow up in the Utah obesity study. Heart Rhythm 8:84–90

    Article  PubMed  Google Scholar 

  6. Oda E (2012) Metabolic syndrome: its history, mechanisms, and limitations. Acta Diabetol 49:89–95

    Article  PubMed  CAS  Google Scholar 

  7. Peterson HR, Rothschild M, Weinberg CR, Fell RD, McLeish KR, Pfeifer MA (1988) Body fat and the activity of the autonomic nervous system. N Engl J Med 318:1077–1083

    Article  PubMed  CAS  Google Scholar 

  8. Laaksonen DE, Laitinen T, Schönberg J, Rissanen A, Niskanen LK (2003) Weight loss and weight maintenance, ambulatory blood pressure and cardiac autonomic tone in obese persons with the metabolic syndrome. J Hypertens 21:371–378

    Article  PubMed  CAS  Google Scholar 

  9. Agapitov AV, Correia ML, Sinkey CA, Haynes WG (2008) Dissociation between sympathetic nerve traffic and sympathetically mediated vascular tone in normotensive human obesity. Hypertension 52:687–695

    Article  PubMed  CAS  Google Scholar 

  10. Diaz A, Bourassa MG, Guertin MC, Tardif JC (2005) Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J 26:967–974

    Article  PubMed  Google Scholar 

  11. Pal GK, Pal P, Nanda N, Amudharaj D, Karthik S (2009) Spectral analysis of heart rate variability (HRV) may predict the future development of essential hypertension. Med Hypotheses 72:183–185

    Article  PubMed  CAS  Google Scholar 

  12. Ashrafian H, le Roux CW, Darzi A, Athanasiou T (2008) Effects of bariatric surgery on cardiovascular function. Circulation 118:2091–2102

    Article  PubMed  Google Scholar 

  13. Perego L, Pizzocri P, Corradi D, Maisano F, Paganelli M, Fiorina P, Barbieri M, Morabito A, Paolisso G, Folli F, Pontiroli AE (2005) Circulating leptin correlates with left ventricular mass in morbid (grade III) obesity before and after weight loss induced by bariatric surgery: a potential role for leptin in mediating human left ventricular hypertrophy. J Clin Endocrinol Metab 90:4087–4093

    Article  PubMed  CAS  Google Scholar 

  14. Pontiroli AE, Pizzocri P, Saibene A, Girola A, Koprivec D, Fragasso G (2004) Left ventricular hypertrophy and QT interval in obesity and in hypertension: effects of weight loss and of normalisation of blood pressure. Int J Obes Relat Metab Disord 28:1118–1123

    Article  PubMed  CAS  Google Scholar 

  15. Pontiroli AE, Laneri M, Veronelli A, Frigè F, Micheletto G, Folli F, Adami G, Scopinaro N (2009) Biliary pancreatic diversion and laparoscopic adjustable gastric banding in morbid obesity: their long-term effects on metabolic syndrome and on cardiovascular parameters. Cardiovasc Diabetol 8:37

    Article  PubMed  Google Scholar 

  16. Rissanen P, Franssila-Kallunki A, Rissanen A (2001) Cardiac parasympathetic activity is increased by weight loss in healthy obese women. Obes Res 9:637–643

    Article  PubMed  CAS  Google Scholar 

  17. Sharma AM, Golay A (2002) Effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension. J Hypertens 20:1873–1878

    Article  PubMed  CAS  Google Scholar 

  18. Poirier P, Hernandez TL, Weil KM, Shepard TJ, Eckel RH (2003) Impact of diet-induced weight loss on the cardiac autonomic nervous system in severe obesity. Obes Res 11:1040–1047

    Article  PubMed  Google Scholar 

  19. Straznicky NE, Lambert EA, Lambert GW, Masuo K, Esler MD, Nestel PJ (2005) Effects of dietary weight loss on sympathetic activity and cardiac risk factors associated with the metabolic syndrome. J Clin Endocrinol Metab 90:5998–6005

    Article  PubMed  CAS  Google Scholar 

  20. Nault I, Nadreau E, Paquet C, Brassard P, Marceau P, Marceau S, Biron S, Hould F, Lebel S, Richard D, Poirier P (2007) Impact of bariatric surgery-induced weight loss on heart rate variability. Metabolism 56:1425–1430

    Article  PubMed  CAS  Google Scholar 

  21. Alam I, Lewis MJ, Lewis KE, Stephens JW, Baxter JN (2009) Influence of bariatric surgery on indices of cardiac autonomic control. Auton Neurosci 151:168–173

    Article  PubMed  CAS  Google Scholar 

  22. Machado MB, Velasco IT, Scalabrini-Neto A (2009) Gastric bypass and cardiac autonomic activity: influence of gender and age. Obes Surg 19:332–338

    Article  PubMed  Google Scholar 

  23. Bobbioni-Harsch E, Sztajzel J, Barthassat V, Makoundou V, Gastaldi G, Sievert K, Chassot G, Huber O, Morel P, Assimacopoulos-Jeannet F, Golay A (2009) Independent evolution of heart autonomic function and insulin sensitivity during weight loss. Obesity (Silver Spring) 17:247–253

    Article  CAS  Google Scholar 

  24. Sjoberg N, Brinkworth GD, Wycherley TP, Noakes M, Saint DA (2011) Moderate weight loss improves heart rate variability in overweight and obese adults with type 2 diabetes. J Appl Physiol 110:1060–1064

    Article  PubMed  Google Scholar 

  25. Martin J, Paquette C, Marceau S, Hould FS, Lebel S, Simard S, Dumesnil JG, Poirier P (2011) Impact of orlistat-induced weight loss on diastolic function and heart rate variability in severely obese subjects with diabetes. J Obes 39:46–58

    Google Scholar 

  26. Pontiroli AE, Pizzocri P, Librenti MC, Vedani P, Marchi M, Cucchi E, Orena C, Paganelli M, Giacomelli M, Ferla G, Folli F (2002) Laparoscopic adjustable gastric banding for the treatment of morbid (grade 3) obesity and its metabolic complications: a three-year study. J Clin Endocrinol Metab 87:3555–3561

    Article  PubMed  Google Scholar 

  27. Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, Sandrone G, Malfatto G, Dell’Orto S, Piccaluga E, Turiel M, Baselli G, Cerutti S, Malliani A (1986) Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 58:178–193

    Article  Google Scholar 

  28. Camm AJ, Malik M, Bigger JT, Breithardt G, Cerutti S, Cohen RJ, Coumel P, Fallen EL, Kennedy HL, Kleiger RE, Lombardi F, Malliani A, Moss AJ, Rottman JN, Schmidt G, Schwatz PJ, Singer DH (1996) Task force of the European society of cardiology and the North American society of pacing and electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Circulation 93:1043–1065

    Article  Google Scholar 

  29. Lombardi F (2002) Clinical implications of present physiological understanding of HRV components. Card Electrophysiol Rev 6:245–249

    Article  PubMed  Google Scholar 

  30. Milliez P, Leenhardt A, Maisonblanche P, Vicaut E, Badilini F, Siliste C, Benchetrit C, Coumel P (2005) EMIAT Investigators. Usefulness of ventricular repolarization dynamicity in predicting arrhythmic deaths in patients with ischemic cardiomyopathy (from the European myocardial infarct amiodarone trial). Am J Cardiol 95:821–826

    Article  PubMed  Google Scholar 

  31. Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502

    PubMed  CAS  Google Scholar 

  32. Pontiroli AE, Folli F, Paganelli M, Micheletto G, Pizzocri P, Vedani P, Luisi F, Perego L, Morabito A, Bressani Doldi S (2005) Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity: a 4-year case-controlled study. Diabetes Care 28:2703–2709

    Article  PubMed  Google Scholar 

  33. le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, Shurey S, Ghatei MA, Patel AG, Bloom SR (2006) Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 243:108–114

    Article  PubMed  Google Scholar 

  34. Burcelin R, Serino M, Chabo C, Blasco-Baque V, Amar J (2011) Gut microbiota and diabetes: from pathogenesis to therapeutic perspective. Acta Diabetol 48:257–273

    Article  PubMed  Google Scholar 

  35. Prachand VN, Alverdy JC (2009) The role of malabsorption in bariatric surgery. World J Surg 33:1989–1994

    Article  PubMed  Google Scholar 

  36. Zhang H, DiBaise JK, Zuccolo A et al (2009) Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci USA 106:2365–2370

    Article  PubMed  CAS  Google Scholar 

  37. Arterburn DE, Bogart A, Sherwood NE, Sidney S, Coleman KJ, Haneuse S, O’Connor PJ, Theis MK, Campos GM, McCulloch D, Selby J 2012 A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg [Nov 18, Epub ahead of print]

Download references

Acknowledgments

Supported by Grant 200825M9SC-002, Ministero dell’Istruzione dell’Università e della Ricerca (Italy).

Conflict of interest

The authors have no conflict of interest with the contents of this manuscript.

Author information

Authors and Affiliations

  1. Cattedra di Medicina Interna II and Cattedra di Cardiologia, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy

    Antonio E. Pontiroli, Claudia Merlotti, Annamaria Veronelli & Federico Lombardi

Authors
  1. Antonio E. Pontiroli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudia Merlotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annamaria Veronelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Federico Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio E. Pontiroli.

Additional information

Communicated by Antonio Secchi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pontiroli, A.E., Merlotti, C., Veronelli, A. et al. Effect of weight loss on sympatho-vagal balance in subjects with grade-3 obesity: restrictive surgery versus hypocaloric diet. Acta Diabetol 50, 843–850 (2013). https://doi.org/10.1007/s00592-013-0454-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-013-0454-1

Keywords

Search

Navigation