Sympathetic neural activity, metabolic parameters and cardiorespiratory fitness in obese youths.

OBJECTIVE: The main objective of this cross-sectional study is to assess the cardiac autonomic neural activity in the presence of abnormally increased body weight in youths and its relationship to metabolic risk factors and cardiorespiratory fitness (CRF). METHODS: Sixty-four overweight and obese patients, aged 9-17 years, of both sexes, stratified according to the international BMI cut-off, were enrolled. Continuous ECG was recorded during 15 min in resting conditions, and the heart rate variability (HRV) was measured in the time domain, frequency domain and for nonlinear dynamics. In addition, cardiometabolic risk factors and CRF in effort conditions were assessed. RESULTS: Among the overweight and obese youths, no significant differences were observed regarding metabolic parameters and heart rate, although CRF was the lowest in the severely obese youths. Likewise, no significant differences were observed in HRV, independent of how it was assessed. A positive and significant relationship, independent of the degree of obesity, pubertal stage and breathing rate under resting conditions, has been observed among sympathovagal balance, insulin and the homeostatic model assessment index. Furthermore, CRF assessed by volume oxygen peak was associated with insulin levels (r = -0.273; P < 0.05), the SD of the NN interval series (r = 0.268, P < 0.05) and the long-term variation using the Poincaré plot (PS1: r = 0.275, P < 0.05; PS2: r = 0.273, P < 0.05). CONCLUSION: The key findings of the present study were the presence of a link among fasting insulin, HRV and CRF independent of the degree of obesity, indicating the heterogeneity of obese children and adolescents

Current and birth weights exert independent influences on nocturnal pressure-natriuresis relationships in normotensive children

The objective was to study the impact of birth weight on the relationship between ambulatory blood pressure and urinary sodium excretion in children and adolescents. The study included 134 healthy children (61 boys), all Caucasians, who were born at term after a normotensive pregnancy. For each subject, a 24-hour ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. Average ambulatory blood pressure (BP) and the urinary excretion rates for sodium, potassium, and creatinine were calculated separately for 24-hour, awake, and sleep periods defined by a mini-diary. The excretion rate of sodium during sleep time was positively correlated with ambulatory systolic BP; such a positive relationship was not found for waking hours. Consequently, the impact of birth weight on the relationship between blood pressure and the urinary sodium excretion rate was analyzed during sleeping hours. Stepwise multiple regression analysis shows that although current weight was the strongest predictor for the sodium excretion rate during sleep (P3.500 kg) of birth weight (P<.02). Differences in sodium excretion rates, adjusted for current weight, between the two extreme tertiles of birth weight became significant at the highest systolic BP (P<.04). The children who had the lowest birth weight tended to excrete less sodium during sleep. The results of the present study show a blunted pressure natriuresis curve in children and adolescents with the lowest birth weight. Whether this abnormal renal sodium handling may be present as an initial or as an intermediate mechanism leading to higher BP values must be assessed in additional studies.Lurbe Ferrer, Maria Desamparados, [email protected] ; Redon Mas, Josep, [email protected]

Birth weight influences blood pressure values and variability in children and adolescents

The objective of the present study was to assess the relationships between birth weight and the values and variability of ambulatory blood pressure. Six hundred thirty healthy children (369 girls) age 4 to 18 years (mean, 9.9 years) born at term after a normotensive pregnancy were included. The subjects were divided into 5 groups according to birth weight. For each subject, a 24-hour ambulatory blood pressure monitoring was performed according to the protocol designed. Average and variability (estimated as the standard deviation) of ambulatory blood pressure and heart rate were calculated separately for 24-hour, daytime, and nighttime periods. When values were adjusted for gender, current age, weight, and height, children with the lowest birth weights had the highest ambulatory blood pressure values and variability, whereas no differences in heart rate were observed. Multiple regression analysis showed that although current weight was the strongest predictor for 24-hour systolic blood pressure (P<0.001), there was also an independent and significant inverse relationship for birth weight (P<0.002) after controlling for gender, current age, and height. Likewise, birth weight was independently and inversely correlated with 24-hour systolic blood pressure variability (P<0.03). In conclusion, children who had lower birth weights tended to have not only the highest blood pressure values but also the highest blood pressure variability, independent of the increases in ambulatory blood pressure values. Knowing that high blood pressure variability is at least partially independent of blood pressure values, the importance of this variability on further blood pressure rises and/or on vascular damage later in life needs to be assessed in future studies.Lurbe Ferrer, Maria Desamparados, [email protected] ; Redon Mas, Josep, [email protected]

Birth weight impacts on wave reflections in children and adolescents

The objective of the present study was to assess central aortic pressure and wave reflection in children and adolescents at different birth weights. Two hundred nineteen healthy children (126 girls), from 7 to 18 years of age (mean, 11.3 years) and born at term after a normotensive pregnancy, were included. The subjects were divided according to birth weight: 3.5 kg. Pressure waveforms were recorded from the radial artery of the wrist, and the waveform data were then processed by the SphygmoCor radial/aortic transform software module to produce the estimated aortic pressure waveform. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in children with the lowest birth weights compared with the other birth weight groups. In a multiple regression analysis, short stature, low heart rate, female gender, and lower birth weight had independent significant inverse correlations to the augmentation index when adjusted for diastolic blood pressure (R^2=0.21). In summary, the results showed a relatively aged phenotype of large-vessel function in the children with the lowest birth weights. These early alterations may be amplified throughout life and may contribute to the increased cardiovascular risk associated with low birth weight.Lurbe Ferrer, Maria Desamparados, [email protected] ; Redon Mas, Josep, [email protected]

Prognostic Value of Ambulatory Blood Pressure Monitoring in Refractory Hypertension : A Prospective Study

The objective of this study was to establish whether ambulatory blood pressure offers a better estimate of cardiovascular risk than does its clinical blood pressure counterpart in refractory hypertension. This prospective study assessed the incidence of cardiovascular events over time during an average follow-up of 49 months (range, 6 to 96). Patients were referred to specialized hypertension clinics (86 essential hypertension patients who had diastolic blood pressure >100 mm Hg during antihypertensive treatment that included three or more antihypertensive drugs, one being a diuretic). Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed at the time of entrance. End-organ damage was monitored yearly, and the incidence of cardiovascular events was recorded. Patients were divided into tertiles of average diastolic blood pressure during activity according to the ABPM, with the lowest tertile 97 mm Hg (HT, n=28). While significant differences in systolic and diastolic ambulatory blood pressures were observed among groups, no differences were observed at either the beginning or at the time of the last evaluation for office blood pressure. During the last evaluation, a progression in the end-organ damage score was observed for the HT group but not for the two other groups. Twenty-one of the patients had a new cardiovascular event; the incidence of events was significantly lower for the LT group (2.2 per 100 patient-years) than it was for the MT group (9.5 per 100 patient-years) or for the HT group (13.6 per 100 patient-years). The probability of event-free survival was also significantly different when comparing the LT group with the other two groups (LT versus MT log-rank, P<.04; LT versus HT log-rank, P<.006). The HT group was an independent risk factor for the incidence of cardiovascular events (relative risk, 6.20; 95% confidence interval, 1.38 to 28.1, P<.02). Higher values of ambulatory blood pressure result in a worse prognosis in patients with refractory hypertension, supporting the recommendation that ABPM is useful in stratifying the cardiovascular risk in patients with refractory hypertension.Redon Mas, Josep, [email protected]

Anthropometric Indicators as a Tool for Diagnosis of Obesity and Other Health Risk Factors: A Literature Review

[EN] Obesity is characterized by the accumulation of an excessive amount of fat mass (FM) in the adipose tissue, subcutaneous, or inside certain organs. The risk does not lie so much in the amount of fat accumulated as in its distribution. Abdominal obesity (central or visceral) is an important risk factor for cardiovascular diseases, diabetes, and cancer, having an important role in the so-called metabolic syndrome. Therefore, it is necessary to prevent, detect, and appropriately treat obesity. The diagnosis is based on anthropometric indices that have been associated with adiposity and its distribution. Indices themselves, or a combination of some of them, conform to a big picture with different values to establish risk. Anthropometric indices can be used for risk identification, intervention, or impact evaluation on nutritional status or health; therefore, they will be called anthropometric health indicators (AHIs). We have found 17 AHIs that can be obtained or estimated from 3D human shapes, being a noninvasive alternative compared to X-ray-based systems, and more accessible than high-cost equipment. A literature review has been conducted to analyze the following information for each indicator: definition; main calculation or obtaining methods used; health aspects associated with the indicator (among others, obesity, metabolic syndrome, or diabetes); criteria to classify the population by means of percentiles or cutoff points, and based on variables such as sex, age, ethnicity, or geographic area, and limitations.BODYPASS Project has received funding from the European Union's Horizon 2020 research and innovation program under Grant Agreement No. 779780. CIBER de Diabetes and Enfermedades Metabolicas Asociadas (CIBERDEM) is an Instituto de Salud Carlos III initiative. SM-H was an investigator in the Juan Rodes program (JR18/00051) financed by the Instituto de Salud Carlos III and the European Regional Development Fund (FEDER). Project (IMDEEA/2020/87) supported by Instituto Valenciano de Competitividad Empresarial (IVACE), call for proposals 2020 for Technology Centers of the Comunitat Valenciana, cofunded by ERDF Funds, EU Operational Program of the Comunitat Valenciana 2014-2020.Piqueras Fiszman, P.; Ballester Fernandez, A.; Durá-Gil, JV.; Martinez-Hervas, S.; Redón, J.; Real, JT. (2021). Anthropometric Indicators as a Tool for Diagnosis of Obesity and Other Health Risk Factors: A Literature Review. Frontiers in Psychology. 12:1-19. https://doi.org/10.3389/fpsyg.2021.6311791191

Peripheral blood mitochondrial DNA content in relation to circulating metabolites and inflammatory markers: a population study

Mitochondrial DNA (mtDNA) content might undergo significant changes caused by metabolic derangements, oxidative stress and inflammation that lead to development and progression of cardiovascular diseases. We, therefore, investigated in a general population the association of peripheral blood mtDNA content with circulating metabolites and inflammatory markers. We examined 310 subjects (50.6% women; mean age, 53.3 years) randomly selected from a Flemish population. Relative mtDNA content was measured by quantitative real-time PCR in peripheral blood cells. Peak circulating metabolites were quantified using nuclear magnetic resonance spectroscopy. The level of inflammation was assessed via established inflammatory markers. Using Partial Least Squares analysis, we constructed 3 latent factors from the 44 measured metabolites that explained 62.5% and 8.5% of the variance in the contributing metabolites and the mtDNA content, respectively. With adjustments applied, mtDNA content was positively associated with the first latent factor (P = 0.002). We identified 6 metabolites with a major impact on the construction of this latent factor including HDL3 apolipoproteins, tyrosine, fatty acid with αCH2, creatinine, β-glucose and valine. We summarized them into a single composite metabolite score. We observed a negative association between the composite metabolic score and mtDNA content (P = 0.001). We also found that mtDNA content was inversely associated with inflammatory markers including hs-CRP, hs-IL6, white blood cell and neutrophil counts as well as neutrophil-to-lymphocyte ratio (P≤0.0024). We demonstrated that in a general population relative peripheral blood mtDNA content was associated with circulating metabolites indicative of perturbed lipid metabolism and with inflammatory biomarkers

Influence of Concurrent Obesity and Low Birth Weight on Blood Pressure Phenotype in Youth

The aim of this study was to assess the impact of obesity and low birth weight on both office and ambulatory blood pressure (BP) values, as well as on aortic-derived parameters in youths. A total of 422 white youths, from 10 to 18 years of age, were included. Subjects were divided into 4 groups according to the presence (234; 55%) or the absence (188; 45%) of obesity and according to low (114; 27%) or normal (308; 73%, birth weight. Spacelabs 90207 was used to measure ambulatory BP during a 24-hour period. SphygmoCor radial/aortic transform software was used to estimate aortic pressure waveform. Office, 24-hour, daytime, and nighttime systolic BP values were significantly higher in those subjects with low birth weight who became obese. The lowest BP values were present in nonobese subjects in the absence of low birth weight. In the middle, with similar BP values, were nonobese subjects with low birth weight and obese subjects in the absence of low birth weight. No interaction existed between obesity and low birth weight in the office (P 0.165) or ambulatory (P 0.603) systolic BP values. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in the nonobese low birth weight group when compared with the other groups after controlling for height, heart rate, and diastolic BP. A significant interaction between low birth weight and obesity (P 0.005) existed. In conclusion, although the low birth weight children who become obese have the highest systolic BP values, the presence of obesity blunts the increment of the reflecting wave observed in low birth weight [email protected] [email protected]

Influence of the i/d polymorphism of the angiotensin-converting enzyme gene on the outcome of microalbuminuria in essential hypertension

The objective of the present study was to analyze the influence of the I/D polymorphism of the ACE gene on the outcome of microalbuminuria in essential hypertensive patients who were receiving antihypertensive treatment. One hundred thirty-six essential hypertensive patients who were <50 years old and had never previously received treatment with antihypertensive drugs were included in the study. During a 3-year period, patients received nonpharmacological treatment consisting of moderate salt restriction and a low-calorie diet they were obese, with or without a regimen of antihypertensive drugs based on ß-blockers or ACE inhibitors. Hydrochlorothiazide was added when necessary to maintain the blood pressure goal of <135/85 mm Hg. At the beginning of the study and at yearly intervals, systolic and diastolic blood pressures (SBP and DBP, respectively), 24-hour urinary albumin excretion (UAE), renal function, and biochemical profile measurements were made. The insertion/deletion (I/D) polymorphism of the ACE gene was determined through the use of polymerase chain reaction. The variables used in the statistical analysis were the measurements at the start of the study and the increase or decrease detected during the follow-up, estimated as individual specific regression line slope values. At baseline, no differences in blood pressure or UAE values were observed among genotypes. Likewise, the genotype or allele frequency was not significantly different between normoalbuminurics and microalbuminurics. After the 3 treatment years, significant reductions in SBP, DBP, and UAE were found (SBP 151.6±17.3 reduced to 137.2±14.3 mm Hg, P<0.001; DBP 96.6±8.9 reduced to 84.5±9.8 mm Hg, P<0.001; UAE 36.7±71.5 reduced to 28.3±78.6 mg/24 h, P<0.05). The slopes of these parameters over time did not differ significantly among genotypes. The slope of SBP was the main factor related to the slope of logUAE (P<0.003). A significant positive correlation coefficient between the SBP and logUAE slopes was observed for the DD patients (r=0.57, P<0.0001) but was absent in patients carrying the I allele (II r=-0.03, P=NS; I/D r=0.01, P=NS). Follow-up studies should be used to achieve a better understanding of the impact of candidate gene polymorphisms on the development of hypertension-induced organ damage. Assessment of the I/D polymorphism of the ACE gene may identify subjects who require a greatly lowered blood pressure to prevent organ damage and to reduce hypertension-associated complications and death.Redon Mas, Josep, [email protected] ; Chaves Martinez, Felipe Javier, [email protected] ; Pascual Izuel, Jose Maria, [email protected]