Impact of malnutrition on cardiac autonomic modulation in children

Heart rate variability to track autonomic nervous system health in young children: Effects of physical activity and cardiometabolic risk factors

Evidence for a key role of dysregulated autonomic nervous system (ANS) activity in maladaptive stress response/recovery and non-communicable disease development is extensive. Monitoring ANS activity via regular heart rate variability (HRV) measurement is growing in popularity in adult populations given that low HRV has been associated with ANS dysregulation, poor stress response/reactivity, increased cardiometabolic disease risk and early mortality. Although cardiometabolic disease may originate in early life, regular HRV measurement for assessing ANS activity in childhood populations, especially those consisting of children < 6 years of age, remains largely unpractised. A greater understanding of ANS activity modifiers in early life may improve analysis and interpretation of HRV measurements, thereby optimising its usefulness. Taking into consideration that HRV and ANS activity can be improved via daily engagement in physical activity (PA), this review will discuss the ANS and HRV, ANS activity modifiers, cardiometabolic disease risk factors and PA as they relate to childhood/adolescent populations (≤ 18 years old).

Autonomic and cardiorespiratory responses to the active tilt test in individuals with Parkinson disease: cross-sectional study

BACKGROUND

The Parkinson disease (PD) is frequently associated with autonomic dysfunctions. However, data regarding the influence of PD on the autonomic responses to postural changes is limited.

OBJECTIVE

To analyze and compare the autonomic responses, evaluated through linear and non-linear methods of heart rate variability, and cardiorespiratory parameters in two groups: Parkinson disease (PDG) and control (CG), at rest and during the active tilt test.

METHODS

A total of 48 participants were analyzed (PDG: n = 25;73.40 ± 7.01 years / CG: n = 23;70.17 ± 8.20 years). The autonomic modulation and cardiorespiratory parameters were evaluated at rest and during the active tilt test. To assess the autonomic modulation the linear indices, at the time (rMSSD, SDNN) and frequency (LF, HF, LF/HF) domains, and the non-linear indices, obtained through the Poincaré plot (SD1, SD2, SD1/SD2), were calculated. The cardiorespiratory parameters evaluated were heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP), peripheral oxygen saturation (SpO₂), and respiratory rate.

RESULTS

At rest, the PDG presented significantly lower values of rMSSD, SDNN, LF, HF, SD1, SD2, and DBP, and higher values of SpO₂. During test, in the PD group, modifications were observed in HR, and SBP, besides a reduced parasympathetic response, and an increased global modulation. The qualitative analysis of the Poincaré plot showed that the PDG has a lower dispersion of the RR intervals during rest and the active tilt test.

CONCLUSION

Individuals with PD present reduced global variability and parasympathetic modulation at rest, and reduced parasympathetic response and damage in HR regulation when performing the active tilt test, compared with controls.

Cryolipolysis Does not Modify the Behavior and Recovery of Cardiac Autonomic Modulation

The desire to reduce and remodel undesirable fatty deposits has increased the popularity and use of aesthetic procedures, among them, cryolipolysis. However, repercussions on the autonomic nervous system must be considered, since the decrease in cutaneous body temperature can have repercussions on sympathetic and parasympathetic components. The aim was to evaluate the behavior of cardiac autonomic modulation during and after a single application of cryolipolysis. A single-arm, prospective interventional study evaluated data from 13 women with a mean age of 22.38 ± 2.95 years, who had an accumulation of abdominal fat of at least 1.5 mm, were using oral contraceptives, and were sedentary. A professional applied cryolipolysis in a single 40-min session. RR intervals were collected by means of a cardiofrequency meter, at rest prior to the technique for 10 min, during the performance of the technique, and immediately after the end of the technique for a period of 50 min. Heart rate variability (HRV) analysis was performed using time, frequency, and Poincaré plot indices. For the mean RR, SDNN, rMSSD, SD1, SD2, and LF [ms²] indices, the values increased during the execution of cryolipolysis when compared to rest. In the recovery period, increases in the mean values of the RR, SDNN, rMSSD, SD1, SD2, HF [ms²], LF [nu], and HF [nu] indices were also observed when compared to the baseline moment. Both during the technique and in the recovery period, there were changes in the behavior of HRV characterized by an increase in global and vagal indices. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording

BACKGROUND

Malnutrition is associated with cardiovascular disease morbidity and mortality. Arrhythmias may be the cardiac consequences of malnutrition.

OBJECTIVES

The objective of the study was to evaluate the association between prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and arrhythmic events on 24-h electrocardiography (ECG) Holter recording in patients without manifested arrhythmia.

METHODS

In this retrospective analysis of 477 patients who underwent 24-h ECG Holter monitoring, PNI and CONUT score were calculated and patients were divided into tertiles according to PNI and into three groups according to CONUT score; 0: normal, 1-2: mild risk of malnutrition, ≥3: moderate-severe risk of malnutrition. Arrhythmic events were compared between PNI tertiles and CONUT score groups.

RESULTS

Total number of premature atrial contractions, premature ventricular contractions (PVCs), PVC burden, and incidence of paroxysmal atrial fibrillation (PAF) were significantly higher in patients within the lowest PNI tertile. Total number of PVCs, PVC burden, and incidence of PAF were significantly higher in patients with CONUT score ≥3. The cut-off value for PNI to predict the presence of PVC was defined as 39.41 using ROC curve analysis. The area under the curve was 0.650 (p < 0.001). Multivariate analysis showed that PNI was independent predictor of the presence of PVC and PAF. Also, CONUT score was independent predictor of the presence of PVC and PAF. Incidence of nonsustained ventricular tachycardia did not differ between PNI tertiles or CONUT score groups.

CONCLUSION

Poor nutritional status, assessed by PNI and CONUT score, is associated with arrhythmic events on 24-h ECG Holter recording in patients without manifested arrhythmia.

Effects of 12-week Pilates training program on cardiac autonomic modulation: a randomized controlled clinical trial

Aim: To evaluate the effects of 12-week Pilates training program on cardiac autonomic modulation. Materials & methods: A randomized controlled trial of a 12-week Pilates training program was conducted. A total of 54 men were randomly allocated to either a control or a Pilates group. Initially, the RR intervals were captured for 20 min for later analysis of heart rate variability (HRV). The training protocol was then initiated, in which the Pilates group performed 36 sessions of the Pilates method for approximately 60 min each session, three-times a week, totaling 12 weeks. The control group was instructed to maintain their normal activities during this period. One week after the end of the training, the final evaluations were performed with the capture of RR intervals in both the groups. Linear indices in the time (SDNN and rMSSD) and frequency (low frequency [LF] and high frequency [HF]) domains, and the Poincaré plot (SD1 and SD2) were used. Nonlinear indices were also analyzed (approximate entropy and detrended fluctuation analysis). Descriptive statistics and generalized mixed models were performed. Results: There was a group effect for LF (ms²) and a time effect for SD2. There was a training effect observed by the time*group interactions in which an increase in global HRV indices was found for the Pilates group after 12 weeks (SDNN: mean difference [MD] = 9.82; standard deviation [SD] = 18.52; ES = -0.514; LF [ms²]: MD = 334.23; SD = 669.43; ES = -0.547; SD2: MD = 14.58; SD = 24.28; ES = -0.693). Conclusion: A 12-week Pilates training program promotes significant improvement in global modulation of HRV in the Pilates group considering the significant increase in SDNN, LF (ms²) and SD2 indices. Trial registration number: NCT03232866.

Combining Wearable Devices and Mobile Surveys to Study Child and Youth Development in Malawi: Implementation Study of a Multimodal Approach

BACKGROUND

Multimodal approaches have been shown to be a promising way to collect data on child development at high frequency, combining different data inputs (from phone surveys to signals from noninvasive biomarkers) to understand children's health and development outcomes more integrally from multiple perspectives.

OBJECTIVE

The aim of this work was to describe an implementation study using a multimodal approach combining noninvasive biomarkers, social contact patterns, mobile surveying, and face-to-face interviews in order to validate technologies that help us better understand child development in poor countries at a high frequency.

METHODS

We carried out a mixed study based on a transversal descriptive analysis and a longitudinal prospective analysis in Malawi. In each village, children were sampled to participate in weekly sessions in which data signals were collected through wearable devices (electrocardiography [ECG] hand pads and electroencephalography [EEG] headbands). Additionally, wearable proximity sensors to elicit the social network were deployed among children and their caregivers. Mobile surveys using interactive voice response calls were also used as an additional layer of data collection. An end-line face-to-face survey was conducted at the end of the study.

RESULTS

During the implementation, 82 EEG/ECG data entry points were collected across four villages. The sampled children for EEG/ECG were 0 to 5 years old. EEG/ECG data were collected once a week. In every session, children wore the EEG headband for 5 minutes and the ECG hand pad for 3 minutes. In total, 3531 calls were sent over 5 weeks, with 2291 participants picking up the calls and 984 of those answering the consent question. In total, 585 people completed the surveys over the course of 5 weeks.

CONCLUSIONS

This study achieved its objective of demonstrating the feasibility of generating data through the unprecedented use of a multimodal approach for tracking child development in Malawi, which is one of the poorest countries in the world. Above and beyond its multiple dimensions, the dynamics of child development are complex. It is the case not only that no data stream in isolation can accurately characterize it, but also that even if combined, infrequent data might miss critical inflection points and interactions between different conditions and behaviors. In turn, combining different modes at a sufficiently high frequency allows researchers to make progress by considering contact patterns, reported symptoms and behaviors, and critical biomarkers all at once. This application showcases that even in developing countries facing multiple constraints, complementary technologies can leverage and accelerate the digitalization of health, bringing benefits to populations that lack new tools for understanding child well-being and development.

Heart rate variability in the evaluation of the autonomic nervous system of premature infants

One way to analyze the function of the autonomic nervous system (ANS) is through heart rate variability (HRV). This approach is based on the analysis of the distance between the peaks of two consecutive R waves expressed in electrocardiograms. HRV evaluations have been developed and have become more accessible and reliable through technological advances that enable the data collection in a simpler, non-invasive, and reliable way. However, there is little information in the scientific literature on the implementation of this methodology to assess the ANS of preterm infants. In this article, we survey the barriers, potential uses, and other topics regarding the assessment of the ANS in preterm infants using HRV.

Technical Innovation for Visual Assessment of Preterm Newborns in a Neonatal Intensive Care Unit: Exploratory Study

Objective

The present study is aimed at assessing heart rate variability (HRV) and its correlation with visual acuity (VA) assessment of preterm newborns (PTNB) in neonatal intensive care units.

Method

Cross-sectional study analyzing HRV during assessment of VA with the aid of a Polar RS800CX heart rate monitor (Polar Electro Oy, Finland). HRV was analyzed according to time and frequency domains and the chaos domain used the autocorrelation coefficient and entropy. The sample consisted of hospitalized PTNB, and static analysis included simple regression diagnosis.

Results

A total of 14 PTNB were included in the sample. VA varied between 0.23 and 1.60 cpd, and only five PTNB obtained below-expected values for age. Statistical analysis demonstrated a negative correlation between VA and time domain (SDDN and SD2) and a positive correlation between frequency domain (heart rate and hertz), but in simple linear regression analysis, these variables did not influence VA.

Conclusion

The results of the study demonstrate that visual acuity was inversely correlated with SDNN and SD2 and during stimulation, showing that the higher the visual performance, the lower the autonomic modulation response.

The Relationship between Autonomic Regulation of Cardiovascular Function and Body Composition

Background

We investigated whether the results of autonomic function tests correlate with body composition and shape in healthy young people.

Methods

We conducted cardiovascular reflex tests (heart rate [HR] and blood pressure [BP] responses to the Valsalva maneuver and HR response to deep breathing) and the tilt table test with 32 subjects (19 males; mean age, 22.1±1.9 years). Participants also completed an anthropometric measurement sequence (weight; height; upper arm, hips, and waist circumference; triceps and subscapular skinfold), bioelectric impedance testing, and hand grip strength measurements.

Results

Markers of obesity, other anthropometric measures, functional measures, and the basal metabolic rate (BMR) were significantly positively correlated with systolic BP (SBP) and diastolic BP (DBP) in both the supine and tilted positions. There was a positive correlation between the difference in HR (ΔHR) between the tilt and supine body positions and markers of obesity, the functional marker of dominant handgrip strength, and BMR. Participants with a body mass index (BMI) <25 kg/m² had significantly lower median values of ΔHR, DBP in the tilt-test, SBP at rest, and SBP in the tilt-test than participants who had a BMI ≥25 kg/m² (10.55 vs. 21.95 bpm, P=0.003; 77.55 vs. 90.05 mmHg, P=0.045; 113.45 vs. 140.55 mmHg, P=0.013; 117.00 vs. 135.25 mmHg, P=0.006, respectively). Body fat percentage was identified as an independent positive predictor (β=0.993; 95% confidence interval [CI], 0.070 to 1.916; P=0.036) and body water percentage was an independent negative predictor of tilted SBP (β=-1.370; 95% CI, -2.634 to 0.106; P=0.035).

Conclusion

High sympathetic activity, as evaluated by cardiovascular regulation, correlates with a high share of adipose tissue in young healthy persons.

Heart rate variability for determining autonomic nervous system effects of lifestyle behaviors in early life: A systematic review

BACKGROUND

An unhealthy lifestyle negatively alters autonomic nervous system (ANS) activity as reflected by decreased heart rate variability (HRV), increasing cardiovascular disease (CVD) risk. Research investigating the effect of modifiable lifestyle factors on ANS activity in young children is limited. Early identification of these risk factors is vital to improving long-term individual and public health outcomes. A systematic review was conducted to assess the effect of maternal or child modifiable lifestyle factors on child ANS activity.

METHODS

Following the 2009 PRISMA guidelines, three electronic databases were searched from February 2018 - July 2019 for articles describing human trials between 1996 - 2019. Included studies examined ANS activity of children between 28 weeks gestational age - 6 years in relation to modifiable lifestyle CVD risk factors.

RESULTS

Twenty-six studies fulfilled inclusion criteria. Sixteen studies reported that modifiable lifestyle factors significantly influenced the HRV of children. Increased HRV was significantly associated with higher maternal zinc and omega-3 fatty acid intake, regular maternal aerobic exercise and a non-smoking environment. Child diet and body composition demonstrated some support for an association between these modifiable lifestyle factors and child HRV.

CONCLUSION

There is cross-sectional evidence supporting an association between maternal lifestyle factors and child HRV. Evidence is less supportive of a relationship between child modifiable lifestyle factors and child HRV. Monitoring the effects of lifestyle interventions on the ANS via HRV measurements of both mother and child may identify child CVD risk.

Cardiac Autonomic Function in the First Hours of Postnatal Life: An Observational Cross-Sectional Study in Term Neonates

The aim of this study was to evaluate heart rate variability (HRV) within the first hours of extrauterine life in term neonates. HRV at 2-h and 14-h postpartum were compared by means of time domains (iRR, SDNN, and rMSSD); frequency domains (TP, LF, HF, and LF/HF ratio); and Poincare's Plot (SD1 and SD2) indices of HRV in 27 healthy, male, term newborns (NBs) born of elective cesarean delivery. Within 14 h after birth, the mean of the iRRs increased (Δ% = 4.4, p < 0.001) as well as parasympathetic indices (rMSSD: Δ% = 32.6; p < 0.03; HF: Δ% = 43.6; p < 0.00; SD1: Δ% = 32.6, p < 0.03). Respiratory rate (RR) decreased (RR: 2 h = 48 (43-55) cycle/min vs. 14 h = 45 (40-48) cycle/min p < 0.01). We concluded that within the first 14 h of birth, cardiac autonomic adjustments are characterized by an increase in parasympathetic activity. Concurrently, there were no significant changes observed in all other HRV indices in healthy, male, term neonates, and born of elective cesarean delivery.

Evaluation of the autonomic nervous system by analysis of heart rate variability in the preterm infants

BACKGROUND

Premature infants may present with damage to the autonomic nervous system (ANS), which may be related to poorer neurological development. Among the techniques used to evaluate the ANS, heart rate variability (HRV) emerged as a simple, non-invasive, and easy to apply tool. The aim of the present study was to analyze and compare HRV in preterm infants at different times of hospitalization in order to verify the possible environmental relationships or clinical evolution with HRV.

METHODS

A longitudinal, prospective, and descriptive study with non-probabilistic sampling composed of 25 collections of preterm infants of HRV at two moments: moment I (within 15 days of birth) and moment II (after 45 days post-birth). The Polar V800 heart rate monitor was used with the Polar H10 cardiac transducer to collect HRV, which was collected in the supine position for 15 min. The HRV data were analyzed by the linear method in frequency domain and time domain and by the nonlinear method using Kubios HRV analysis software, version 3.0.2.

RESULTS

There was an increase in HRV values at moment II, these being statistically significant in the SD1, ApEn, and SampEn. Data related to increased sympathetic nervous system activity, parasympathetic nervous system activity, and increased index complexity.

CONCLUSIONS

The data demonstrate an increase in HRV values in premature infants at moment II, demonstrating a possible development in the maturation of the ANS during hospitalization.

TRIAL REGISTRATION

RBR-3x7gz8 retrospectively registered.

Albuminuria, renal function and blood pressure in undernourished children and recovered from undernutrition

BACKGROUND

The objective of this study was to investigate some biomarkers of renal function and blood pressure in children who had recovered from undernutrition.

METHODS

This was cross-sectional, comparative study in which a convenience sample of children of both genders (n = 126; age range 6-16 years) treated at the Centre for Nutritional Recovery and Education (São Paulo, Brazil) was used. These children were classified into four groups for analysis: (1) children who were well nourished (control group; n = 50), (2) those showing stunted growth (stunted group; n = 22), (3) those who were underweight (underweight group; n = 23) and (4) those who had recovered from undernutrition (recovered group; n = 31).

RESULTS

No between-group differences were found for mean levels of albuminuria, serum creatinine and cystatin C, and similar mean estimates of glomerular filtration rate (eGFR; using either creatinine, cystatin C or both). Almost 14% of the stunted group, 4% of the underweight group and 3% of the recovered group had albuminuria of >30 mg/g creatinine (chi-square p = 0.034); none of the control children showed albuminuria of >30 mg/g creatinine. Mean systolic (SBP) and diastolic blood pressure (DBP) adjusted for age and gender of the children in the stunted [SBP (95% confidence interval): 92 (88-96) mmHg; DBP: 47 (44-49) mmHg] and recovered [SBP: 93 (90-96) mmHg; DBP: 49 (47-51) mmHg] groups were significantly lower than those of the controls [SBP: 98 (95-100) mmHg, P = 0.027; DBP: 53 (52-55) mmHg, P = 0.001]. After additional adjustment for height, mean DBP remained significantly lower in the recovered group compared with the control group [49 (46-51) vs. 53 (51-55) mmHg, respectively; P = 0.018). Logistic regression analysis showed that the stunted group had a 8.4-fold higher chance of developing albuminuria (>10 mg/g creatinine) than the control children (P = 0.006).

CONCLUSIONS

No alterations in renal function were found in underweight children and those who had recovered from undernutrition, whereas children with stunted growth presented with a greater risk for albuminuria. A lower DBP was found in children with stunted growth and those who had recovered from undernutrition.