1
|
Mattos S, Rabello da Cunha M, Barreto Silva MI, Serfaty F, Tarvainen MP, Klein MRST, Neves MF. Effects of weight loss through lifestyle changes on heart rate variability in overweight and obese patients: A systematic review. Clin Nutr 2022; 41:2577-2586. [PMID: 36228570 DOI: 10.1016/j.clnu.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/27/2022] [Accepted: 09/16/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS The effects of calorie restriction and physical activity on autonomic regulation and cardiac vagal control in overweight and obese individuals remain inconsistent. Thus, this systematic review aimed to evaluate the weight loss effects through lifestyle changes on heart rate variability (HRV) markers in overweight and obese subjects. METHODS A systematic search for studies published up to November 2021 was conducted in MEDLINE, Embase, EBSCO host and VHL REGIONAL/LILACS. The main outcomes were changes in HRV indices from pre- and post-nutritional intervention and exercise in overweight and obese individuals. This review was registered in PROSPERO: CRD42021274467. RESULTS The literature search retrieved 959 articles, of which 12 were included in this review. The intervention in nine studies was diet only, in two studies was diet and exercise, and in one study diet was compared to diet and exercise. The weight loss was greater than 10% in four studies and between 5 and 10% in three studies. Most of the studies revealed that weight loss through lifestyle changes seems to promote beneficial effects on HRV, restoring sympathovagal balance by increasing parasympathetic activity and reducing sympathetic activation. CONCLUSION This systematic review exhibited the beneficial effects of weight loss through lifestyle changes on cardiac autonomic control in overweight and obese individuals. Future investigations need standardization of HRV indices for better interpretation of autonomic function in different clinical situations.
Collapse
Affiliation(s)
- Samanta Mattos
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria Inês Barreto Silva
- Department of Applied Nutrition, Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Applied Nutrition, Nutrition School, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabiano Serfaty
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mika P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Mario Fritsch Neves
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
2
|
Głuszewska A, Gryglewska B, Gąsowski J, Bilo G, Zarzycki B, Dzieża-Grudnik A, Major P, Budzyński A, Faini A, Parati G, Grodzicki T. Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension. Eur J Intern Med 2019; 60:39-45. [PMID: 30420135 DOI: 10.1016/j.ejim.2018.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 12/24/2022]
Abstract
UNLABELLED Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability. AIM To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension. MATERIALS & METHODS A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ± 11.3, BMI = 46.7 ± 5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention. RESULTS Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status. CONCLUSIONS Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension.
Collapse
Affiliation(s)
- Anna Głuszewska
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland.
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Grzegorz Bilo
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Bartosz Zarzycki
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Anna Dzieża-Grudnik
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Piotr Major
- Department of General Surgery, Jagiellonian University, Medical College, Krakow, Poland
| | - Andrzej Budzyński
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Andrea Faini
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| |
Collapse
|
3
|
Maseli A, Aeschbacher S, Schoen T, Fischer A, Jung M, Risch M, Risch L, Conen D. Healthy Lifestyle and Blood Pressure Variability in Young Adults. Am J Hypertens 2017; 30:690-699. [PMID: 28402434 DOI: 10.1093/ajh/hpx034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/14/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the relationships between healthy lifestyle metrics and blood pressure variability (BPV) in young and healthy adults. METHODS A population-based sample of 1,999 individuals aged 25-41 years was investigated. A lifestyle-score from 0 (most unhealthy) to 7 (most healthy) was calculated by giving one point for each of the following components: never smoking cigarettes, adhering to a healthy diet, performing moderate or intense physical activity, having a body mass index <25 kg/m2, a total cholesterol <200 mg/dl, a glycated hemoglobin <5.7%, or a conventional BP <120/80 mm Hg. Standardized ambulatory 24-hour BP measurements were obtained in all individuals. BPV was defined as the SD of all individual ambulatory BP recordings. We constructed multivariable linear regression models to assess the relationships between the lifestyle-score and BPV. None of the results were adjusted for multiple testing. RESULTS Median age was 37 years and 46.8% were men. With increasing lifestyle-score, systolic and diastolic BPV is decreasing linearly (P for trend <0.0001), even after multivariable adjustment. Per 1-point increase in lifestyle-score, the β-coefficient (95% confidence interval) for systolic and diastolic 24-hour BPV was -0.03 (-0.03; -0.02) and -0.04 (-0.05; -0.03), respectively, both P for trend <0.0001. These relationships were attenuated but remained statistically significant after additional adjustment for mean individual BP. CONCLUSION In this study of young and healthy adults, adopting a healthy lifestyle was associated with a lower BPV. These associations were independent of mean BP levels.
Collapse
Affiliation(s)
- Anna Maseli
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Schoen
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Andreas Fischer
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Manuel Jung
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Martin Risch
- Labormedizinisches Zentrum Dr Risch, Schaan, Principality of Liechtenstein
- Division of Laboratory Medicine, Kantonsspital Graubünden, Chur, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch, Schaan, Principality of Liechtenstein
- Division of Clinical Biochemistry, Medical University, Innsbruck, Austria
- Private University, Triesen, Principality of Liechtenstein
| | - David Conen
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiology Division, St.Joseph's Healthcare, Hamilton, Ontario, Canada
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
| |
Collapse
|
4
|
Middlemiss JE, McEniery CM. Feeling the pressure: (patho) physiological mechanisms of weight gain and weight loss in humans. Hypertens Res 2016; 40:226-236. [PMID: 27760999 DOI: 10.1038/hr.2016.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
Obesity is an ongoing global epidemic and has adverse consequences for cardiovascular health. Obesity is often associated with hypertension, which is, itself, a common condition and an important cause of morbidity and mortality worldwide. Although animal models of obesity have provided extensive data on the links between obesity and hypertension, a greater understanding of the pathways linking obesity and hypertension in humans is likely to assist translation of animal data, and may, itself, identify important treatment strategies. Ultimately, this could have a substantial impact on human health, both at an individual and population level. The current review will focus specifically on studies of experimental weight gain and weight loss in humans and the following key areas, which are strongly related to blood pressure: cardiovascular function, autonomic nervous system function, metabolic function and the impact of cardiorespiratory fitness.
Collapse
Affiliation(s)
- Jessica E Middlemiss
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| |
Collapse
|
5
|
Fidan-Yaylali G, Yaylali YT, Erdogan Ç, Can B, Senol H, Gedik-Topçu B, Topsakal S. The Association between Central Adiposity and Autonomic Dysfunction in Obesity. Med Princ Pract 2016; 25:442-8. [PMID: 27194294 PMCID: PMC5639620 DOI: 10.1159/000446915] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/18/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the relationship between central adiposity parameters and autonomic nervous system (ANS) dysfunction. SUBJECTS AND METHODS The study included 114 obese individuals without any cardiovascular risk factors. Weight (in kg), height (in m), and waist circumference (WC; in cm) were measured and body mass index was calculated. Echocardiographic examination was performed to measure left ventricular mass and epicardial fat thickness (EFT). All the participants underwent an exercise test and electrophysiological evaluation using electromyography. Heart rate recovery (HRR) at 1-5 min, R-R interval variation at rest and during hyperventilation, and sympathetic skin response were measured. Pearson's correlation analysis was used. Multiple linear regression analysis was used to identify the factors associated with autonomic dysfunction. RESULTS The HRR at 1-5 min was negatively correlated with WC and age (WC-HRR1: r = -0.32; WC-HRR2: r = -0.31; WC-HRR3: r = -0.26; WC-HRR4: r = -0.23; WC-HRR5: r = -0.21; age-HRR2: r = -0.32; age-HRR3: r = -0.28; age-HRR4: r = -0.41; age-HRR5: r = -0.42). Age was the only independent predictor of reduced HRR at 1-5 min. In addition, WC predicted a reduced HRR at 3 min. There were no significant associations between central obesity and electrophysiological parameters. EFT was not associated with ANS dysfunction. CONCLUSION In this study, central adiposity and aging were associated with ANS dysfunction in obese individuals. The WC could be a marker of ANS dysfunction in obese individuals without any cardiovascular risk factors. The HRR assessment at a later decay phase could be more valuable for evaluating ANS function than during early recovery.
Collapse
Affiliation(s)
- Güzin Fidan-Yaylali
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Yalin Tolga Yaylali
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Çağdaş Erdogan
- Department of Neurology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Beray Can
- Department of Internal Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Hande Senol
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Bengi Gedik-Topçu
- Department of Neurology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Senay Topsakal
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| |
Collapse
|
6
|
Blüher S, Petroff D, Keller A, Wagner A, Classen J, Baum P. Effect of a 1-Year Obesity Intervention (KLAKS Program) on Preexisting Autonomic Nervous Dysfunction in Childhood Obesity. J Child Neurol 2015; 30:1174-81. [PMID: 25406153 DOI: 10.1177/0883073814555190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 09/19/2014] [Indexed: 11/16/2022]
Abstract
Childhood obesity may involve autonomic nervous system dysfunction. Whether it improves following weight loss remains unclear. Thirty-one obese children (body mass index standard deviation scores 2.33 ± 0.47; age 11.2 ± 2.0) completed a 1-year lifestyle intervention (KLAKS: Concept Leipzig: Adiposity Therapy for School-Aged Children). Anthropometric/biochemical parameters and autonomic nervous system function (heart rate variability, quantitative pupillography) were assessed at baseline and follow-up. A multivariate model for changes in body mass index standard deviation scores considered age, gender, and changes in autonomic nervous system function. Weight status (Δ body mass index standard deviation scores: 0.16 [0.05, 0.29], P = .008), glycemic control, and free fatty acids (all P < .05) improved after the intervention. Redilation velocity increased by 0.22 mm/s [0.06, 0.38] (P = .008), and changes tended to be negatively associated with Δ body mass index standard deviation scores (P = .08 [-0.61, 0.03]). Relative reflex amplitude (23.4 vs 26.3, P = .004) and constriction velocity (4.97 mm/s vs 5.47 mm/s, P < .001) also improved. Our data provide preliminary evidence that lifestyle-intervention induced improvement of weight status/metabolic risk factors may ameliorate some parameters of autonomic nervous system dysfunction in childhood obesity.
Collapse
Affiliation(s)
- Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Germany Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | | | | | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Petra Baum
- Department of Neurology, University of Leipzig, Leipzig, Germany
| |
Collapse
|
7
|
Grewal S, Sekhon TS, Walia L, Gambhir RS. Cardiovascular response to acute cold stress in non-obese and obese healthy adults. Ethiop J Health Sci 2015; 25:47-52. [PMID: 25733784 PMCID: PMC4337083 DOI: 10.4314/ejhs.v25i1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Obesity is a global epidemic with important health care and financial implications. The cold pressor test (CPT) which is considered to be a sympathy-excitatory manoeuvre is a simple, noninvasive and validated test. The objective of this study was to assess and compare the cardiovascular response to cold pressor test in non-obese and obese healthy adults. METHODS The study included 400 subjects, of which the study group included 200 adults who had body mass index (BMI) of more than 30 Kg/m,(2) and 200 non-obese adults were enrolled as controls with BMI less than 25 kg/m(2). The study was conducted for a period of two months. CPT was used to assess cardiac response to acute cold exposure in the present study. Baseline systolic and diastolic blood pressure recording was done using mercury sphygmomanometer during resting condition and following cold pressor test. The results were expressed as mean, standard deviation, and data were analyzed using ANOVA test. P < 0.05 was considered statistically significant. RESULTS The mean change in systolic blood pressure before and after cold pressor test (CPT) was less in obese (7.12 ± 5.28) as compared to non-obese subjects (10.38 ±6.35). This was statistically significant which indicates impaired sympathetic function in otherwise healthy obese. CONCLUSION The study concluded that blood pressure response to cold pressor test was reduced in obese compared to non-obese subjects indicating reduced sympathetic activity in healthy obese adults.
Collapse
Affiliation(s)
- S Grewal
- MM Medical College and Hospital, Solan, India
| | - T S Sekhon
- SKSS Dental College and Hospital, Ludhiana, India
| | - L Walia
- MM Medical College and Hospital, Solan, India
| | - R S Gambhir
- Gian Sagar Dental College and Hospital, India
| |
Collapse
|
8
|
Wu JM, Yu HJ, Lai HS, Yang PJ, Lin MT, Lai F. Improvement of heart rate variability after decreased insulin resistance after sleeve gastrectomy for morbidly obesity patients. Surg Obes Relat Dis 2014; 11:557-63. [PMID: 25630807 DOI: 10.1016/j.soard.2014.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/11/2014] [Accepted: 09/13/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Morbidly obese patients display both an autonomic nervous imbalance and impaired glucose metabolism, and both of these conditions can be partially reversed after bariatric surgery. The aim of the present study was to investigate changes in heart rate variability (HRV) and glucose metabolism in patients after laparoscopic sleeve gastrectomy (SG). METHODS Eighteen morbidly obese patients who underwent SG were examined before surgery and at 7, 30, 90, and 180 days after surgery. Indices of HRV included time-domain, frequency-domain, and nonlinear parameters. Glucose metabolism was evaluated by the measuring levels of insulin resistance, glycated hemoglobin (HbA(1c)), and gut hormones. RESULTS The study included 9 men and 9 women with a mean age of 34 years. In the HRV study, the average R-R interval, median R-R interval, standard deviation of the R-R intervals, root mean squared successive difference of the R-R intervals (RMSSD), and the number of pairs of successive normal-to-normal beat intervals that differed by>50 ms significantly increased at 180 days after surgery. Regarding the frequency-domain indices, the low frequency (LF)/high frequency (HF) ratio was more balanced at 90 days after SG compared with baseline, and increases in the total power, LF band, and HF band were observed at 180 days. The assessments of insulin resistance, glucose metabolism, and gut hormones revealed not only improvements in the homeostasis model assessment of insulin resistance and HbA1c levels but also increases in the levels of glucagon-like peptide-1 at 90 and 180 days after surgery compared with baseline. A multivariable regression model revealed significantly negative associations between the perioperative changes in HOMA-IR and changes in both the RMSSD and HF band. CONCLUSIONS SG leads to early improvements in insulin resistance and glucose metabolism that are followed by improvements in HRV indices. Improvements in insulin resistance were associated with increases in the RMSSD and HF band index, but the mechanism of these changes require further study.
Collapse
Affiliation(s)
- Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Hwan-Jeu Yu
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Jen Yang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
9
|
Effects of weight on blood pressure at rest and during exercise. Hypertens Res 2013; 36:1045-50. [PMID: 23966058 DOI: 10.1038/hr.2013.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/15/2013] [Accepted: 04/24/2013] [Indexed: 11/08/2022]
Abstract
Body weight (BW) and blood pressure (BP) have a close relationship, which has been accounted for by hormonal changes. No previous study has evaluated the effect of wearing an external weight vest on BP to determine whether there is a simple mechanism between BW and BP. Seventeen healthy volunteers underwent weight reduction (WR) through caloric restriction. Before and after WR, BW, body fat percentage and BP at rest and during exercise were measured. Before and after WR, exercise testing was performed twice with the random allocation of a weight vest (10 kg) during one of the tests. Linear regression was used to detect independent associations between BP and the weight vest, BW and body fat percentage. BW decreased from 89.4 ± 15.4 kg to 79.1 ± 14.0 kg following WR (P<0.001). WR led to significant decreases in BP at rest (from 130.0/85.9 mm Hg to 112.5/77.8 mm Hg, P<0.001 for systolic and diastolic BPs) and during exercise. The weight vest significantly increased BP at rest (to 136.1/90.7 mm Hg before and 125.8/84.6 mm Hg after WR) and during exercise. Linear regression analysis identified an independent association between the weight vest and BP (P=0.006 for systolic BP and P=0.009 for diastolic BP at rest). This study demonstrates that wearing an external weight vest has immediate effects on BP at rest and during exercise independent of BW or body fat. More research is needed to understand the physiological mechanisms between weight and BP.
Collapse
|
10
|
Esco MR, Williford HN. Relationship between post-exercise heart rate variability and skinfold thickness. SPRINGERPLUS 2013; 2:389. [PMID: 24010045 PMCID: PMC3758487 DOI: 10.1186/2193-1801-2-389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/15/2013] [Indexed: 11/11/2022]
Abstract
This investigation aimed to determine if groupings based upon sum of skinfold thickness (SF) would reflect the differences in heart rate variability (HRV) measured for up to 30-minutes following maximal exercise, and to determine the extent in variation in post-exercise HRV that could be accounted for between the following independent variables: SF, body mass index (BMI) and maximal oxygen consumption (VO2max). SF and BMI measurements were performed on fifty-four men who completed maximal exercise testing to determine VO2max. HRV was evaluated for five-minutes before (Pre), at 0-5 minutes post- (Post1) and 25-30 minutes post-exercise (Post2), and analyzed by frequency domain [high frequency (HF) power, and HF to low frequency power ratio (LF:HF)). Two groups were formed based on being above or below the sample mean value of SF. HF and LF:HF were significantly higher and lower, respectively, at Pre and Post 2 in Group 1 compared to Group 2 (p < 0.05), which remained after controlling for VO2max and BMI. Furthermore, there was a significant trend toward baseline in post-exercise HRV in Group 1 (p < 0.05) but not in Group 2 (p > 0.05). In addition, SF was the only variable to significantly relate to the post-exercise HRV parameters (p < 0.05). The findings of this investigation suggest greater SF is related to a delayed return of HRV toward baseline from maximal exercise. The association between SF and HRV is independent of VO2max and BMI.
Collapse
Affiliation(s)
- Michael R Esco
- Human Performance Laboratory, Auburn University at Montgomery, P.O. Box 244023, Montgomery, AL 36124-4023 USA
| | | |
Collapse
|
11
|
Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obes Surg 2013; 23:31-8. [PMID: 22923313 DOI: 10.1007/s11695-012-0743-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Morbidly obese patients display cardiac abnormalities which are partially reversed after weight loss. The aim of the present study was to assess the potential difference in cardiovascular disease indices between patients who underwent either gastric bypass surgery or sleeve gastrectomy. METHODS Thirty-seven morbidly obese patients who underwent either Roux-en-Y gastric bypass (RYGB) (n = 14) or SG (n = 23) were examined before, 3 and 6 months after surgery. Indices of cardiac autonomic nervous system activity were evaluated, namely baroreflex sensitivity (BRS) and heart rate variability (HRV). A complete echocardiographic study was performed in a subgroup of 17 patients (RYGB 8, SG 9) preoperatively and 6 months after surgery, evaluating epicardial fat thickness, aortic distensibility, left ventricular (LV) Tei index, left atrium diameter, ejection fraction, and LV mass. RESULTS All subjects experienced significant (p < 0.001) and similar weight loss independently of the type of operation. BRS and HRV indices improved significantly and to the same degree after surgery in both groups. In the echocardiographic study, all parameters improved significantly at 6 months in comparison with the baseline values. In addition, the RYGB group displayed significantly greater reduction in epicardial fat thickness (p = 0.007) and also tended to have a better LV performance as expressed by the lower values of the Tei index (p = 0.06) compared to the SG group 6 months after surgery. CONCLUSIONS Both RYGB and SG exert comparable effects on weight loss and improvement of cardiovascular parameters. RYGB displays a more beneficial influence on epicardial fat thickness and left ventricular performance than SG.
Collapse
|
12
|
Mazurak N, Günther A, Grau FS, Muth ER, Pustovoyt M, Bischoff SC, Zipfel S, Enck P. Effects of a 48-h fast on heart rate variability and cortisol levels in healthy female subjects. Eur J Clin Nutr 2013; 67:401-6. [DOI: 10.1038/ejcn.2013.32] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
13
|
He Z, Zhu HH, Bauler TJ, Wang J, Ciaraldi T, Alderson N, Li S, Raquil MA, Ji K, Wang S, Shao J, Henry RR, King PD, Feng GS. Nonreceptor tyrosine phosphatase Shp2 promotes adipogenesis through inhibition of p38 MAP kinase. Proc Natl Acad Sci U S A 2013; 110:E79-88. [PMID: 23236157 PMCID: PMC3538237 DOI: 10.1073/pnas.1213000110] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The molecular mechanism underlying adipogenesis and the physiological functions of adipose tissue are not fully understood. We describe here a unique mouse model of severe lipodystrophy. Ablation of Ptpn11/Shp2 in adipocytes, mediated by aP2-Cre, led to premature death, lack of white fat, low blood pressure, compensatory erythrocytosis, and hepatic steatosis in Shp2(fat-/-) mice. Fat transplantation partially rescued the lifespan and blood pressure in Shp2(fat-/-) mice, and administration of leptin also restored partially the blood pressure of mutant animals with endogenous leptin deficiency. Consistently, homozygous deletion of Shp2 inhibited adipocyte differentiation from embryonic stem (ES) cells. Biochemical analyses suggest a Shp2-TAO2-p38-p300-PPARγ pathway in adipogenesis, in which Shp2 suppresses p38 activation, leading to stabilization of p300 and enhanced PPARγ expression. Inhibition of p38 restored adipocyte differentiation from Shp2(-/-) ES cells, and p38 signaling is also suppressed in obese patients and obese animals. These results illustrate an essential role of adipose tissue in mammalian survival and physiology and also suggest a common signaling mechanism involved in adipogenesis and obesity development.
Collapse
Affiliation(s)
- Zhao He
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Helen H. Zhu
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Timothy J. Bauler
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI 48109-5620; and
| | - Jing Wang
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Theodore Ciaraldi
- Veteran’s Administration San Diego Healthcare System and Department of Medicine, and
| | - Nazilla Alderson
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Shuangwei Li
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Marie-Astrid Raquil
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Kaihong Ji
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Shufen Wang
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| | - Jianhua Shao
- Department of Pediatrics, University of California at San Diego, La Jolla,CA 92093
| | - Robert R. Henry
- Veteran’s Administration San Diego Healthcare System and Department of Medicine, and
| | - Philip D. King
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI 48109-5620; and
| | - Gen-Sheng Feng
- Department of Pathology and Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0864
| |
Collapse
|
14
|
Yi SH, Lee K, Shin DG, Kim JS, Ki HC. Differential association of adiposity measures with heart rate variability measures in Koreans. Yonsei Med J 2013; 54:55-61. [PMID: 23225799 PMCID: PMC3521274 DOI: 10.3349/ymj.2013.54.1.55] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Although obesity has been associated with imbalances in cardiac autonomic nervous system, it is unclear whether there are differential relationships between adiposity measures and heart rate variability (HRV) measures. We aimed to examine differences in the relationship between adiposity measures and HRV indices in a healthy Korean population. MATERIALS AND METHODS In all, 1409 non-smokers (811 males, 598 females) without known histories of cardiovascular (CV), endocrine, or neurological diseases underwent adiposity measurements [(body mass index (BMI), percentage of body fat mass (PBF), and waist-to-hip ratio (WHR)], the HRV assessment (SDNN, RMSSD, LF, HF, LF/HF, and pNN50), and examination for CV risk factors (fasting glucose, LDL-cholesterol, HDL-cholesterol, triglycerides, hs-CRP, and blood pressure). RESULTS Compared with BMI and PBF, WHR was more strongly correlated with each HRV index and more likely to predict decreased HRV (<15 percentile vs. ≥ 15 percentile of each HRV index) in ROC curves analysis. In linear regression analysis, all adiposity measures were inversely associated with each HRV measure before adjusting for age, gender, and CV risk factors (p<0.05). After adjusting for the covariates, WHR was inversely related to RMSSD, LF, and pNN50; PBF with RMSSD, HF, and pNN50; BMI with RMSSD (p<0.05). The inversed association between HRV indices and the gender-specific WHR tertile was significant for subjects with BMI ≥ 25 kg/m(2), but not for those with BMI <25 kg/m(2). CONCLUSION WHR and PBF appear to be better indicators for low HRV than BMI, and the association between abdominal adiposity and HRV may be stronger in overweight subjects.
Collapse
Affiliation(s)
- Sang Hoon Yi
- School of Computer Aided Science & Institute of Basic Science, Inje University, Gimhae, Korea
| | - Kayoung Lee
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Gu Shin
- Cardiovascular Division, Yeungnam University Hospital, Daegu, Korea
| | - Jun Su Kim
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hee-Cheol Ki
- School of Computer Engineering & Ubiquitous Healthcare Research Center, Inje University, Gimhae, Korea
| |
Collapse
|
15
|
Liu C, Su D. Nicotinic acetylcholine receptor α7 subunit: a novel therapeutic target for cardiovascular diseases. Front Med 2012; 6:35-40. [PMID: 22460446 DOI: 10.1007/s11684-012-0171-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/02/2011] [Indexed: 12/19/2022]
Abstract
Inflammation is important in the pathogenesis and development of cardiovascular diseases. Recent studies show that vagus nerve stimulation inhibits pro-inflammatory cytokine production through "the cholinergic anti-inflammatory pathway," more specifically via the α7 nicotinic acetylcholine receptor (α7nAChR). In the current study, the role of the cholinergic anti-inflammatory pathway during septic shock, hypertension, and myocardial infarction is reviewed, and its possible clinical implications in cardiovascular diseases are discussed.
Collapse
Affiliation(s)
- Chong Liu
- Department of Pharmacology, Second Military Medical University, Shanghai 200433, China
| | | |
Collapse
|
16
|
Esco MR, Williford HN, Olson MS. Skinfold thickness is related to cardiovascular autonomic control as assessed by heart rate variability and heart rate recovery. J Strength Cond Res 2011; 25:2304-10. [PMID: 21691230 DOI: 10.1519/jsc.0b013e3181f90174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to determine if heart rate recovery (HRR) and heart rate variability (HRV) are related to maximal aerobic fitness and selected body composition measurements. Fifty men (age = 21.9 ± 3.0 years, height = 180.8 ± 7.2 cm, weight = 80.4 ± 9.1 kg, volunteered to participate in this study. For each subject, body mass index (BMI), waist circumference (WC), and the sum of skinfolds across the chest, abdomen, and thigh regions (SUMSF) were recorded. Heart rate variability (HRV) was assessed during a 5-minute period while the subjects rested in a supine position. The following frequency domain parameters of HRV were recorded: normalized high-frequency power (HFnu), and low-frequency to high-frequency power ratio (LF:HF). To determine maximal aerobic fitness (i.e., VO2max), each subject performed a maximal graded exercise test on a treadmill. Heart rate recovery was recorded 1 (HRR1) and 2 (HRR2) minutes during a cool-down period. Mean VO2max and BMI for all the subjects were 49.5 ± 7.5 ml·kg(-1)·min(-1) and 24.7 ± 2.2 kg·m(-2), respectively. Although VO2max, WC, and SUMSF was each significantly correlated to HRR and HRV, only SUMSF had a significant independent correlation to HRR1, HRR2, HFnu, LF:HF (p < 0.01). The results of the regression procedure showed that SUMSF accounted for the greatest variance in HRR1, HRR2, HFnu, and LF:HF (p < 0.01). The results of this study suggest that cardiovascular autonomic modulation is significantly related to maximal aerobic fitness and body composition. However, SUMSF appears to have the strongest independent relationship with HRR and HRV, compared to other body composition parameters and VO2max.
Collapse
Affiliation(s)
- Michael R Esco
- Department of Physical Education and Exercise Science, Auburn University Montgomery, Montgomery, Alabama, USA.
| | | | | |
Collapse
|
17
|
Su DF. Parasympathetic nervous system: A new therapeutic target in cardiovascular disease? Clin Exp Pharmacol Physiol 2011; 38:290-1. [DOI: 10.1111/j.1440-1681.2011.05500.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
18
|
Rogozina OP, Bonorden MJL, Seppanen CN, Grande JP, Cleary MP. Effect of chronic and intermittent calorie restriction on serum adiponectin and leptin and mammary tumorigenesis. Cancer Prev Res (Phila) 2011; 4:568-81. [PMID: 21257708 DOI: 10.1158/1940-6207.capr-10-0140] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The effect of chronic (CCR) and intermittent (ICR) caloric restriction on serum adiponectin and leptin levels was investigated in relation to mammary tumorigenesis. 10-wks old MMTV-TGF-α female mice were assigned to ad libitum fed (AL; AIN-93M diet), ICR (3-week 50% caloric restriction, AIN-93M-mod diet, 2× protein, fat, vitamins, and minerals followed by 3-wks 100% AL consumption of AIN-93M), and CCR (calorie and nutrient intake matched for each 6-wks ICR cycle, ∼ 75% of AL) groups. Mice were sacrificed at 79 (end of restriction) or 82 (end of refeeding) wks of age. Serum was obtained in cycles 1, 3, 5, 8, 11, and terminal. Mammary tumor incidence was 71.0%, 35.4%, and 9.1% for AL, CCR, and ICR mice, respectively. Serum adiponectin levels were similar among groups with no impact of either CCR or ICR. Serum leptin level rose in AL mice with increasing age but was significantly reduced by long-term CCR and ICR. The ICR protocol was also associated with an elevated adiponectin/leptin ratio. In addition, ICR-restricted mice had increased mammary tissue AdipoR1 expression and decreased leptin and ObRb expression compared with AL mice. Mammary fat pads from tumor-free ICR-mice had higher adiponectin expression than AL and CCR mice whereas all tumor-bearing mice had weak adiponectin signal in mammary fat pad. Although we did not show an association of either adiponectin or leptin with individual mice in relation to mammary tumorigenesis, we did find that reduced serum leptin and elevated adiponectin/leptin ratio were associated with the protective effect of intermittent calorie restriction.
Collapse
Affiliation(s)
- Olga P Rogozina
- 1The Hormel Institute, University of Minnesota, Austin and 2Mayo Clinic, Rochester, Minnesota 55912, USA
| | | | | | | | | |
Collapse
|
19
|
Stumbo PJ, Weiss R, Newman JW, Pennington JA, Tucker KL, Wiesenfeld PL, Illner AK, Klurfeld DM, Kaput J. Web-enabled and improved software tools and data are needed to measure nutrient intakes and physical activity for personalized health research. J Nutr 2010; 140:2104-15. [PMID: 20980656 PMCID: PMC3139235 DOI: 10.3945/jn.110.128371] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 07/27/2010] [Accepted: 09/16/2010] [Indexed: 02/04/2023] Open
Abstract
Food intake, physical activity (PA), and genetic makeup each affect health and each factor influences the impact of the other 2 factors. Nutrigenomics describes interactions between genes and environment. Knowledge about the interplay between environment and genetics would be improved if experimental designs included measures of nutrient intake and PA. Lack of familiarity about how to analyze environmental variables and ease of access to tools and measurement instruments are 2 deterrents to these combined studies. This article describes the state of the art for measuring food intake and PA to encourage researchers to make their tools better known and more available to workers in other fields. Information presented was discussed during a workshop on this topic sponsored by the USDA, NIH, and FDA in the spring of 2009.
Collapse
Affiliation(s)
- Phyllis J Stumbo
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA 52242, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Fisher JP, Fadel PJ. Therapeutic strategies for targeting excessive central sympathetic activation in human hypertension. Exp Physiol 2010; 95:572-80. [PMID: 20304932 DOI: 10.1113/expphysiol.2009.047332] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The pathogenesis of hypertension and its mode of progression are complex, multifactoral and incompletely understood. However, there is accumulating evidence from humans and animal models of hypertension indicating that excessive central sympathetic nerve activity (SNA) plays a pathogenic role in triggering and sustaining the essential hypertensive state (the so-called 'neuroadrenergic hypothesis'). Importantly, augmented central sympathetic outflow has also been implicated in the initiation and progression of a plethora of pathophysiological processes independent of any increase in blood pressure, such as left ventricular hypertrophy and cardiac arrhythmias. Thus, the sympathetic nervous system constitutes an important putative drug target in hypertension. However, traditional pharmacological approaches for the management of essential hypertension appear ineffective in reducing central sympathetic outflow. Recently, several new and promising therapeutic strategies targeting neurogenic hypertension have been developed. The present report will provide a brief update of this topic with a particular emphasis on human studies examining the efficacy of novel pharmacological approaches (central sympatholytics and statins), lifestyle modification (aerobic exercise training, weight loss and stress reduction) and surgical intervention (renal denervation, chronic carotid baroreflex stimulation and deep brain stimulation) in reducing excessive central sympathetic activation in hypertension.
Collapse
Affiliation(s)
- James P Fisher
- School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | | |
Collapse
|
21
|
Abstract
Abnormalities of the autonomic nervous system have been repeatedly shown in hypertension. We studied the associations between being overweight, blood pressure, cardiac vagal tone as measured by variability in heart rate, and well-being in a large cohort of young men. We hypothesised an inverse correlation between body mass index and the variability in heart rate. Further, we assessed systolic and diastolic blood pressure as traditional indicators of cardiovascular risk. Exclusion criteria were the use of drugs or pharmaceuticals. The following data from 786 men with a mean age of 19.4 years (standard deviation = 1.4, with a range from 16 to 24 years) were analysed in a cross-sectional study: body mass index, sleep duration, sporting activities, psychological well-being, blood pressure, heart rate, and variability in heart rate. Despite the young age of the men in this study, increased values for the body mass index were already associated with a shift in sympathovagal balance trending towards sympathetic dominance. There was also a significant positive correlation between body mass index and systolic and diastolic blood pressure. A multiple stepwise regression analysis showed that significant factors, which were associated with variability in heart rate, were body mass index and sporting activities. In addition, sporting activity and sleep duration had a significant positive impact on psychological well-being. Even in young men, being overweight is associated with increased cardiovascular risk, especially an increased sympathetic and/or lowered cardiovascular tone and increased blood pressure. Our study gives additional motivation for the early prevention and treatment of obesity in childhood and adolescence.
Collapse
|
22
|
Marzetti E, Wohlgemuth SE, Anton SD, Bernabei R, Carter CS, Leeuwenburgh C. Cellular mechanisms of cardioprotection by calorie restriction: state of the science and future perspectives. Clin Geriatr Med 2009; 25:715-32, ix. [PMID: 19944269 PMCID: PMC2786899 DOI: 10.1016/j.cger.2009.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Evidence from animal models and preliminary studies in humans indicates that calorie restriction (CR) delays cardiac aging and can prevent cardiovascular disease. These effects are mediated by a wide spectrum of biochemical and cellular adaptations, including redox homeostasis, mitochondrial function, inflammation, apoptosis, and autophagy. Despite the beneficial effects of CR, its large-scale implementation is challenged by applicability issues as well as health concerns. However, preclinical studies indicate that specific compounds, such as resveratrol, may mimic many of the effects of CR, thus potentially obviating the need for drastic food intake reductions. Results from ongoing clinical trials will reveal whether the intriguing alternative of CR mimetics represents a safe and effective strategy to promote cardiovascular health and delay cardiac aging in humans.
Collapse
Affiliation(s)
- Emanuele Marzetti
- Department of Aging and Geriatric Research, Institute on Aging, Division of Biology of Aging, University of Florida, Gainesville, FL 32610−0143, USA
- Department of Orthopaedics and Traumatology, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Stephanie E. Wohlgemuth
- Department of Aging and Geriatric Research, Institute on Aging, Division of Biology of Aging, University of Florida, Gainesville, FL 32610−0143, USA
| | - Stephen D. Anton
- Department of Aging and Geriatric Research, Institute on Aging, Division of Biology of Aging, University of Florida, Gainesville, FL 32610−0143, USA
| | - Roberto Bernabei
- Department of Gerontology, Geriatrics and Physiatrics, Catholic University of the Sacred Heart, Rome, 00168, Italy
| | - Christy S. Carter
- Department of Aging and Geriatric Research, Institute on Aging, Division of Biology of Aging, University of Florida, Gainesville, FL 32610−0143, USA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, Institute on Aging, Division of Biology of Aging, University of Florida, Gainesville, FL 32610−0143, USA
| |
Collapse
|