Yonsei Med J.  2013 Jan;54(1):55-61. 10.3349/ymj.2013.54.1.55.

Differential Association of Adiposity Measures with Heart Rate Variability Measures in Koreans

• Yi SH
• Lee K
• Shin DG
• Kim JS
• Ki HC

• KMID: 1776918
• DOI: http://doi.org/10.3349/ymj.2013.54.1.55

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. > or =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 > or =25 kg/m2, but not for those with BMI <25 kg/m2.
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.

Keyword

Heart rate variability; adiposity; abdominal fat; cardiac autonomic function; obesity

MeSH Terms

*Adiposity
Adult
Female
Heart/physiopathology
Heart Diseases/complications/diagnosis/ethnology
Heart Rate/*physiology
Humans
Male
Middle Aged
Models, Statistical
Obesity/*complications/*diagnosis/ethnology
Overweight/complications/diagnosis/ethnology
ROC Curve
Regression Analysis
Republic of Korea
Risk Factors

Figure

• 

  Fig. 1 Linear trend of heart rate variability index according to gender-specific waist-to-hip (WHR) tertiles in weight subgroups. *p for trend <0.05 using multiple linear regression analysis after adjusting for age, gender, high blood pressure (<130/85 mm Hg vs. ≥130/85 mm Hg), fasting glucose, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglycerides, and high sensitivity C-reactive protein. On the X-axis, 1 and 2 denote BMI subgroups of <25 kg/m2 and ≥25 kg/m2, respectively. ln, natural logarithm; SDNN, standard deviation of all normal RR intervals; RMSSD, root mean square of successive differences; LF, low frequency power; HF, high frequency power; pNN50, percentage of differences between adjacent RR intervals that are greater than 50 ms; LF/HF, ratio of the low/high frequency power; BMI, body mass index.

Reference

1. Laederach-Hofmann K, Mussgay L, Rúddel H. Autonomic cardiovascular regulation in obesity. J Endocrinol. 2000. 164:59–66.

2. Piccirillo G, Vetta F, Fimognari FL, Ronzoni S, Lama J, Cacciafesta M, et al. Power spectral analysis of heart rate variability in obese subjects: evidence of decreased cardiac sympathetic responsiveness. Int J Obes Relat Metab Disord. 1996. 20:825–829.

3. Piccirillo G, Vetta F, Viola E, Santagada E, Ronzoni S, Cacciafesta M, et al. Heart rate and blood pressure variability in obese normotensive subjects. Int J Obes Relat Metab Disord. 1998. 22:741–750.

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

5. Sztajzel J, Golay A, Makoundou V, Lehmann TN, Barthassat V, Sievert K, et al. Impact of body fat mass extent on cardiac autonomic alterations in women. Eur J Clin Invest. 2009. 39:649–656.

6. Rossi M, Marti G, Ricordi L, Fornasari G, Finardi G, Fratino P, et al. Cardiac autonomic dysfunction in obese subjects. Clin Sci (Lond). 1989. 76:567–572.

7. Karason K, Mølgaard H, Wikstrand J, Sjöström L. Heart rate variability in obesity and the effect of weight loss. Am J Cardiol. 1999. 83:1242–1247.

8. Ito H, Ohshima A, Tsuzuki M, Ohto N, Yanagawa M, Maruyama T, et al. Effects of increased physical activity and mild calorie restriction on heart rate variability in obese women. Jpn Heart J. 2001. 42:459–469.

9. Akehi Y, Yoshimatsu H, Kurokawa M, Sakata T, Eto H, Ito S, et al. VLCD-induced weight loss improves heart rate variability in moderately obese Japanese. Exp Biol Med (Maywood). 2001. 226:440–445.

10. Ashida T, Ono C, Sugiyama T. Effects of short-term hypocaloric diet on sympatho-vagal interaction assessed by spectral analysis of heart rate and blood pressure variability during stress tests in obese hypertensive patients. Hypertens Res. 2007. 30:1199–1203.

11. Martin J, Paquette C, Marceau S, Hould FS, Lebel S, Simard S, et al. Impact of orlistat-induced weight loss on diastolic function and heart rate variability in severely obese subjects with diabetes. J Obes. 2011. 2011:394658.

12. Arone LJ, Mackintosh R, Rosenbaum M, Leibel RL, Hirsch J. Autonomic nervous system activity in weight gain and weight loss. Am J Physiol. 1995. 269(1 Pt 2):R222–R225.

13. Reis JP, Macera CA, Araneta MR, Lindsay SP, Marshall SJ, Wingard DL. Comparison of overall obesity and body fat distribution in predicting risk of mortality. Obesity (Silver Spring). 2009. 17:1232–1239.

14. Taylor AE, Ebrahim S, Ben-Shlomo Y, Martin RM, Whincup PH, Yarnell JW, et al. Comparison of the associations of body mass index and measures of central adiposity and fat mass with coronary heart disease, diabetes, and all-cause mortality: a study using data from 4 UK cohorts. Am J Clin Nutr. 2010. 91:547–556.

15. Després JP. Is visceral obesity the cause of the metabolic syndrome? Ann Med. 2006. 38:52–63.

16. Antelmi I, de Paula RS, Shinzato AR, Peres CA, Mansur AJ, Grupi CJ. Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol. 2004. 93:381–385.

17. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2010. 141:122–131.

18. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation. 1996. 93:1043–1065.

19. Goldberger AL, Amaral LA, Glass L, Hausdorff JM, Ivanov PC, Mark RG, et al. PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation. 2000. 101:E215–E220.

20. Mietus JE, Peng CK, Henry I, Goldsmith RL, Goldberger AL. The pNNx files: re-examining a widely used heart rate variability measure. Heart. 2002. 88:378–380.

21. Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res. 1986. 59:178–193.

22. Lombardi F. Chaos theory, heart rate variability, and arrhythmic mortality. Circulation. 2000. 101:8–10.

23. Toda Y, Segal N, Toda T, Morimoto T, Ogawa R. Lean body mass and body fat distribution in participants with chronic low back pain. Arch Intern Med. 2000. 160:3265–3269.

24. Lindmark S, Lönn L, Wiklund U, Tufvesson M, Olsson T, Eriksson JW. Dysregulation of the autonomic nervous system can be a link between visceral adiposity and insulin resistance. Obes Res. 2005. 13:717–728.

25. Syme C, Abrahamowicz M, Leonard GT, Perron M, Pitiot A, Qiu X, et al. Intra-abdominal adiposity and individual components of the metabolic syndrome in adolescence: sex differences and underlying mechanisms. Arch Pediatr Adolesc Med. 2008. 162:453–461.

26. Kreier F, Yilmaz A, Kalsbeek A, Romijn JA, Sauerwein HP, Fliers E, et al. Hypothesis: shifting the equilibrium from activity to food leads to autonomic unbalance and the metabolic syndrome. Diabetes. 2003. 52:2652–2656.