title: Hyperinsulinemia and autonomic nervous system dysfunction in obesity: effects of weight loss.
abstract: BACKGROUND
  Because hyperinsulinemia acutely stimulates adrenergic activity, it has been postulated that chronic hyperinsulinemia may lead to enhanced sympathetic tone and cardiovascular risk.
  
  
  RESULTS
  In 21 obese (body mass index, 35+/-1 kg/m(2)) and 17 lean subjects, we measured resting cardiac output (by 2-dimensional echocardiography), plasma concentrations and timed (diurnal versus nocturnal) urinary excretion of catecholamines, and 24-hour heart rate variability (by spectral analysis of ECG). In the obese versus lean subjects, cardiac output was increased by 22% (P:<0.03), and the nocturnal drop in urinary norepinephrine output was blunted (P:=0.01). Spectral power in the low-frequency range was depressed throughout 24 hours (P:<0.04). During the afternoon and early night, ie, the postprandial phase, high-frequency power was lower, heart rate was higher; and the ratio of low to high frequency, an index of sympathovagal balance, was increased in direct proportion to the degree of hyperinsulinemia independent of body mass index (partial r=0.43, P:=0.01). In 9 obese subjects who lost 10% to 18% of their body weight, cardiac output decreased and low-frequency power returned toward normal (P:<0.05).
  
  
  CONCLUSIONS
  In free-living subjects with uncomplicated obesity, chronic hyperinsulinemia is associated with a high-output, low-resistance hemodynamic state, persistent baroreflex downregulation, and episodic (postprandial) sympathetic dominance. Reversal of these changes by weight loss suggests a causal role for insulin.
authors.affiliation: Metabolism Unit and Coronary Division, CNR Institute of Clinical Physiology, and Department of Internal Medicine, University of Pisa, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Emdin
authors.forename: A
authors.initials: A
authors.lastname: Gastaldelli
authors.forename: E
authors.initials: E
authors.lastname: Muscelli
authors.forename: A
authors.initials: A
authors.lastname: Macerata
authors.forename: A
authors.initials: A
authors.lastname: Natali
authors.forename: S
authors.initials: S
authors.lastname: Camastra
authors.forename: E
authors.initials: E
authors.lastname: Ferrannini
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002395:Catecholamines / Q000652:urine; D002940:Circadian Rhythm; D004562:Electrocardiography; D004837:Epinephrine / Q000097:blood / Q000652:urine; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006946:Hyperinsulinism / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D008297:Male; D009765:Obesity / Q000503:physiopathology*; D014636:Valsalva Maneuver; D014655:Vascular Resistance / Q000502:physiology; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose; D002395:Catecholamines; D007328:Insulin; D004837:Epinephrine