Assessment of cardiac autonomic modulation during adolescent obesity.
OBJECTIVE
To investigate the cardiovascular autonomic function in pediatric obesity of different duration by using standard time domain, spectral heart rate variability (HRV), and nonlinear methods.


METHODS
Fifty obese children (13.9 +/- 1.7 years) were compared with 12 lean subjects (12.9 +/- 1.6 years). Obese children were classified as recent obese (ROB) (<4 years), intermediate obese (IOB) (4 to 7 years), and long-term obese (OB) (>7 years). In all participants, we performed blood pressure (BP) measurements, laboratory tests, and 24-hour electrocardiogram/ambulatory BP monitoring. The spectral power was quantified in total power, very low-frequency (LF) power, high-frequency (HF) power, and LF to HF ratio. Total, long-term, and short-term time domain HRV were calculated. Poincaré plot and quadrant methods were used as nonlinear techniques.


RESULTS
All obese groups had higher casual and ambulatory BP and higher glucose, homeostasis model assessment, and triglyceride levels. All parameters reflecting parasympathetic tone (HF band, root mean square successive difference, proportion of successive normal-to-normal intervals, and scatterplot width) were significantly and persistently reduced in all obese groups in comparison with lean controls. LF normalized units, LF/HF, and cardiac acceleration (reflecting sympathetic activation) were significantly increased in the ROB group. In IOB and OB groups, LF, but not nonlinear, measures were similar to lean controls, suggesting biphasic behavior of sympathetic tone, whereas nonlinear analysis showed a decreasing trend with the duration of obesity. Long-term HRV measures were significantly reduced in ROB and IOB.


CONCLUSIONS
Autonomic nervous system changes in adolescent obesity seem to be related to its duration. Nonlinear methods of scatterplot and quadrant analysis permit assessment of autonomic balance, despite measuring different aspects of HRV.
Rabbia
Franco
F
Hypertension Unit, S. Vito Hospital, University of Turin, Italy. franco.rabbia@libero.it
Silke
Bernard
B
Conterno
Andrea
A
Grosso
Tiziana
T
De Vito
Barbara
B
Rabbone
Ivana
I
Chiandussi
Livio
L
Veglio
Franco
F
D000293:Adolescent; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D002648:Child; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009765:Obesity / Q000503:physiopathology*; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D014280:Triglycerides