title: Impact of body mass and body composition on circulating levels of natriuretic peptides: results from the Dallas Heart Study.
abstract: BACKGROUND
  The association between higher body mass index (BMI) and lower B-type natriuretic peptide (BNP) level is thought to be mediated by expression of the natriuretic peptide clearance receptor (NPR-C) in adipose tissue. To explore this association, we tested 2 hypotheses: (1) that N-terminal (NT)-proBNP, which is not believed to bind NPR-C, would not be associated with BMI and (2) that lower BNP would be more closely associated with fat mass than with lean mass.
  
  
  RESULTS
  Measurements of BNP, NT-proBNP, and body composition by direct dual energy x-ray absorptiometry (DEXA) were performed in 2707 subjects from the Dallas Heart Study. The associations between obesity and low BNP (<4 ng/L) or low NT-proBNP (lowest sex-specific quartile) were evaluated with multivariable logistic regression models stratified by sex and adjusted for age, race/ethnicity, hypertension, left ventricular mass, and end-diastolic volume. Higher BMI was independently associated with lower BNP and NT-proBNP (all P<0.001). When BMI was replaced with both DEXA-derived lean and fat mass, greater lean mass, but not fat mass, was associated with low BNP and NT-proBNP levels.
  
  
  CONCLUSIONS
  In a large, population-based cohort, we confirm the previously described association between higher BMI and lower BNP and demonstrate a similar inverse association between BMI and NT-proBNP. Interestingly, both BNP and NT-proBNP are more closely associated with lean mass than with fat mass. These findings do not support the hypothesis that the lower BNP levels seen in obesity are driven by enhanced BNP clearance mediated via NPR-C.
authors.affiliation: Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA. sandeep.das@utsouthwestern.edu
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
authors.forename: Mark H
authors.initials: MH
authors.lastname: Drazner
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dries
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Vega
authors.forename: Harold G
authors.initials: HG
authors.lastname: Stanek
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.forename: Russell M
authors.initials: RM
authors.lastname: Canham
authors.forename: Anne K
authors.initials: AK
authors.lastname: Chung
authors.forename: David
authors.initials: D
authors.lastname: Leonard
authors.forename: Frank H
authors.initials: FH
authors.lastname: Wians
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D001835:Body Weight; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009765:Obesity / Q000097:blood; D010446:Peptide Fragments / Q000097:blood*; D013781:Texas
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain