title: Reduced brain natriuretic peptide levels in class III obesity: the role of metabolic and cardiovascular factors.
abstract: OBJECTIVE
  Brain natriuretic peptide (BNP) has potent lipolytic action and, probably, a role in the biological mechanisms of obesity. Clinically, high levels are found in subjects with heart failure (HF). Low levels and inverse relation to BMI lead to questioning of its clinical utility in obese subjects, but heterogeneous results are found in severe obesity.
  
  
  METHODS
  In order to describe BNP behavior and its metabolic and cardiovascular determinants in class III obesity, we performed BNP measurement as well as clinical and echocardiographic evaluation of 89 subjects from two public hospitals in Brazil. Multivariate logistic ordinal regression with BNP tertiles as the dependent variable was performed.
  
  
  RESULTS
  Mean (± SD) age and BMI (± SD) was 44 ± 11.5 years and 53.2 ± 7.9 kg/m(2), respectively. 72 (81%) participants were women, and 18 (20%) had HF. Median BNP was 9.5 pg/ml(Q1 4.9; Q3 21.2 pg/ml). 30% of BNP values were below the detection limit of the method. In multivariate analysis, left atrial volume (LAV) was the only determinant of BNP levels (p 0.002) with odds-ratio of 1.1 (95% CI 1.03-1.16).
  
  
  CONCLUSIONS
  BNP levels are low in severe obesity, even in subjects with HF. LAV, which marks diastolic dysfunction, determines BNP levels, but not BMI and metabolic abnormalities.
authors.affiliation: Universidade Federal de Minas Gerais , Belo Horizonte, Brazil. beleigoli@yahoo.com
authors.forename: Alline
authors.initials: A
authors.lastname: Beleigoli
authors.forename: Maria
authors.initials: M
authors.lastname: Diniz
authors.forename: Maria
authors.initials: M
authors.lastname: Nunes
authors.forename: Marcia
authors.initials: M
authors.lastname: Barbosa
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fernandes
authors.forename: Mery
authors.initials: M
authors.lastname: Abreu
authors.forename: Antonio
authors.initials: A
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009767:Obesity, Morbid / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D016017:Odds Ratio; D015995:Prevalence; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain