title: Differential response of the natriuretic peptide system to weight loss and exercise in overweight or obese patients.
abstract: OBJECTIVE
  Relative atrial natriuretic peptide (ANP) deficiency has been implicated in the pathogenesis of obesity-associated cardiovascular and metabolic disease. We tested the hypothesis that more than 5% body weight reduction through 6 months hypocaloric dieting alters ANP release at rest and more so during exercise in overweight or obese patients.
  
  
  METHODS
  Venous mid-regional pro-ANP concentration was assessed at rest and after incremental exhaustive exercise testing before and after weight reduction. We also measured natriuretic peptide receptor A and C mRNA expression in subcutaneous adipose tissue to gauge both ANP responsiveness and clearance mechanisms.
  
  
  RESULTS
  The average weight reduction of 9.1 ± 3.8  kg was associated with reductions in visceral and subcutaneous abdominal fat mass, liver fat content, insulin resistance, and ambulatory blood pressure. However, mid-regional pro-ANP plasma concentrations were unchanged with weight loss (51 ± 24 vs. 53 ± 24  pmol/l). Exercise elicited similar acute mid-regional pro-ANP increases before and after weight loss. Adipose tissue natriuretic peptide receptor type A mRNA expression remained unchanged, whereas natriuretic peptide receptor type C mRNA decreased with weight loss.
  
  
  CONCLUSIONS
  We conclude that physical exercise acutely increases ANP release in obese patients, whereas modest diet-induced weight loss primarily affects ANP clearance mechanisms. Interventions combining weight loss and regular physical exercise may be particularly efficacious in reversing obesity-associated relative natriuretic peptide deficiency.
authors.affiliation: aInstitute of Clinical Pharmacology, Hannover Medical School, Hannover bDepartment of Psychology, University of Potsdam, Potsdam cWorking Group Cardiac MRI, Clinic for Cardiology and Nephrology, HELIOS Klinikum Berlin-Buch, and University Medicine Berlin, Charité Campus Buch, and Experimental and Clinical Research Centre dFranz Volhard Clinical Research Center at the Experimental and Clinical Research Center, University Medicine Berlin, Charité Campus Buch, and Max Delbrück Center for Molecular Medicine eDepartment of Endocrinology, Diabetes and Nutrition, Center for Cardiovascular Research, University Medicine Berlin, Charité, Berlin fInstitute for Clinical Chemistry, Hannover Medical School, Hannover, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Haufe
authors.forename: Jana
authors.initials: J
authors.lastname: Kaminski
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Utz
authors.forename: Verena
authors.initials: V
authors.lastname: Haas
authors.forename: Anja
authors.initials: A
authors.lastname: Mähler
authors.forename: Martin A
authors.initials: MA
authors.lastname: Daniels
authors.forename: Andreas L
authors.initials: AL
authors.lastname: Birkenfeld
authors.forename: Ralf
authors.initials: R
authors.lastname: Lichtinghagen
authors.forename: Friedrich C
authors.initials: FC
authors.lastname: Luft
authors.forename: Jeanette
authors.initials: J
authors.lastname: Schulz-Menger
authors.forename: Stefan
authors.initials: S
authors.lastname: Engeli
authors.forename: Jens
authors.initials: J
authors.lastname: Jordan
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism; D000328:Adult; D009320:Atrial Natriuretic Factor / Q000097:blood / Q000378:metabolism*; D018660:Blood Pressure Monitoring, Ambulatory; D004038:Diet, Reducing; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000628:therapy*; D017461:Receptors, Atrial Natriuretic Factor / Q000096:biosynthesis / Q000235:genetics; D012146:Rest; D015431:Weight Loss / Q000502:physiology*; D061217:Weight Reduction Programs
chemical_list: D009320:Atrial Natriuretic Factor; D017461:Receptors, Atrial Natriuretic Factor; C091715:atrial natriuretic factor receptor A