Association of Myocardial Energetic Efficiency with Circumferential and Longitudinal Left Ventricular Myocardial Function in Subjects with Increased Body Mass Index (the FATCOR Study)

Lower myocardial mechanic-energetic efficiency (MEEi), expressed as stroke volume/heart rate ratio (SV/HR) in mL/s/g of the left ventricular (LV) mass, is associated with the incidence of heart failure in subjects with cardiometabolic disorders. We explored the association of MEEi with LV systolic circumferential and longitudinal myocardial function in 480 subjects with increased body mass index (BMI) without known cardiovascular disease (mean age 47 ± 9 years, 61% women, 63% obese, 74% with hypertension) participating in the fat-associated cardiovascular dysfunction (FATCOR) study. Insulin resistance was assessed by the homeostasis model assessment insulin-resistance index (HOMA-IR). SV was calculated by Doppler echocardiography. The LV systolic circumferential myocardial function was evaluated by midwall fractional shortening (MFS) and longitudinal function by global longitudinal strain (GLS). Patients were grouped into MEEi quartiles. The lowest MEEi quartile (< 0.41 mL/s per g) was considered low MEEi. The association of MEEi with MFS and GLS were tested in multivariable linear regression analyses. Patients with low MEEi were more frequently men, with obesity and hypertension, dyslipidemia and higher HOMA-IR index (all p for trend < 0.05). In multivariable analyses, lower MEEi was associated with lower LV myocardial function by MFS and GLS independent of higher LV mass and clinical variables, including older age, male sex, presence of hypertension and a higher triglycerides level (all p < 0.05). In conclusion, in subjects with increased BMI without known cardiovascular disease participating in the FATCOR study, reduced MEEi was associated with lower LV myocardial function both in the circumferential and longitudinal direction, independent of cardiometabolic factors.

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Body Mass Index Predicts Aldosterone Production in Normotensive Adults on a High-Salt Diet

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-1088 ◽

2007 ◽

Vol 92 (11) ◽

pp. 4472-4475 ◽

Cited By ~ 125

Author(s):

Rhonda Bentley-Lewis ◽

Gail K. Adler ◽

Todd Perlstein ◽

Ellen W. Seely ◽

Paul N. Hopkins ◽

...

Keyword(s):

Insulin Resistance ◽

Cardiovascular Disease ◽

Body Mass Index ◽

Body Mass ◽

Model Assessment ◽

High Sodium ◽

Sodium Diet ◽

Serum Aldosterone ◽

Aldosterone Production ◽

High Sodium Diet

Abstract Context: The mechanisms underlying obesity-mediated cardiovascular disease are not fully understood. Aldosterone and insulin resistance both are associated with obesity and cardiovascular disease. Objectives: The objectives of this study were to test the hypotheses that aldosterone production is elevated and associated with insulin resistance in overweight adults on a high-sodium diet. Participants/Interventions: Healthy normotensive adults were categorized as lean body mass index (BMI) less than 25 kg/m2 (n = 63) or overweight BMI 25 kg/m2 or greater (n = 57). After 7 d of a high-sodium diet, participants fasted overnight and remained supine throughout hemodynamic and laboratory assessments and angiotensin II (AngII) stimulation. Results: The overweight group, compared with the lean group, had higher 24-h urinary aldosterone (9.0 ± 0.8 vs. 6.6 ± 0.5 μg per 24 h; P = 0.003) and higher AngII-stimulated serum aldosterone (11.4 ± 1.0 vs. 9.0 ± 0.6 ng/dl; P = 0.04). There were no differences in 24-h urinary cortisol or sodium or supine measurements of plasma renin activity, serum aldosterone, or serum potassium. The homeostasis model assessment of insulin resistance was predicted by urinary aldosterone excretion (r = 0.32, P = 0.03) and serum aldosterone response to AngII stimulation (r = 0.28, P = 0.02) independent of age and BMI. Conclusion: Urinary aldosterone excretion and AngII-stimulated aldosterone are increased in overweight, compared with lean, normotensive adults. The correlation of these measures of aldosterone production with insulin resistance suggests a potential role for aldosterone in the pathophysiology of obesity-mediated insulin resistance.

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Circulating Irisin in Relation to Insulin Resistance and the Metabolic Syndrome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-2373 ◽

2013 ◽

Vol 98 (12) ◽

pp. 4899-4907 ◽

Cited By ~ 235

Author(s):

Kyung Hee Park ◽

Lesya Zaichenko ◽

Mary Brinkoetter ◽

Bindiya Thakkar ◽

Ayse Sahin-Efe ◽

...

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Body Mass Index ◽

Body Mass ◽

Model Assessment ◽

Homeostasis Model Assessment ◽

Cvd Risk ◽

Baseline Serum ◽

The Metabolic Syndrome ◽

Increased Risk

Context: Irisin, a recently identified hormone, has been proposed to regulate energy homeostasis and obesity in mice. Whether irisin levels are associated with risk of the metabolic syndrome (MetS), cardiometabolic variables, and cardiovascular disease (CVD) risk in humans remains unknown. Objective: Our objective was to assess the associations between baseline serum irisin levels and MetS, cardiometabolic variables, and CVD risk. Design, Setting, and Subjects: We conducted a comparative cross-sectional evaluation of baseline circulating levels of the novel hormone irisin and the established adipokine adiponectin with MetS, cardiometabolic variables, and CVD risk in a sample of 151 subjects. Results: Baseline irisin levels were significantly higher in subjects with MetS than in subjects without MetS. Irisin was associated negatively with adiponectin (r = −0.4, P < .001) and positively with body mass index (r = 0.22, P = .008), systolic (r = 0.17, P = .04) and diastolic (r = 0.27, P = .001) blood pressure, fasting glucose (r = 0.25, P = .002), triglycerides (r = 0.25, P = .003), and homeostasis model assessment for insulin resistance (r = 0.33, P < .001). After adjustment for potential confounders, including body mass index, subjects in the highest tertile of irisin levels were more likely to have MetS (odds ratio [OR] = 9.44, 95% confidence interval [CI] = 2.66–33.44), elevated fasting blood glucose (OR = 5.80, 95% CI = 1.72–19.60), high triglycerides (OR = 3.89, 95% CI = 1.16–13.03), and low high-density lipoprotein cholesterol (OR = 3.30, 95% CI = 1.18–9.20). Irisin was independently associated with homeostasis model assessment for insulin resistance and general Framingham risk profile in multiple linear regression analyses after adjustment for confounders. Adiponectin demonstrated the expected associations with outcomes. Conclusions: Irisin is associated with increased risk of MetS, cardiometabolic variables, and CVD in humans, indicating either increased secretion by adipose/muscle tissue and/or a compensatory increase of irisin to overcome an underlying irisin resistance in these subjects.

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Subclinical left ventricular disfunction in obese children: are we late?

10.1101/2020.10.10.20195743 ◽

2020 ◽

Author(s):

B Riaño-Mendez ◽

M Ruiz del Campo ◽

P Garcia-Navas ◽

CM Amiama-Perez de Villarreal ◽

MY Ruiz del Prado

Keyword(s):

Insulin Resistance ◽

Body Mass Index ◽

Body Mass ◽

Systolic Function ◽

Left Ventricular ◽

Function Evaluation ◽

Obese Children ◽

Global Strain ◽

Cardiovascular Evaluation ◽

Control Study

ABSTRACTAimLongitudinal global strain (LGS) is reduced in obese patients with normal ejection fraction of the left ventricle. TAPSE/PAPS ratio, recently described, may be a step forward a more efficient RV function evaluation.There are still few publications in the application of these methods in pediatric patients.MethodsThis case-control study compared 104 children aged 5-18 years between October 2017 and February 2019, 52 obese children with body mass index (BMI) > +2 SD, and 52 matched controls.They were screened for other cardiovascular risk factors like insulin resistance or hypercholesterolemia. A complete echocardiography including standard and functional parameters was performed.ResultsWe found that obese children presented poor systolic function (LGS −15,90 ± 3,84 %) in comparison with non-obese children (−19,44 ± 5,75 %, p=0,001). LGS correlated positively with body mass index (BMI).Standard echocardiography also revealed cardiomegaly and hypertrophy.TAPSE/PASP ratio correlated negatively with triglycerides levels (β −0,402, p=0,014). Diastolic function was poor in those with HOMA-IR (β −0,375, p=0,016) and hypertriglyceridemia (β −0,375 p=0,024).ConclusionWe think that is necessary to perform a standarised cardiovascular evaluation in obese children for early identification of subclinical dysfunction especially in those with insulin resistance and dyslipidemia

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Circulating Adiponectin Is Associated with Obesity and Serum Lipids in West Africans

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-2765 ◽

2010 ◽

Vol 95 (7) ◽

pp. 3517-3521 ◽

Cited By ~ 25

Author(s):

Katherine G. Meilleur ◽

Ayo Doumatey ◽

Hanxia Huang ◽

Bashira Charles ◽

Guanjie Chen ◽

...

Keyword(s):

Insulin Resistance ◽

Body Mass Index ◽

Body Mass ◽

Serum Lipids ◽

Density Lipoprotein ◽

Human Populations ◽

Model Assessment ◽

Serum Triglycerides ◽

And Gender ◽

The Relationship

Context: Adiponectin, a hormone secreted by adipose tissue, has both metabolic and antiinflammatory properties. Although multiple studies have described the relationship between adiponectin and obesity in several human populations, no large studies have evaluated this relationship in Africans. Objective: We investigated the relationship between adiponectin and measures of obesity, serum lipids, and insulin resistance in a large African cohort. Design: Participants are from the Africa America Diabetes Mellitus (AADM) Study, a case-control study of genetic and other risk factors associated with development of type 2 diabetes in Africans. Setting: Patients were recruited from five academic medical centers in Nigeria and Ghana (Accra and Kumasi in Ghana and Enugu, Ibadan, and Lagos in Nigeria) over 10 yr. Main Outcome Measures: Circulating adiponectin levels were measured in 690 nondiabetic controls using an ELISA. The correlation between log-transformed circulating adiponectin levels and age, gender, measures of obesity (body mass index, waist circumference, and percent fat mass), and serum lipid levels was assessed. Linear regression was used to explore the association between adiponectin levels and measures of obesity, lipids, and insulin resistance as measured by homeostasis model assessment. Results: Significant negative associations were observed between log-adiponectin levels and measures of obesity after adjusting for age and gender. Similarly, log-adiponectin levels were significantly negatively associated with serum triglycerides and insulin resistance but positively associated with high-density lipoprotein-cholesterol and total cholesterol after adjusting for age, gender, and body mass index. Conclusions: Circulating adiponectin is significantly associated with measures of obesity, serum lipids, and insulin resistance in this study of West African populations.

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Effect of weight loss on early left atrial myopathy in obese patients without known cardiovascular disease

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.053 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

O Deal ◽

J Rayner ◽

A Stracquadanio ◽

R Wijesurendra ◽

S Neubauer ◽

...

Keyword(s):

Cardiovascular Disease ◽

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Left Atrial ◽

Normal Weight ◽

Obese Patients ◽

Weight Loss Intervention ◽

Reservoir Function ◽

Lv Mass

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): BHF & NIHR BRC Introduction Obesity is strongly associated with increased risk of heart failure and ischaemic stroke independently of associated co-morbidities. Left atrial (LA) reservoir dysfunction, a marker of atrial distensibility and compliance, is an early pathophysiological change which precedes the onset of cardiovascular disease in patients with obesity. It is unclear whether a weight loss intervention may be sufficient to reverse LA reservoir dysfunction. Purpose To longitudinally assess whether a weight loss intervention normalizes LA reservoir function by cardiac magnetic resonance (CMR) feature-tracking in patients with obesity and only subclinical cardiovascular disease and compared this age and sex matched non-obese normal weight controls. Methods A total of 45 patients with severe obese (age = 45 ± 11 years, body mass index = 39.1 ± 6.7 kg/m2, 51 ± 18 kg of excess body weight [EBW], 67% female) underwent CMR for quantification of LA and left ventricular (LV) size and function before and a median of 373 days following weight loss intervention. Weight loss was achieved by means of a very-low calorie diet (N = 28; 800 kcal/day) or by bariatric surgery (N = 17). A total of N = 27 non-obese healthy controls (age = 41 ± 12 years, body mass index = 22.3 ± 2.4 kg/m2, 75% female) underwent the same CMR protocol once. Results At baseline, patients with obesity displayed signs of atrial myopathy with increased LA volume and reduced LA reservoir function as compared to normal-weight controls (both P < 0.05, Figure 1) alongside increased LV mass and hyper-normal LV ejection fraction [LVEF] (both p < 0.01). As expected, weight loss led to a significant reduction of LA volume and LV mass with normalization of LVEF regardless of the degree of weight loss achieved (all P < 0.05, Figure 2). By contrast, only a large weight loss (>46.6% EBW, in red in Figure 2) was sufficient to improve and normalize the LA reservoir function (P < 0.05, Figure 2). On the other hand, moderate or milder weight loss (in orange and red) had no significant effect on LA reservoir function (both P > 0.05). Conclusion Successful weight loss can completely revert early LA myopathic phenotype in obese patients without known cardiovascular disease although this can be achieved only with larger weight loss targets.

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Effect of haemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diabetic hypertensive patients

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3553 ◽

1970 ◽

Vol 8 (2) ◽

pp. 173-178

Author(s):

N Gupta ◽

P Karki ◽

S Sharma ◽

N Shrestha ◽

P Acharya

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Stroke Volume ◽

Left Ventricular Mass ◽

Body Mass ◽

Left Ventricular ◽

Metabolic Factors ◽

Hypertensive Patients ◽

Ventricular Mass ◽

Lv Mass

Background: Left ventricular hypertrophy is a forerunner of coronary heart disease, congestive cardiac failure, stroke and may also lead to sudden death. Estimation of left ventricular mass by echocardiography offers prognostic information better than the evaluation of traditional cardiovascular risk factors. Objective: The aim of this study was to determine the relative contributions of haemodynamic and metabolic factors affecting left ventricular mass in non-diabetic patients with essential hypertension. Material and methods: 100 non-diabetic hypertensive patients were taken. The association between age, gender, smoking, alcohol, height, weight, heart rate, clinic blood pressure, fasting blood glucose, lipid profile, haemoglobin, body mass index and stroke volume with LV mass was studied. Left ventricular mass was measured by using standard M-mode echocardiography measurement obtained by way of standard recommended by the American Society of Echocardiography. Results: Left ventricular mass was analyzed as a continuous variable. In males body mass index (r=.35, p<.004) and stroke volume(r=-.26, p<.039) were significantly correlated with LV mass. In females body weight was significantly related to left ventricular mass(r=.36, p<.02). The independent association between significant factors and left ventricular mass was assessed by stepwise multivariate logistic regression. Body mass index and systolic blood pressure came as independent determinants of left ventricular mass in all patients. A maximum of 13% of left ventricular mass variability could be explained by these two factors. Conclusion: In untreated patients with hypertension patient's body mass index and systolic blood pressure are independent predictors of left ventricular mass after adjustment for other haemodynamic and metabolic factors. They explain a maximum of 13% of left ventricular mass variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients. Key words: Echocardiography; Haemodynamic; Metabolic Factors; Left Ventricular Mass; Non-diabetic; Hypertensive DOI: 10.3126/kumj.v8i2.3553 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 173-178

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Lower Zinc-α2-Glycoprotein Production by Adipose Tissue and Liver in Obese Patients Unrelated to Insulin Resistance

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-0758 ◽

2009 ◽

Vol 94 (11) ◽

pp. 4499-4507 ◽

Cited By ~ 67

Author(s):

David M. Selva ◽

Albert Lecube ◽

Cristina Hernández ◽

Juan A. Baena ◽

José M. Fort ◽

...

Keyword(s):

Insulin Resistance ◽

Body Mass Index ◽

Adipose Tissue ◽

Body Mass ◽

Control Group ◽

Mrna Levels ◽

Model Assessment ◽

Obese Patients ◽

Obese Subjects

Context: Zinc-α2 glycoprotein (ZAG) has been proposed as a new candidate in the pathogenesis of obesity, but most of the information stems from studies performed in rodents and in vitro assays. Objective: The main aim of the study was to compare serum levels of ZAG and its expression (mRNA levels and protein) in adipose tissue and the liver between obese and nonobese subjects. The relationship between ZAG and insulin resistance was also explored. Design: This was a case-control study. Setting: The study was conducted at a university referral center. Patients and Methods: Samples of serum, sc adipose tissue (SAT), visceral adipose tissue (VAT), and liver were obtained from 20 obese subjects during bariatric surgery. Samples from 10 nonobese patients matched by age and gender were used as a control group. Serum ZAG levels were determined by ELISA. ZAG mRNA levels were measured by real-time PCR and protein content by Western blot. The effect of insulin on liver production of ZAG was assessed using HepG2 cultures. Results: Serum concentration of ZAG (micrograms per milliliter) was significantly lower in obese subjects (40.87 ± 10.45 vs. 63.26 ± 16.40; P = 0.002). ZAG expression was significantly lower in the adipose tissue (SAT and VAT) and liver of obese patients than in control subjects. Significant negative correlations between body mass index and circulating ZAG (r = −0.65, P < 0.001) as well as between body mass index and mRNA ZAG levels in SAT (r = −0.68, P < 0.001) and VAT were detected (r = −0.64, P < 0.001). No relationship was found between ZAG and homeostasis model assessment for insulin resistance and insulin had no effect on ZAG production in vitro. Conclusion: A down-regulation of ZAG in SAT, VAT, and liver exists in obese patients but seems unrelated to insulin resistance. A downregulation of zinc-α2 glycoprotein in adipose tissue and liver exists in obese patients, and it is unrelated to insulin resistance.

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Modulation of Adiponectin and Leptin during Refeeding of Female Anorexia Nervosa Patients

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-1683 ◽

2007 ◽

Vol 92 (5) ◽

pp. 1843-1847 ◽

Cited By ~ 60

Author(s):

Dalit Modan-Moses ◽

Daniel Stein ◽

Clara Pariente ◽

Amit Yaroslavsky ◽

Anka Ram ◽

...

Keyword(s):

Insulin Resistance ◽

Body Mass Index ◽

Anorexia Nervosa ◽

Insulin Sensitivity ◽

Body Mass ◽

Female Adolescent ◽

Model Assessment ◽

Homeostasis Model Assessment ◽

Hmw Adiponectin ◽

Total Adiponectin

Abstract Context: Several studies assessed adiponectin levels in anorexia nervosa (AN) patients, however, data regarding the dynamics of changes in adiponectin levels during refeeding of these patients is limited and contradicting. Objective: Our objective was to assess adiponectin levels and the distribution of its different isoforms in AN patients before and after long-term refeeding, and to relate them to alterations in body mass index, leptin, insulin sensitivity, and additional endocrine parameters. Design, Setting, and Participants: We conducted a longitudinal controlled study of 38 female adolescent malnourished AN inpatients, with 13 young, lean, healthy women serving as controls. Blood samples were obtained upon admission and thereafter at 1, 3, and 5 months (at target weight). Main Outcome Measures: Changes in body mass index, leptin, adiponectin, insulin sensitivity, and adiponectin multimeric forms were measured. Results: At admission, leptin levels of AN patients were significantly lower, whereas insulin sensitivity (assessed by homeostasis model assessment-insulin resistance), adiponectin levels, and the ratio of high molecular weight (HMW) adiponectin to total adiponectin were significantly higher compared with controls. During weight recovery, leptin levels and homeostasis model assessment-insulin resistance increased significantly, whereas adiponectin and HMW adiponectin/total adiponectin ratio decreased significantly, to levels similar to controls. An initial increase in adiponectin levels was observed after 1 month of refeeding. There was no correlation between adiponectin and either T4 or cortisol levels. Conclusions: Our study demonstrates hyperadiponectinemia, increased adiponectin HMW isoform, and increased insulin sensitivity in adolescent AN female patients and reversal of these findings with weight rehabilitation. We hypothesize that increased adiponectin levels may have a protective role in maintaining energy homeostasis during extreme malnourishment.

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Relation among Left Ventricular Mass, Insulin Resistance, and Blood Pressure in Nonobese Subjects1

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.83.12.5331 ◽

1998 ◽

Vol 83 (12) ◽

pp. 4284-4288

Author(s):

Robert A. Phillips ◽

Lawrence R. Krakoff ◽

Andrea Dunaif ◽

Diane T. Finegood ◽

Richard Gorlin ◽

...

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Body Mass Index ◽

Insulin Sensitivity ◽

Body Mass ◽

Tolerance Test ◽

Left Ventricular ◽

Sensitivity Index ◽

Consecutive Series ◽

Arterial Blood

Because left ventricular (LV) mass (LVM) is a powerful predictor of future cardiovascular events, it is important to identify hemodynamic and nonhemodynamic factors that increase LVM. We studied the separate contribution to LVM of daily arterial blood pressure (BP) and insulin resistance in a consecutive series of 29 (mean ± sd age, 43 ± 13 yr) nonobese (body mass index, 24 ± 1.8 kg/m2), nondiabetic, glucose-tolerant subjects with untreated borderline or mild hypertension. The insulin sensitivity index (SI) was quantitatively determined from the frequently sampled iv glucose tolerance test. BP was characterized by ambulatory 24-h BP monitoring, and LVM index (LVMI) was determined by two-dimensional directed M-mode echocardiography. LVMI was directly related to 24-h mean BP (r = 0.47; P = 0.01). LMVI was also significantly related to SI (r = −0.43; P = 0.02). In this nonobese group, neither LVMI nor SI was related to body mass index or age. After adjustment for the influence of BP on LVMI, a significant relation remained between LVMI and SI (P < 0.05). We conclude that in nonobese subjects with high normal BP, insulin sensitivity is related to LVM independently of BP and may be an important modulator of LV growth. In addition to a reduction of arterial BP, optimal prevention of LV hypertrophy in hypertensives may require improved insulin sensitivity.

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