Aim: To study autonomic dysfunction in Asian Indian T2DM patients by heart rate variability and it's relation with body fat content, distribution and insulin resistance.
Subjects and Methods: Subjects: 33 T2DM patients aged (46.96 ± 8.90 yrs), and 33 healthy controls aged (44.08 ± 9.15 yrs).
Methods: Short-term heart rate variability (HRV) was measured by impedance plethysmograph recording of pulse wave in distal superficial arteries. Time domain and Frequency domain analysis of HRV was carried out. Time domain parameters (SDNN, rMSSD, pNN50) and frequency domain parameters (Total Power, LF power, HF Power, LF (nu), HF (nu), LF/HF Ratio) were determined. Body fat content and distribution was estimated by (DEXA). Insulin Resistance was assessed by HOMA-R. Student t test was used for comparison of parameters in two groups. Multiple regression was used to find out relation between parameters of adiposity and HRV.
Results: Parameters rMSSD, pNN50, Total power, LF Power, HF Power were significantly lower in diabetics. Total power showed negative correlation with BMI and truncal fat (r=-.43; p<. 05) and (r=-.41; p<. 05) respectively. Frequency domain parameter HF (ms2) showed negative correlation with BMI and trunk fat (gm %) (r= -.47; p<. 05) and (r=-.40; p<. 05) respectively. HF (nu) was negatively correlated with BMI (r=-.43; p<. 05) whereas positive correlation was observed between LF (nu) and BMI (r=. 40; p<. 05).
Conclusion: T2DM is associated with overall reduction in autonomic activity however, body fat content influences relative modulation of sympathetic and parasympathetic activity among diabetics but not among controls. Contrary to most previous reports, insulin resistance as well as W: H ratio had no influences on autonomic activity.
Nagai N, Matsumoto T, Kita H, Moritani T. Autonomic nervous system activity and the state and development of obesity in Japanese school children. Obes Res 2003; 11: 25-32. http://dx.doi.org/10.1038/oby.2003.6
Schwartz MW, Baskin DG, Kaiyala KJ, Woods SC. Model for the regulation of energy balance and adiposity by the central nervous system. Am J Clin Nutr 1999; 69: 58.
Tentoloris N, Argyrakopoulou G, Katsilambros N. Perturbed Autonomic nervous system function in metabolic syndrome. Neuromol Med 2008; 10:169-178. http://dx.doi.org/10.1007/s12017-008-8022-5
Chethan HA, Murthy N, Basavaraju K. Comparative study of heart rate variability in normal and obese young adult males. Int J Biol Med Res. 2012; 3(2): 1621-1623.
Windham BG, Fumagalli S, Ble A, Sollers JJ, Thayer JF,Najjar SS et al. The Relationship between Heart Rate Variability and Adiposity Differs for Central and Overall Adiposity. Journal of Obesity 2012; 2012.
Kim JA, Park YG, Cho KH, Hong MH, Han HC, Choi YS, et al. Heart Rate Variability and Obesity Indices: Emphasis on the Response to Noise and Standing. J Am Board Fam Pract 2005; 18: 97-103. http://dx.doi.org/10.3122/jabfm.18.2.97
Rjalakshmi R, VijayaVageesh Y, Nataraj SM, MuraliDhar, Srinath CG Heart Rate Variability in Indian Obese Young Adults. Pak J Physiol 2012; 8(1); 39-44.
Karason K, Mølgaard H, Wikstrand J, Sjöström L. Heart rate variability in obesity and the effect of weight loss. Am J Cardiol 1999; 83(8): 1242-47. http://dx.doi.org/10.1016/S0002-9149(99)00066-1
Gadegbeku CA, Dhandayuthapani A, Sadler ZE, Egan BM. Raising lipids acutely reduces barore?ex sensitivity. Am J Hypertens 2002; 15: 479-85. http://dx.doi.org/10.1016/S0895-7061(02)02275-6
Beske SD, Alvarez GE, Ballard TP, Davy KP. Reduced cardiovagal barore?ex gain in visceral obesity: implications for the metabolic syndrome. Am J Physiol 2002; 282: 630-5.
Pikkujamsa SM, Huikuri HV, Airaksinen KE, Ran-tala AO, Kauma H, Lilja M, et al. Heart rate variability and barore?ex sensitivity in hypertensive subjects with and without metabolic features of insulin resistance syndrome. Am J Hypertens 1998; 11: 523-31. http://dx.doi.org/10.1016/S0895-7061(98)00035-1
Bjorntorp P, Holm G, Rosmond R. Hypothalamic arousal, insulin resistance and type 2 diabetes mellitus. Diabetic Med 1999; 16: 373-83. 25.
Egan BM. Insulin resistance and the sympathetic nervous system. Curr Hypertens Rep 2003; 5: 247-54. http://dx.doi.org/10.1007/s11906-003-0028-7
Perciaccante A, Fiorentini A, Paris A, Serra P, Tubani L. Circadian rhythm of the autonomic nervous system in insulin resistant subjects with normoglycemia, impaired fasting glycemia, impaired glucose tolerance, type 2 diabetes mellitus. BMC Cardiovascular Disorders 2006; 6: 19. http://dx.doi.org/10.1186/1471-2261-6-19
Lindmark S, Loan L, Wicklund U, Tufvesson M, Olsson T, Eriksson JW. Dysregulation of the Autonomic Nervous System Can Be a Link between Visceral Adiposity and Insulin Resistance. Obes Res 2005; 13: 717-28. http://dx.doi.org/10.1038/oby.2005.81
Bjorntorp P. Do stress reactions cause abdominal obesity and comorbidites? Obesity Rev 2001; 2: 73-86. http://dx.doi.org/10.1046/j.1467-789x.2001.00027.x
McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991; 337: 382-86. http://dx.doi.org/10.1016/0140-6736(91)91164-P
Mohan V, Sharp PS, Cloke HR, Burrin JM, Schumer B, Kohner EM. Serum immunoreactive insulin responses to a glucose load in Asian Indian and European type-2 (non-insulin dependent) diabetic patients and control subjects. Diabetologia 1986; 29: 235-37. http://dx.doi.org/10.1007/BF00454882
Sharp PS, Mohan V, Levy JC, Mather HM, Kohner EM. Insulin resistance in patient's of Asian Indian and European origin with noninsulin dependent diabetes. Horm Metab Res 1987; 19: 84-85. http://dx.doi.org/10.1055/s-2007-1011745
Mathur SK, Chandra P, Mishra S, Ajmera P, Sharma P. Type-2 Diabetes related Intermediate Phenotypic Traits in North Indian Diabetics. Ind J Clin Biochem 2007; 22: 70-73. http://dx.doi.org/10.1007/BF02913317
Barma PD, Ranabir S, Prasad L, Singh TP. Clinical and biochemical profile of lean type 2 diabetes mellitus. Indian J Endocrinol Metab 2011; 15: 40-43. http://dx.doi.org/10.4103/2230-8210.83061
Gerritsen J, Dekker JM, TenVoorde BJ, Kostense PJ, Heine RJ, Bouter LM, et al. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension or a history of cardiovascular disease. Diabetes Care 2001; 24: 1794-98. http://dx.doi.org/10.2337/diacare.24.10.1793
Javorka M, Javorkova J, Tonhajzerova I, Calkovska A, Javorka K. Heart rate variability in young patients with diabetes mellitus and healthy subjects explored by Poincare and sequence plots. Clin Physiol Funct Imaging 2005; 25: 119-27. http://dx.doi.org/10.1111/j.1475-097X.2004.00601.x
Schroeder EB, Chambless LE, Liao D, Prineas RJ, Evans GW, Rosamond WD, et al. Diabetes, glucose, insulin, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes Care 2005; 28(3): 668-74. http://dx.doi.org/10.2337/diacare.28.3.668
Singh JP, Larson MG, O'Donnell CJ, Wilson PF, Tsuji H, Lloyd-Jones DM, et al. Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study). Am J Cardiol 2000; 86(3): 309-12. http://dx.doi.org/10.1016/S0002-9149(00)00920-6
Banks WA, Thomas DR, Willoughby LM, Morley JE. Insulin resistance syndrome in elderly. Diabetes Care 2007; 30: 2369-73. http://dx.doi.org/10.2337/dc07-0649
Mathews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RL. Homeostasis model assessment: insulin resistance and b cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-19. http://dx.doi.org/10.1007/BF00280883
Meigs JB, Rutter MK, Sullivan LM, Fox CS, D'Agostino Sr RB, Wilson PW. Impact of insulin resistance on risk of type 2 diabetes and cardiovascular disease in people with metabolic syndrome. Diabetes Care 2007; 30: 1219-25. http://dx.doi.org/10.2337/dc06-2484
Task Force of European society of cardiovascular and North American society of pacing and Electrophysiology. Heart rate variability; Standard of measurement, physiological interpretation and clinical use. Circulation 1996; 93: 1043-65. http://dx.doi.org/10.1161/01.CIR.93.5.1043
Syed Ahamed PT, Ahamed VIT, Jacob J, Joseph KP. Time and Frequency Domain Analysis of Heart Rate Variability and their Correlations in Diabetes Mellitus. Int J Biol Life Scis 2008; 4(1): 24-27.
Arumugam JMR, Mary A. Heart Rate Variability a Cardiac Indicator in Diabetic Autonomic Neuropathy: A Systematic Review Int J Med Res 2013; 1(2): 13-16.
Arati R, Prashanthmohan BH, Ganaraja B, Bhat MR. Cardiac autonomic functions are compromised in diabetes mellitus- A study of south Indian elderly patients. Int J Appl Biol Pharmaceut Technol 2011; 2(3): 502-11.
Boer-Martins L, Figueiredo NV, Demacq C, Martins LC, Consolin-Colombo F, Figueiredo MJ, Cannavan FPS, Moreno H. Relationship of autonomic imbalance and circadian disruption with obesity and type 2 diabetes in resistant hypertensive patients. Cardiovasc Diabetol 2011; 10: 24. http://dx.doi.org/10.1186/1475-2840-10-24
Mathur SK, Jain P, Mathur P, Punjabi P, Agarwal A, Sharma A. Transcriptomic Analysis Of visceral Adipose Tissue From healthy and Diabetic Obese Subjects. Ind J Endocrinol Metab 2013; 17: 447-50. http://dx.doi.org/10.4103/2230-8210.111639
Tai C, Ding ST. Polyunsaturated fatty acids regulate lipid metabolism through several inflammation mediators: mechanisms and implications for obesity prevention. J Nutr Biochem 2010; 21: 357-63. http://dx.doi.org/10.1016/j.jnutbio.2009.09.010
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