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Fat intake and cardiac autonomic dysfunction in obese children: What is the relationship?
Lípidos da dieta e disfunção autonómica cardíaca na obesidade em idade pediátrica: qual a associação?
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "509" "paginaFinal" => "511" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Helena Ferreira Mansilha" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Helena" "apellidos" => "Ferreira Mansilha" "email" => array:1 [ 0 => "helenamansilha@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidade de Nutrição, Serviço de Pediatria, Departamento da Infância e Adolescência, Centro Materno-Infantil do Norte, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Lípidos da dieta e disfunção autonómica cardíaca na obesidade em idade pediátrica: qual a associação?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease in children is becoming ever more common, in parallel with the increasing prevalence of childhood obesity. Tracking of childhood obesity to adulthood increases the risk of developing cardiovascular disease, and by 2035, the number of excess cardiovascular events attributable to adolescent overweight in the USA is expected to exceed 100<span class="elsevierStyleHsp" style=""></span>000 a year.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1,2</span></a> There is thus an urgent need to focus on this problem, in order to prevent cardiovascular disease from affecting children at ever younger ages.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The article by Gulgun et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> in this issue of the <span class="elsevierStyleItalic">Journal</span> on the relationship between the levels of different types of erythrocyte membrane fatty acids and cardiac autonomic dysfunction in pubertal children is thus of considerable interest, especially as it deals with the effects of obesity on the autonomic nervous system rather than with the more commonly discussed impact on premature development and accelerated cardiovascular atherosclerosis,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> including in childhood.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The authors of this case-control study, which included 48 obese and 32 healthy pubertal children aged 11.95±2.42 and 12.48±2.27 years, respectively, conclude that the differences they found between these groups in levels of omega-6 essential fatty acids may play a role in impairment of autonomic cardiac function in obese children.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It has been known for over twenty years that dietary fat intake can influence the fatty acid composition of cell membranes,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> changes in which can affect the membranes’ structural characteristics, particularly the function of membrane proteins, and this in turn can have important effects on cell metabolism and other physiological processes.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> Escriba et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a> showed that changes in the lipid composition of cell membranes in hypertensive patients affected signaling proteins involved in control of blood pressure. At the same time, obesity itself causes a highly pro-oxidant metabolic state that can also contribute to structural and functional alterations in the cell membrane through lipid peroxidation.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is generally accepted that measurement of plasma fatty acid levels merely reflects the quality of recent dietary fat intake and is also subject to various other influences from diet. Since the fatty acid composition of the erythrocyte membrane appears to remain constant throughout the life of the cell (around 120 days), measuring this will give a more consistent result, and thus a better indication of medium- to long-term intake. This was the approach adopted by Gulgun et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">As an illustration of the complexity of this subject, as well as being ingested in food, fatty acids can also be synthesized endogenously, through a process known as de novo lipogenesis. This is an adaptive mechanism in situations of excessive dietary intake of carbohydrate, which is converted into fatty acids and triglycerides, especially in obese individuals. In de novo lipogenesis, endogenous acetyl-CoA is used to produce saturated fatty acids, which are then elongated and/or desaturated to varying degrees.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The erythrocyte membrane lipid profile in obese adolescents is characterized by a high cholesterol/phospholipid ratio, increased saturated fatty acid levels and lower levels of mono- and polyunsaturated fatty acids, leading to a significantly reduced unsaturation index.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6,10</span></a> As pointed out above, it is thus logical that such alterations would directly affect flow properties and lipid peroxidation conditions in these membranes, and this has in fact been demonstrated experimentally. Several studies have also shown that low omega-3 fatty acid levels exacerbate the low-level inflammatory state found in adolescent obesity, and that erythrocyte membrane eicosapentaenoic acid levels are inversely correlated with insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> Various mechanisms have been put forward to explain this association, including competition between glucose and fatty acids as oxidation substrates, inhibition of glucose transport and/or phosphorylation, and release of fatty acids into the portal circulation as a result of lipolytic activity by visceral adipose tissue and release of hormones and cytokines,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> as also noted by Gulgun et al., although this was not reflected in their results because their study population did not include insulin-resistant obese subjects.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In recent years, several epidemiological studies have produced evidence of impaired cardiac autonomic modulation (CAM) in obese children. Autonomic activity in humans has a circadian rhythm, with predominantly parasympathetic activity at night and predominantly sympathetic activity during the day.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> CAM reflects the balance between the sympathetic and parasympathetic systems, but in obese children, reduced parasympathetic activity may be seen compared to normal weight children.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> However, other studies have shown impairment of CAM not only through reduced parasympathetic activity, but also through absolute or relative sympathetic hyperactivity or preponderance in obese children.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The cardiac autonomic nervous system can be assessed non-invasively, simply and reproducibly through analysis of heart rate variability (HRV), which measures the extent of variation between heartbeats. This reflects the balance between sympathetic and parasympathetic activity, which in turn modulates the way cardiac function responds to differing levels of metabolic activity in the body.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> CAM can thus be assessed by analyzing HRV, which appears to be reduced in obese children and adolescents.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There are associations between the sympathetic nervous system (SNS) and energy balance and metabolic syndrome, and between SNS activity and diet.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> Sympathetic activation reduces food intake regulated by the hypothalamus and inhibits leptin secretion. Leptin in turn inhibits ectopic lipid accumulation, prevents pancreatic beta cell dysfunction and protects beta cells from apoptosis induced by cytokines and fatty acids. Adiponectin, another adipokine, also promotes fatty acid oxidation and glucose uptake.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18,19</span></a> Together, these effects increase insulin sensitivity and reduce serum lipid levels. In obesity and type 2 diabetes, circulating adiponectin levels fall, and a state of peripheral resistance to hyperleptinemia develops; this appears to play an important role in SNS activation.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> A study of 32 obese children showed that HRV was reduced through decreased parasympathetic activity and predominance of sympathetic activity, but that these changes were much more marked in children with insulin resistance than in those without.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> The study by Gulgun et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> also shows parasympathetic impairment in obese pubertal children compared to controls, and aims to establish a relation between this impairment and omega-3 and -6 fatty acid levels in the two groups.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Low HRV is associated with cardiovascular morbidity and mortality, and is therefore a powerful parameter to be assessed and monitored for the early identification of cardiovascular risk in childhood obesity.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">13,14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">At the same time, the question remains whether the alterations in CAM associated with obesity precede and contribute to the etiopathogenesis of cardiac autonomic dysfunction, or are merely a consequence of obesity. Which is cause and which is effect?</p><p id="par0065" class="elsevierStylePara elsevierViewall">The article by Gulgun et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> is a contribution to the accumulating evidence on this subject, which points to disruptions in cell metabolism resulting from long-standing dietary imbalances that lead to organ dysfunction and the development of comorbidities, including impairment of cardiac autonomic control.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The article highlights how important it is for nutritional counseling to focus not only on calorie counts but also on quality and balance in dietary constituents, in view of their value in cardiovascular prevention. Clinical monitoring of obese individuals could include assessment of the erythrocyte membrane lipid profile as a dietary biomarker, as well as HRV analysis as a means for detecting cardiac autonomic dysfunction in obese children.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferreira Mansilha H. Lípidos da dieta e disfunção autonómica cardíaca na obesidade em idade pediátrica: qual a associação? Rev Port Cardiol. 2017;36:509–511.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "709–14 e1" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular impact of the pediatric obesity epidemic: higher left ventricular mass is related to higher body mass index" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.I. Crowley" 1 => "P.R. Khoury" 2 => "E.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 7 | 13 |
| 2024 October | 37 | 28 | 65 |
| 2024 September | 37 | 26 | 63 |
| 2024 August | 35 | 28 | 63 |
| 2024 July | 31 | 26 | 57 |
| 2024 June | 22 | 24 | 46 |
| 2024 May | 30 | 17 | 47 |
| 2024 April | 25 | 27 | 52 |
| 2024 March | 27 | 20 | 47 |
| 2024 February | 25 | 19 | 44 |
| 2024 January | 21 | 31 | 52 |
| 2023 December | 19 | 21 | 40 |
| 2023 November | 44 | 25 | 69 |
| 2023 October | 18 | 16 | 34 |
| 2023 September | 24 | 19 | 43 |
| 2023 August | 28 | 17 | 45 |
| 2023 July | 24 | 11 | 35 |
| 2023 June | 17 | 12 | 29 |
| 2023 May | 33 | 22 | 55 |
| 2023 April | 20 | 5 | 25 |
| 2023 March | 35 | 30 | 65 |
| 2023 February | 28 | 19 | 47 |
| 2023 January | 18 | 18 | 36 |
| 2022 December | 34 | 22 | 56 |
| 2022 November | 34 | 25 | 59 |
| 2022 October | 43 | 26 | 69 |
| 2022 September | 46 | 28 | 74 |
| 2022 August | 69 | 27 | 96 |
| 2022 July | 81 | 43 | 124 |
| 2022 June | 55 | 32 | 87 |
| 2022 May | 24 | 25 | 49 |
| 2022 April | 26 | 35 | 61 |
| 2022 March | 22 | 38 | 60 |
| 2022 February | 30 | 42 | 72 |
| 2022 January | 25 | 22 | 47 |
| 2021 December | 25 | 28 | 53 |
| 2021 November | 26 | 40 | 66 |
| 2021 October | 34 | 41 | 75 |
| 2021 September | 19 | 27 | 46 |
| 2021 August | 19 | 26 | 45 |
| 2021 July | 19 | 22 | 41 |
| 2021 June | 23 | 24 | 47 |
| 2021 May | 28 | 36 | 64 |
| 2021 April | 54 | 37 | 91 |
| 2021 March | 47 | 30 | 77 |
| 2021 February | 44 | 14 | 58 |
| 2021 January | 28 | 11 | 39 |
| 2020 December | 41 | 11 | 52 |
| 2020 November | 21 | 16 | 37 |
| 2020 October | 18 | 13 | 31 |
| 2020 September | 50 | 10 | 60 |
| 2020 August | 15 | 15 | 30 |
| 2020 July | 36 | 9 | 45 |
| 2020 June | 39 | 9 | 48 |
| 2020 May | 30 | 6 | 36 |
| 2020 April | 30 | 15 | 45 |
| 2020 March | 25 | 6 | 31 |
| 2020 February | 40 | 23 | 63 |
| 2020 January | 31 | 8 | 39 |
| 2019 December | 18 | 4 | 22 |
| 2019 November | 26 | 6 | 32 |
| 2019 October | 32 | 5 | 37 |
| 2019 September | 14 | 8 | 22 |
| 2019 August | 29 | 7 | 36 |
| 2019 July | 23 | 11 | 34 |
| 2019 June | 22 | 5 | 27 |
| 2019 May | 28 | 4 | 32 |
| 2019 April | 28 | 13 | 41 |
| 2019 March | 90 | 9 | 99 |
| 2019 February | 65 | 7 | 72 |
| 2019 January | 41 | 6 | 47 |
| 2018 December | 109 | 12 | 121 |
| 2018 November | 159 | 7 | 166 |
| 2018 October | 322 | 17 | 339 |
| 2018 September | 70 | 14 | 84 |
| 2018 August | 69 | 10 | 79 |
| 2018 July | 35 | 6 | 41 |
| 2018 June | 65 | 10 | 75 |
| 2018 May | 78 | 12 | 90 |
| 2018 April | 119 | 16 | 135 |
| 2018 March | 115 | 11 | 126 |
| 2018 February | 119 | 9 | 128 |
| 2018 January | 64 | 6 | 70 |
| 2017 December | 180 | 15 | 195 |
| 2017 November | 82 | 17 | 99 |
| 2017 October | 54 | 26 | 80 |
| 2017 September | 64 | 41 | 105 |
| 2017 August | 93 | 41 | 134 |
| 2017 July | 24 | 11 | 35 |
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