From Cattedra di Medicina Interna I, Università di Milano,
Ospedale S Gerardo dei Tintori, Monza (G.G., M.C., B.M.C., G.M.); Centro
Auxologico Italiano, IRCCS, Milano (G.S., B.M.C., F.C., G.M.); and Centro di
Fisiologia Clinica e Ipertensione, IRCCS, Ospedale Maggiore, Milano (G.G.,
G.B., G.M.), Italy.
Correspondence to Professor Giuseppe Mancia, Cattedra di Medicina Interna I, Ospedale S Gerardo dei Tintori, Via Donizetti 103—Monza, Milano, Italy.
Background—Previous studies have
shown that sympathetic cardiovascular outflow is
increased in obese normotensive subjects and that this increase is
associated with a baroreflex impairment. The purpose of this study was
to determine whether these abnormalities are irreversible or can be
favorably affected by body weight reduction.
Methods and Results—In 20 obese normotensive subjects (age,
31.3±1.7 years; body mass index, 37.6±0.9 kg/m2,
mean±SEM), we measured beat-to-beat arterial blood
pressure (Finapres technique), heart rate (ECG), postganglionic muscle
sympathetic nerve activity (microneurography at a peroneal nerve), and
venous plasma norepinephrine (high-performance
liquid chromatography) at rest and during baroreceptor
stimulation and deactivation induced by increases and reductions of
blood pressure via stepwise intravenous infusions of
phenylephrine and nitroprusside. Measurements were repeated
in 10 subjects after a 16-week hypocaloric diet with normal sodium
content (4600 to 5000 J and 210 mmol NaCl/d) and in the remaining
10 subjects after a 16-week observation period without any reduction in
the caloric intake. The hypocaloric diet significantly reduced body
mass index, slightly reduced blood pressure, and caused a significant
and marked decrease in both muscle sympathetic nerve activity (from
50.0±5.1 to 32.9±4.6 bursts per 100 heart beats,
P<.01) and plasma norepinephrine (from
356.2±43 to 258.4±29 pg/mL, P<.05). This was
associated with a significant improvement in the sensitivity of the
baroreceptor heart rate (+71.5±11%, P<.01) and muscle
sympathetic nerve activity (+124.5±22%, P<.001)
reflex. Total body glucose uptake also increased significantly
(+60.8±12.0%, P<.05), indicating an increase in
insulin sensitivity. All variables remained unchanged in subjects
not undergoing caloric restriction.
Conclusions—In obese normotensive subjects, a reduction in body
weight induced by a hypocaloric diet with normal sodium content exerts
a marked reduction in sympathetic activity owing to central
sympathoinhibition. This can be due to the consequences of an increased
insulin sensitivity but also to a restoration of the baroreflex control
of the cardiovascular system with weight loss.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Body Weight Reduction, Sympathetic Nerve Traffic, and Arterial Baroreflex in Obese Normotensive Humans
Key Words: obesity • nervous system, autonomic • reflex • diet
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