The Influence of Obesity in the Autonomic Nervous System Activity in School-Aged Children in Northern Portugal: A Cross-Sectional Study
Keywords:Autonomic Nervous System/physiopathology, Child, Obesity/physiopathology, Pediatric Obesity, Portugal
Introduction: Obesity is one of the most prevalent chronic diseases in childhood, being an important public health issue. Excessive weight has been associated with autonomic dysfunction but the evidence in children is scarce. Therefore, the aim of this study was to assess the effect of overweight and obesity on the autonomic nervous system activity, in children.
Material and Methods: Data from a cross-sectional study of 1602 children, aged 7 to 12 years, was used and 858 children were included in the analysis. Body mass index was calculated and classified according to criteria of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF). Body composition was characterized by bioelectrical impedance. Linear regression models were used to determine the association between body mass index, body composition and the autonomic nervous system activity, assessed by pupillometry.
Results: Average dilation velocity was higher among children with obesity, according to the CDC and percentage of body fat criteria (β = 0.053, 95% CI = 0.005 to 0.101 and β = 0.063, 95% CI = 0.016 to 0.109, respectively). The same trend was observed for WHO and IOTF criteria (β = 0.045, 95% CI = -0.001 to 0.091, and β = 0.055, 95% CI = -0.001 to 0.111, respectively). CDC and WHO body mass index z-scores were also positively associated with the values of average dilation velocity (rs = 0.030, p = 0.048; and rs = 0.027, p = 0.042, respectively).
Conclusion: Our findings suggest an association between body mass and changes in the autonomic activity, Moreover, this study provides proof of concept for interventions targeting the prevention/treatment of obesity in children that may offer some benefit in re-establishing the balance of the autonomic nervous system, and subsequently preventing the consequences associated with the autonomic nervous system dysfunction.
World Health Organization. Obesity and overweight 2018. [cited 2019 Apr 25]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight.
Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015;4:187-92.
Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci. 2018;1411:166-83.
Correia-Costa L, Azevedo A, Caldas Afonso A. Childhood obesity and impact on the kidney. Nephron. 2019;143:8-11.
Grewal S, Gupta V. Effect of obesity on autonomic nervous system. Int J Cur Bio Med Sci. 2011;1:15-8.
Costa J, Moreira A, Moreira P, Delgado L, Silva D. Effects of weight changes in the autonomic nervous system: a systematic review and meta-analysis. Clin Nutr. 2019;38:110-26.
LeBouef T, Whited L. Physiology, autonomic nervous system. Treasure Island: StatPearls Publishing LLC; 2019.
Wehrwein EA, Orer HS, Barman SM. Overview of the anatomy, physiology, and pharmacology of the autonomic nervous system. Compr Physiol. 2016;6:1239-78.
Guarino D, Nannipieri M, Iervasi G, Taddei S, Bruno RM. The role of the autonomic nervous system in the pathophysiology of obesity. Front Physiol. 2017;8:665.
Balasubramanian P, Hall D, Subramanian M. Sympathetic nervous system as a target for aging and obesity-related cardiovascular diseases. Geroscience. 2019;41:13-24.
Lambert GW, Schlaich MP, Eikelis N, Lambert EA. Sympathetic activity in obesity: a brief review of methods and supportive data. Ann N Y Acad Sci. 2019;1454:56-67.
Landsberg L. Diet, obesity and hypertension: an hypothesis involving insulin, the sympathetic nervous system, and adaptive thermogenesis. Q J Med. 1986;61:1081-90.
Smith MM, Minson CT. Obesity and adipokines: effects on sympathetic overactivity. J Physiol. 2012;590:1787-801.
Zangemeister WH, Gronow T, Grzyska U. Pupillary responses to single and sinusoidal light stimuli in diabetic patients. Neurol Int. 2009;1:e19.
Vanderlei LC, Pastre CM, Hoshi RA, Carvalho TD, Godoy MF. Basic notions of heart rate variability and its clinical applicability. Rev Bras Cir Cardiovasc. 2009;24:205-17.
Hall CA, Chilcott RP. Eyeing up the future of the pupillary light reflex in neurodiagnostics. Diagnostics. 2018;8(1):19.
Larson MD, Behrends M. Portable infrared pupillometry: a review. Anesth Analg. 2015;120:1242-53.
Paciência I, Cavaleiro Rufo J, Silva D, Martins C, Mendes F, Farraia M, et al. Exposure to indoor endocrine-disrupting chemicals and childhood asthma and obesity. Allergy. 2019;74:1277-91.
Gibney MJ, Lanham-New SA, Cassidy A, Vorster HH, editors. Introduction to human nutrition. 2nd ed. New Jersey:Wiley-Blackwell;2009.
Silva D, Severo M, Paciencia I. Setting definitions of childhood asthma in epidemiologic studies. Pediat Allergy Immunol. 2019;30:708-15.
World Health Organization. WHO child growth standards : length/heightfor-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: WHO; 2006.
Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120:S164-92.
Cole TJ, Lobstein T. Extended international (IOTF) body mass index cutoffs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284-94.
McCarthy HD, Cole TJ, Fry T, Jebb SA, Prentice AM. Body fat reference curves for children. Int J Obes . 2006;30:598-602.
Javed A, Jumean M, Murad MH, Okorodudu D, Kumar S, Somers VK, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis. Pediatr Obes. 2015;10:234-44.
Verrotti A, Penta L, Zenzeri L, Agostinelli S, De Feo P. Childhood obesity: prevention and strategies of intervention. A systematic review of school-based interventions in primary schools. J Endocrinol Invest. 2014;37:1155-64.
Must A, Anderson SE. Body mass index in children and adolescents: considerations for population-based applications. Int J Obes. 2006;30:590-4.
Ramírez-Vélez R, Correa-Bautista JE, Martínez-Torres J, González-Ruíz K, González-Jiménez E, Schmidt-RioValle J, et al. Performance of two bioelectrical impedance analyses in the diagnosis of overweight and obesity in children and adolescents: the FUPRECOL study. Nutrients. 2016;8:1-13.
Lyons-Reid J, Ward LC, Kenealy T, Cutfield W. Bioelectrical impedance analysis- an easy tool for quantifying body composition in Infancy? Nutrients. 2020;12:920.
Talma H, Chinapaw MJ, Bakker B, HiraSing RA, Terwee CB, Altenburg TM. Bioelectrical impedance analysis to estimate body composition in children and adolescents: a systematic review and evidence appraisal of validity, responsiveness, reliability and measurement error. Obes Rev. 2013;14:895-905.
Chula de Castro JA, Lima TR, Silva DA. Body composition estimation in children and adolescents by bioelectrical impedance analysis: a systematic review. J Bodyw Mov Ther. 2018;22:134-46.
Steinberg A, Manlhiot C, Li P, Metivier E, Pencharz PB, McCrindle BW, et al. Development and validation of bioelectrical impedance analysis equations in adolescents with severe obesity. J Nutr. 2019;149:1288-93.
Xu R, Zhou Y, Li Y, Zhang X, Chen Z, Wan Y, et al. Snack cost and percentage of body fat in Chinese children and adolescents: a longitudinal study. Eur J Nutr. 2019;58:2079-86.
Hebestreit A, Bornhorst C, Barba G, Siani A, Huybrechts I, Tognon G, et al. Associations between energy intake, daily food intake and energy density of foods and BMI z-score in 2-9-year-old European children. Eur J Nutr. 2014;53:673-81.
Montgomery C, Reilly JJ, Jackson DM, Kelly LA, Slater C, Paton JY, et al. Validation of energy intake by 24-hour multiple pass recall: comparison with total energy expenditure in children aged 5-7 years. Br J Nutr. 2005;93:671-6.
Adamo KB, Prince SA, Tricco AC, Connor-Gorber S, Tremblay M. A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. Int J Pediatr Obes. 2009;4:2-27.
van Deutekom AW, Chinapaw MJ, Gademan MG, Twisk JW, Gemke RJ, Vrijkotte TG. The association of birth weight and infant growth with childhood autonomic nervous system activity and its mediating effects on energy-balance-related behaviours-the ABCD study. Int J Epidemiol. 2016;45:1079-90.
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.
Couto M, Silva D, Santos P, Queiros S, Delgado L, Moreira A. Exploratory study comparing dysautonomia between asthmatic and non-asthmatic elite swimmers. Rev Port Pneumol. 2015;21:22-9.
Lundahl A, Kidwell KM, Nelson TD. Parental underestimates of child weight: a meta-analysis. Pediatrics. 2014;133:e689-703.
Taşçılar ME, Yokuşoğlu M, Boyraz M, Baysan O, Köz C, Dündaröz R. Cardiac autonomic functions in obese children. J Clin Res Pediatr Endocrinol. 2011;3:60-4.
Riva P, Martini G, Rabbia F, Milan A, Paglieri C, Chiandussi L, et al. Obesity and autonomic function in adolescence. Clin Exp Hypertens. 2001;23:57-67.
Baum P, Petroff D, Classen J, Kiess W, Bluher S. Dysfunction of autonomic nervous system in childhood obesity: a cross-sectional study. PLoS One. 2013;8:e54546.
Rabbia F, Silke B, Conterno A, Grosso T, De Vito B, Rabbone I, et al. Assessment of cardiac autonomic modulation during adolescent obesity. Obes Res. 2003;11:541-8.
O’Brien PD, Hinder LM, Callaghan BC, Feldman EL. Neurological consequences of obesity. Lancet Neurol. 2017;16:465-77.
Messina G, Valenzano A, Moscatelli F, Salerno M, Lonigro A, Esposito T, et al. Role of autonomic nervous system and orexinergic system on adipose tissue. Front Physiol. 2017;8:137.
Mazurak N, Sauer H, Weimer K, Dammann D, Zipfel S, Horing B, et al. Effect of a weight reduction program on baseline and stress-induced heart rate variability in children with obesity. Obesity. 2016;24:439-45.
de Jonge L, Moreira EA, Martin CK, Ravussin E. Impact of 6-month caloric restriction on autonomic nervous system activity in healthy, overweight, individuals. Obesity. 2010;18:414-6.
Silva D, Moreira R, Beltrao M, Sokhatska O, Montanha T, Pizarro A, et al. What is the effect of a Mediterranean compared with a fast food meal on the exercise induced adipokine changes? A randomized cross-over clinical trial. PLoS One. 2019;14:e0215475.
Browning KN, Verheijden S, Boeckxstaens GE. The vagus nerve in appetite regulation, mood, and intestinal inflammation. Gastroenterology. 2017;152:730-44.
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