Effect of various weight loss interventions on serum NT-proBNP concentration in severe obese subjects without clinical manifest heart failure

Abstract

Obesity is associated with a “natriuretic handicap” indicated by reduced N-terminal fragment of proBNP (NT-proBNP) concentration. While gastric bypass surgery improves the natriuretic handicap, it is presently unclear if sleeve gastrectomy exhibits similar effects. We examined NT-proBNP serum concentration in n = 72 obese participants without heart failure before and 6 months after sleeve gastrectomy (n = 28), gastric bypass surgery (n = 19), and 3-month 800 kcal/day very-low calorie diet (n = 25). A significant weight loss was observed in all intervention groups. Within 6 months, NT-proBNP concentration tended to increase by a median of 44.3 pg/mL in the sleeve gastrectomy group (p = 0.07), while it remained unchanged in the other groups (all p ≥ 0.50). To gain insights into potential effectors, we additionally analyzed NT-proBNP serum concentration in n = 387 individuals with different metabolic phenotypes. Here, higher NT-proBNP levels were associated with lower nutritional fat and protein but not with carbohydrate intake. Of interest, NT-proBNP serum concentrations were inversely correlated with fasting glucose concentration in euglycemic individuals but not in individuals with prediabetes or type 2 diabetes. In conclusion, sleeve gastrectomy tended to increase NT-proBNP levels in obese individuals and might improve the obesity-associated “natriuretic handicap”. Thereby, nutritional fat and protein intake and the individual glucose homeostasis might be metabolic determinants of NT-proBNP serum concentration.

Natriuretic Peptide: Diagnostic, Prognostic, and Clinical Relevance in Patients With Type 2 Diabetes Mellitus, Arterial Hypertension and Obesity

“…Our results confirm the importance of determining NT-proBNP in patients with comorbid pathology, namely, AH in combination with Т2DM and obesity is a prognostically significant parameter of heart failure in this patient group. Our study is consistent with other authors who have studied the importance of NT-proBNP in the development of cardiovascular complications in patients with monopathology of AH, T2DM, and obesity [12][13][14][15][16][17][18].…”

Natriuretic peptides, body mass index and heart failure risk: Pooled analyses of SAVOR‐TIMI 53, DECLARE‐TIMI 58 and CAMELLIA‐TIMI 61

“…However, data regarding the effect of weight loss on natriuretic peptides are conflicting. While prior observational studies have demonstrated an increase in NP concentrations following weight loss, [26][27][28] with markedly improved NP response to saline loading, 26 the recent STEP-HFpEF trial demonstrated a reduction in both weight and NPs with use of the GLP1-RA semaglutide, with resultant improvement in HF-related symptoms, functional capacity and a reduction in HF events. 29 As such, the putative mechanisms underlying the relationship between the NP system and obesity warrant further investigation.…”

Prognostic value of the inferior vena cava diameter, lung ultrasound, and the NT-proBNP level in patients with acute decompensated heart failure and obesity

“…Results. Obese patients had a smaller sum of B-lines according to lung ultrasound than overweight patients and those with normal weight [33 (21-51); 38 (27-54), and 42 (30-58), respectively; p = 0.002] and a lower level of 404 (1,630;5,516); 4,458 (2,697; 5,969); 5,085 (2,871; 7,351) pg / ml, respectively, p = 0.013]. The IVC diameter did not differ significantly depending on body mass index (BMI): with obesity -2.3 (1.9-2.8) cm, with overweightness -2.3 (1.9-2.8) cm, and with normal weight -2.2 (1.8-2.4) mm, p = 0.324.…”

“…Upon admission, all patients underwent a standard clinical and laboratory examination, including lung ultrasound with the calculation of the sum of B-lines, IVC ultrasound, and determination of the NT-proBNP level.Results. Obese patients had a smaller sum of B-lines according to lung ultrasound than overweight patients and those with normal weight [33 (21-51); 38 (27-54), and 42 (30-58), respectively; p = 0.002] and a lower level of 404 (1,630;5,516); 4,458 (2,697; 5,969); 5,085 (2,871; 7,351) pg / ml, respectively, p = 0.013]. The IVC diameter did not differ significantly depending on body mass index (BMI): with obesity -2.3 (1.9-2.8) cm, with overweightness -2.3 (1.9-2.8) cm, and with normal weight -2.2 (1.8-2.4) mm, p = 0.324.According to the multivariate Cox regression analysis, the sum of B-lines > 7 at discharge (hazard ratio (HR) 8.90, 95% confidence interval (CI) 2.03-38.30, p = 0.003) and IVC > 2.4 cm at admission (HR 5.42, 95% CI 1.04-28.13, p = 0.045) were independently associated with a higher risk of 12-month mortality from cardiovascular disease.…”