Influence of Visceral Adiposity on Cardiovascular Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus

Abstract

BackgroundThe aim of this study was to investigate the influences of visceral adiposity on cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus.MethodsTwo hundred eleven patients with type 2 diabetes participated in this study. Anthropometric and metabolic parameters were measured, and the visceral fat area was assessed using computed tomography. CAN was diagnosed using a cardiovascular reflex test. We analyzed the correlation between the visceral fat area and each parameter in this test.ResultsThe mean age, body mass index (BMI), and duration of diabetes of the study population were 60±14 years (mean±standard deviation), 25.1±4.2 kg/m2, and 12.3±8.9 years, respectively. The visceral fat area showed positive correlations with age, BMI, waist circumference, and subcutaneous fat area. There was no statistically significant difference in the cardiovascular reflex test outcome between genders. Univariate linear regression analysis showed that an increased visceral fat area diminished good heart rate response to a Valsalva maneuver (R2=4.9%, P=0.013 in an unadjusted model), but only in women. This statistical association was preserved after adjusting for age and BMI (R2=9.8%, P=0.0072).ConclusionThe results of this study suggest that visceral adiposity contributes to an autonomic imbalance to some degree, as demonstrated by the impaired cardiovascular reflex test among women with type 2 diabetes.

Contribution of subcutaneous abdominal fat on ultrasonography to carotid atherosclerosis in patients with type 2 diabetes mellitus

“…In particular, VAT confers risks of metabolic and CV complications [4,24,25]. The possibility of an active metabolic role for VAT in the etiology of MS and CVD may be explained by the fact that the VAT has higher lipolytic activity and directly releases free fatty acids into the portal circulation, and this considerably contributes to insulin resistance [26].…”

“…Recent studies have shown that regional adiposity of the body is more closely associated with atherosclerosis than the magnitude of generalized obesity [ 1 , 3 , 23 ]. In particular, VAT confers risks of metabolic and CV complications [ 4 , 24 , 25 ]. The possibility of an active metabolic role for VAT in the etiology of MS and CVD may be explained by the fact that the VAT has higher lipolytic activity and directly releases free fatty acids into the portal circulation, and this considerably contributes to insulin resistance [ 26 ].…”

Síndrome Metabólico: Intervenciones en El Estilo De Vida

“…La neuropatía autonómica cardiovascular (NAC) es la forma clínica más estudiada de las neuropatías autonómicas y diversos trabajos han demostrado su relación con la isquemia miocárdica silente e incluso un aumento de cuatro veces en el riesgo de mortalidad cardiovascular. A su vez la obesidad visceral ha sido mencionada en distintos trabajos con una marcada correlación con alteraciones propias de la disautonomía cardiovascular 3 .…”

“…La obesidad se ha asociado en modelos animales a NAC y en humanos con aumento de la actividad simpática y con efecto inverso sobre la actividad parasimpática 3 .…”

Morphologic Comparison of Peripheral Nerves in Adipocyte Tissue from db/db Diabetic versus Normal Mice

“…Autonomic nerve fibers are prone to damage depending on their location and length. This damage is a subtype of diabetic neuropathy, which can also occur in adipose tissue in relation with autonomic neuropathy or peripheral neuropathy [ 2 3 ], similar to enteric organs in the human body. In obese patients, visceral WAT is associated with increased risk of type 2 diabetes mellitus; however, some patients exhibit decreased fat mass as diabetes progresses although cardiac autonomic neuropathy can be associated with higher waist circumference [ 4 ].…”