Perioperative Heart-Brain Axis Protection in Obese Surgical Patients: The Nutrigenomic Approach

Abstract

The number of obese patients undergoing cardiac and noncardiac surgery is rapidly increasing because they are more prone to concomitant diseases, such as diabetes, thrombosis, sleep-disordered breathing, cardiovascular and cerebrovascular disorders. Even if guidelines are already available to manage anesthesia and surgery of obese patients, the assessment of the perioperative morbidity and mortality from heart and brain disorders in morbidly obese surgical patients will be challenging in the next years. The present review will recapitulate the new mechanisms underlying the Heart-brain Axis (HBA) vulnerability during the perioperative period in healthy and morbidly obese patients. Finally, we will describe the nutrigenomics approach, an emerging noninvasive dietary tool, to maintain a healthy body weight and to minimize the HBA propensity to injury in obese individuals undergoing all types of surgery by personalized intake of plant compounds that may regulate the switch from health to disease in an epigenetic manner. Our review provides current insights into the mechanisms underlying HBA response in obese surgical patients and how they are modulated by epigenetically active food constituents.

Echinacoside reverses myocardial remodeling and improves heart function via regulating SIRT1/FOXO3a/MnSOD axis in HF rats induced by isoproterenol

“…Long‐term chronic ischaemia can cause myocardial hibernation, these hibernating myocardial cells typically show a loss of contractile filaments, there are excess glycogen granules in the cytosol, sarcoplasmic reticulum and transverse tubules are lost, 43 also, there are abnormalities in mitochondrial size and shape, reactive myocardial hypertrophy and interstitial fibrosis, which secondary to myocyte loss 44 . We also observed the above changes in HF rats in our study, whereas ECH significantly relieves these changes, as the latest study reported recovery of cardiac function after ischaemic stress may be a feature of myocardial hibernation, 45 the myocardial glycogen level is also measured, the results indicates that there is no significant difference among the three groups, as shown in Figure 7J.…”

“…All *P < .05 versus Ctrl,**P < .01 versus Ctrl; # P < .05 versus ISO, ## P < .01 versus ISO. Error bars represent SD in HF rats in our study, whereas ECH significantly relieves these changes, as the latest study reported recovery of cardiac function after ischaemic stress may be a feature of myocardial hibernation, 45 the myocardial glycogen level is also measured, the results indicates that there is no significant difference among the three groups, as shown in Figure 7J.…”

Obese mice exposed to psychosocial stress display cardiac and hippocampal dysfunction associated with local brain-derived neurotrophic factor depletion

“…Obesity and PS have widespread targets in the body. However, the cardio- and neural systems are especially vulnerable to their acute or chronic adverse effects [[7], [8], [9], [10], [11]]. What is more, affecting one compartment may have negative reverberation on the other, resulting in an altered brain-heart communication.…”

Contextualising evidence based medicine in determining the key root for translational effectiveness for chronic disease self-management and heart failure

“…The association between agent toxicity versus cardioprotection could not be corroborated [37]. Publications a decade later support the notion that surgery is safer in the current era however rates of perioperative major adverse cardiovascular events, are still a significant clinical problem [38,39]. While we have raised the argument for mixed method research guidelines for translational research on health services needs within health clusters, we certainly support others exploring the bedside to bench translational guidelines for efficacious phase-IV research for these issues.…”