Sympathetic support of energy expenditure and sympathetic nervous system activity after gastric bypass surgery

Curry, Timothy B.; Somaraju, Madhuri; Hines, Casey N.; Groenewald, Cornelius B.; Miles, John J.; Joyner, Michael J.; Charkoudian, Nisha

doi:10.1002/oby.20106

Cited by 30 publications

(29 citation statements)

References 32 publications

(39 reference statements)

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“…We also could not rule out the possibility of differential changes in neurohormonal mediators of metabolism between surgery types. In support of our supposition that LRYGB may protect against AT, others have demonstrated preserved sympathetic support of RMR following LRYGB (22). …”

Section: Discussionsupporting

confidence: 82%

Blunting of adaptive thermogenesis as a potential additional mechanism to promote weight loss after gastric bypass

Browning

Rabl

Campos

2017

Surgery for Obesity and Related Diseases

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BACKGROUND Adaptive thermogenesis (AT) is described as a change in resting metabolic rate (RMR) that is greater than would be predicted from changes in lean body mass (LBM) and fat mass (FM) alone during periods of energy imbalance. Whereas an AT-related downregulation of RMR has been implicated in suboptimal weight loss and weight regain following non-surgical weight loss, defense against AT may underpin the durable weight loss following laparoscopic Roux-en-Y gastric bypass (LRYGB) and other bariatric surgeries. However, methodological differences across the few studies that have evaluated post-operative AT limit interpretation as to the effects of these procedures on RMR. OBJECTIVE To quantify AT six months after LRYGB and laparoscopic adjustable gastric banding (LAGB). SETTING The study was conducted in a large university hospital in the United States. METHODS Changes in body composition and RMR were assessed in thirteen severely obese adults six months after LRYGB (n=8) and LAGB (n=5). AT was calculated as the difference between measured RMR and RMR predicted from LBM, FM, age, and sex before and after surgery. RESULTS RMR significantly decreased after LRYGB (−270±96 kcal/d, p<0.01) but not after LAGB. Despite significantly greater reductions in body weight, FM, and LBM with LRYGB than LAGB, AT responses after LRYGB (15±110 kcal/d, p=0.7) and LAGB (42±97 kcal/d, p=0.4) were similar (p=0.7). CONCLUSION Despite significant body weight and body composition changes, AT was minimal after LRYGB. A blunting of AT may be an additional mechanism that favors sustainable weight loss with LRYGB.

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Section: Discussionsupporting

confidence: 82%

Blunting of adaptive thermogenesis as a potential additional mechanism to promote weight loss after gastric bypass

Browning

Rabl

Campos

2017

Surgery for Obesity and Related Diseases

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“…The present study provides evidences for the beneficial effect of metabolic surgery on HTN and cardiac‐metabolic risks. Our studies confirmed that GI surgical intervention can significantly inhibit the overdrive of SNS in genetic hypertensive rats, which results in reducing BP and improvement of CV remodeling and dysfunction. In addition, metabolic surgery inhibited RSNA and the peripheral vascular nerve induced vasoconstriction as well as central baroreflex in these hypertensive rats.…”

Section: Discussionsupporting

confidence: 79%

“…It has recently been reported that metabolic surgery resulted in a significant reduction in heart rate (HR) and an enhancement in HR recovery . Subjects who had undergone gastric bypass had significantly lower muscle sympathetic nerve activity, compared to obese subjects . These studies suggest that metabolic surgery had an impact on visceral SNS.…”

Section: Introductionmentioning

confidence: 95%

Gastrointestinal Intervention Ameliorates High Blood Pressure Through Antagonizing Overdrive of the Sympathetic Nerve in Hypertensive Patients and Rats

Zhang

Chen

et al. 2014

JAHA

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BackgroundWe investigated the hypothesis that the favorable effects of gastrointestinal (GI) intervention on hypertension (HTN) and cardiovascular (CV) disturbances are mediated by antagonizing overdrive of the sympathetic nervous system (SNS).Methods and ResultsHypertensive patients with metabolic disturbances underwent laparoscopic Roux‐en‐Y gastric bypass surgery, and spontaneously hypertensive rats (SHRs) underwent RYGB or sham surgery. Blood pressure (BP), heart rate (HR), endothelium‐dependent flow‐mediated dilation, and anthropometric as well as laboratory parameters were measured at baseline and during follow‐up. Changes of BP and HR in response to cold stress, renal sympathetic nervous activity (RSNA), vasoconstriction induced by electrical field stimulation, microinjection of nucleus of the solitary tract (NTS), and CV function and structure were examined in SHRs with or without surgery. Compared with baseline, BP and HR were significantly reduced in both hypertensive patients with type 2 diabetes and rats. Impaired endothelial‐dependent vasodilatation and metabolic disturbances in hypertensive patients were also ameliorated after surgery. CV disturbances were reversed by surgery in SHRs. Under acute cold exposure, the variations in BP and HR were smaller in surgically treated SHRs, compared to sham SHRs. RSNA and vasoconstriction induced by perivascular nerve stimulation as well as NTS‐mediated changes of BP were decreased in surgically treated SHRs, compared to sham SHR. Weight loss did not affect BP and RSNA in sham SHRs.ConclusionsGI intervention ameliorates HTN in both hypertensive patients and rats by inhibiting overdrive of the SNS. Therefore, targeting gastrointestine could be a novel strategy to treat HTN with metabolic disturbances.

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“…This allows to more directly and unequivocally document the evidence recently provided by a study showing the lower levels of MSNA in obese subjects 3 years after bariatric surgery compared with a control group. 31 In our obese subjects, bariatric surgery was accompanied by a 6-and 12-month BP reduction (particularly of systolic BP), the size of which was related to the concomitant reduction in MSNA. The relationship, however, did not achieve the level of statistical significance (r= 0.43 and r=0.36; P=not significant) presumably because of the small sample size of the present study.…”

Section: Discussionmentioning

confidence: 68%

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Seravalle

Colombo

et al. 2014

Hypertension

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L ong-term prospective studies have recently shown that bariatric surgery significantly reduces the risk of death in severely obese patients.1 This has been confirmed by retrospective analyses of a large cohort of obese individuals in whom surgery-related reductions in body weight were associated with a significant reduction in death rate compared with obese individuals followed under dietary and medical treatment. [2][3][4] It is a widespread belief that the protective effect of bariatric surgery in obese patients may perhaps be related to a reduction of body weight per se but that the concomitant improvement of the array of risk factors commonly associated with obesity, for example, alterations in lipid and glucose metabolism, is likely to play a major role. [5][6][7] In this context, however, little attention has to date been given to whether bariatric surgery is also associated with the improvement of another adverse phenomenon of obesity (ie, sympathetic activation). 8,9 The only information available comes from 3 studies that assessed sympathetic tone by making use of spectral analysis of heart rate signal or 24-hour norepinephrine urinary excretion [10][11][12] (ie, approaches that display major intrinsic limitations not allowing to provide any direct insight on the effects of the intervention on central sympathetic outflow, as the microneurographic technique only allows to achieve 13 .) The issue has pathophysiological and clinical relevance because sympathetic activation has been shown to be an adverse prognostic factor in several clinical conditions.14-17 Furthermore, evidence has been obtained that sympathetic overdrive may cause or worsen insulin resistance, 18,19 thus contributing to a common metabolic alteration in obesity.Abstract-Weight loss improves insulin sensitivity and exerts sympathomodulatory effects. No data, however, are available on the effects of the weight loss induced by vertical sleeve gastrectomy on sympathetic neural drive, insulin sensitivity, and their reciprocal cross talks. In 10 severe obese hypertensives (age, 54.0±2.3 years [mean±SEM]), we measured sphygmomanometric blood pressure, heart rate, body mass index, homeostatic model assessment index, plasma leptin, muscle sympathetic nerve traffic (microneurography), and baroreflex sensitivity (vasoactive drug technique). Measurements were performed 2 to 3 days before surgery and repeated 6 and 12 months after the procedure. Ten matched hypertensive obeses not undergoing gastrectomy served as controls. Six months after bariatric surgery, a significant (P<0.05) reduction in body mass index (−9.1±1.4 kg/m 2 ), sphygmomanometric systolic blood pressure (−10.2±4.5 mm Hg), heart rate (−11.0±2.4 bpm), homeostatic model assessment index (−3-3±1.3 AU), plasma leptin (−53.6±8.8 μg/L), and muscle sympathetic nerve traffic (−15.0±3.4 bursts/100 heart beats) was observed. The weight loss, the plasma leptin reduction, and the sympathetic inhibition were maintained after 12 months, whereas homeostatic model assessment index showed a tendency ...

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Sympathetic support of energy expenditure and sympathetic nervous system activity after gastric bypass surgery

Cited by 30 publications

References 32 publications

Blunting of adaptive thermogenesis as a potential additional mechanism to promote weight loss after gastric bypass

Blunting of adaptive thermogenesis as a potential additional mechanism to promote weight loss after gastric bypass

Gastrointestinal Intervention Ameliorates High Blood Pressure Through Antagonizing Overdrive of the Sympathetic Nerve in Hypertensive Patients and Rats

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

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