The effect of intraduodenal glucose on muscle sympathetic nerve activity in healthy young and older subjects

Orshoven, Narender P. van; Schelven, Leonard J. van; Akkermans, L.M.A.; Jansen, Paul A. F.; Horowitz, Michael; Feinle‐Bisset, Christine; Huffelen, Alexander C. van; Oey, P. L.

doi:10.1007/s10286-008-0452-5

Cited by 16 publications

(23 citation statements)

References 41 publications

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“…In our recent study of healthy older subjects (22), the fall in blood pressure was less when glucose drinks of the same concentration (12.5%) were ingested at a higher volume (600 ml vs. 200 ml), but from this study, we cannot predict whether blood pressure would have decreased to a greater extent with the 200-ml drinks, had there been no intragastric volume, while glucose was entering the small intestine. This is, however, supported by observations that 1) oral glucose (75 g in 350 ml water), which emptied from the stomach at 1.3-1.7 kcal/min decreases blood pressure significantly in healthy older, but not young subjects (23) and 2) intraduodenal glucose at 3 kcal/min decreases blood pressure in healthy young, as well as older subjects, albeit to a lesser extent (41). In the current study, gastric emptying of water was predictably much slower during intraduodenal glucose infusion, so that the intragastric volume remained at around 300 ml throughout the entire 60-min glucose perfusion, as a result of small intestinal feedback stimulated by the presence of glucose (2).…”

Section: Gastric Emptyingmentioning

confidence: 40%

“…For example, in healthy older subjects, when glucose is infused intraduodenally at a rate of 3 kcal/min, the magnitude of the maximum fall in systolic blood pressure (mean ϳ24 mmHg), is substantially greater compared with infusion at a rate of 1 kcal/min (mean ϳ9 mmHg) (31). Even healthy young subjects exhibit a fall in blood pressure in response to intraduodenal glucose at 3 kcal/min, although the magnitude of this decrease is less than in healthy elderly (41). Studies conducted by both ourselves (22) and others (4,24,25,35,38,40) indicate that gastric distension has the capacity to attenuate the postprandial fall in blood pressure.…”

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confidence: 94%

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Gastric distension attenuates the hypotensive effect of intraduodenal glucose in healthy older subjects

Gentilcore¹,

Meyer²,

Rayner³

et al. 2008

American Journal of Physiology-Regulatory, Integrative and Comp

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Postprandial hypotension occurs frequently, and current management is suboptimal. Recent studies suggest that the magnitude of the fall in postprandial blood pressure (BP) may be attenuated by gastric distension. The aim of this study was to determine the effect of gastric distension on the hypotensive response to intraduodenal (ID) glucose. Eight healthy subjects (5 males, 3 females, aged 65-76 years) received an ID infusion of either 1) 50 g glucose in 300 ml saline (ID glucose) over 60 min (t=0-60 min), 2) 50 g glucose in 300 ml saline over 60 min and intragastric (4) infusion of 500 ml water between t=7-10 min (IG water and ID glucose), or 3) ID saline (0.9%) infusion over 60 min and IG infusion of 500 ml water (IG water and ID saline) all followed by ID saline infusion for another 60 min (t=60-120 min) on three separate days. BP and heart rate (HR) were measured. Gastric emptying (GE) of the IG water was quantified by two-dimensional ultrasonography. Between t=0-60 min, systolic and diastolic BP was greater (P<0.05 for both) with IG water and ID saline compared with IG water and ID glucose, and less (P<0.05 for both) with ID glucose compared with IG water and ID glucose. These effects were evident at relatively low IG volumes (approximately 300 ml). GE was faster with IG water and ID saline when compared with IG water and ID glucose. We conclude that, in healthy older subjects, IG administration of water markedly attenuates the hypotensive response to ID glucose, presumably as a result of gastric distension.

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Section: Gastric Emptyingmentioning

confidence: 40%

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confidence: 94%

Gastric distension attenuates the hypotensive effect of intraduodenal glucose in healthy older subjects

Gentilcore¹,

Meyer²,

Rayner³

et al. 2008

American Journal of Physiology-Regulatory, Integrative and Comp

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“…This approach bypassed the potential effects of gastric distension. Preliminary studies suggest that patients with postprandial hypotension may be more sensitive to small intestinal nutrients i.e., the hypotensive response to a given intraduodenal glucose load is substantially greater (48), and it will be important to define thresholds and load responses in this group given the therapeutic implications. It would also be of interest to know whether intraduodenal water (in the absence of gastric distension) has a significant effect on blood pressure or SMA flow compared with intraduodenal saline.…”

Section: Discussionmentioning

confidence: 98%

Effects of small intestinal glucose load on blood pressure, splanchnic blood flow, glycemia, and GLP-1 release in healthy older subjects

Vanis

Gentilcore

Rayner

et al. 2011

American Journal of Physiology-Regulatory, Integrative and Comp

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Postprandial hypotension is an important problem, particularly in the elderly. The fall in blood pressure is dependent on small intestinal glucose delivery and, possibly, changes in splanchnic blood flow, the release of glucagon-like peptide-1 (GLP-1), and sympathetic nerve activity. We aimed to determine in healthy older subjects, the effects of variations in small intestinal glucose load on blood pressure, superior mesenteric artery flow, GLP-1, and noradrenaline. Twelve subjects (6 male, 6 female; ages 65-76 yr) were studied on four separate occasions, in double-blind, randomized order. On each day, subjects were intubated via an anesthetized nostril, with a nasoduodenal catheter, and received an intraduodenal infusion of either saline (0.9%) or glucose at a rate of 1, 2, or 3 kcal/min (G1, G2, G3, respectively), for 60 min (t = 0-60 min). Between t = 0 and 60 min, there were falls in systolic and diastolic blood pressure following G2 and G3 (P = 0.003 and P < 0.001, respectively), but no change during saline or G1. Superior mesenteric artery flow increased slightly during G1 (P = 0.01) and substantially during G2 (P < 0.001) and G3 (P < 0.001), but not during saline. The GLP-1 response to G3 was much greater (P < 0.001) than to G2 and G1. Noradrenaline increased (P < 0.05) only during G3. In conclusion, in healthy older subjects the duodenal glucose load needs to be > 1 kcal/min to elicit a significant fall in blood pressure, while the response may be maximal when the rate is 2 kcal/min. These observations have implications for the therapeutic strategies to manage postprandial hypotension by modulating gastric emptying.

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“…It should also be recognized that we studied healthy older subjects, not those with known postprandial hypotension, and studies in the latter group are indicated, given that they represent the target population for therapy. However, characterization of responses in healthy elderly subjects was a prerequisite to initiating comparable studies in elderly patients known to have postprandial hypotension, particularly as there is evidence that the hypotensive response to small intestinal nutrients is exaggerated in the latter group (45). The finding that a low-volume gastric distension was effective in abolishing the hypotensive response to small intestinal glucose in healthy older subjects suggests that gastric distension will also be effective in patients with postprandial hypotension, although the volume required may be larger.…”

Section: Discussionmentioning

confidence: 99%

Effects of variations in intragastric volume on blood pressure and splanchnic blood flow during intraduodenal glucose infusion in healthy older subjects

Vanis

Gentilcore

Lange

et al. 2012

American Journal of Physiology-Regulatory, Integrative and Comp

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(BP) is triggered by the interaction of nutrients with the small intestine and associated with an increase in splanchnic blood flow. Gastric distension may attenuate the postprandial fall in BP. The aim of this study was to determine the effects of differences in intragastric volume, including distension at a low (100 ml) volume, on BP and superior mesenteric artery (SMA) blood flow responses to intraduodenal glucose in healthy older subjects. BP and heart rate (HR; automated device), SMA blood flow (Doppler ultrasound), mesenteric vascular resistance (MVR), and plasma norepinephrine of nine male subjects (65-75 yr old) were measured after an overnight fast on 4 separate days in random order. On each day, subjects were intubated with a nasoduodenal catheter, incorporating a duodenal infusion port, and orally with a second catheter, incorporating a barostat bag, positioned in the fundus. Each subject received a 60-min (t ϭ 0 -60 min) intraduodenal glucose infusion (3 kcal/min) and gastric distension at a volume of 1) 0 ml (V0), 2) 100 ml (V100), 3) 300 ml (V300), or 4) 500 ml (V500). Systolic BP fell (P Ͻ 0.05) during V0, but not during V100, V300, or V500. In contrast, HR (P Ͻ 0.01) and SMA blood flow (P Ͻ 0.001) increased and MVR decreased (P Ͻ 0.05) comparably on all 4 days. Plasma norepinephrine rose (P Ͻ 0.01) in response to intraduodenal glucose, with no difference between the four treatments. There was a relationship between the areas under the curve for the change in systolic BP from baseline with intragastric volume (r ϭ 0.60, P Ͻ 0.001). In conclusion, low-volume (Յ100 ml) gastric distension has the capacity to abolish the fall in BP induced by intraduodenal glucose in healthy older subjects without affecting SMA blood flow or MVR. These observations support the concept that nonnutrient gastric distension prior to a meal has potential therapeutic applications in the management of postprandial hypotension.barostat; distension; postprandial hypotension POSTPRANDIAL HYPOTENSION is an important clinical problem, particularly in the elderly (17,27). It is distinct from, and may occur more frequently than, orthostatic hypotension and represents a substantial cause of morbidity and mortality (17). While the mechanisms underlying postprandial hypotension are poorly defined, several interrelated factors, including meal composition, gastric distension, the rate of small intestinal nutrient delivery, changes in splanchnic blood flow, and neural and hormonal mechanisms, have been identified (17, 39). In the elderly, it is likely that "normality" and postprandial hypotension represent a continuum, as is the case with many age-related phenomena. For example, after an oral glucose load, systolic blood pressure predictably falls in healthy older, but not young, subjects, and in the elderly the magnitude of this decrease is variable (18).Our previous studies established that, in healthy older subjects and patients with type 2 diabetes, the magnitude of the fall in blood pressure in response to enteral glucose is depend...

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The effect of intraduodenal glucose on muscle sympathetic nerve activity in healthy young and older subjects

Abstract: The fall in BP induced by IDGI was greater in healthy elderly compared to healthy young subjects. The reason for this is unclear, as they have similar increases in MSNA.

Cited by 16 publications

References 41 publications

Gastric distension attenuates the hypotensive effect of intraduodenal glucose in healthy older subjects

Gastric distension attenuates the hypotensive effect of intraduodenal glucose in healthy older subjects

Effects of small intestinal glucose load on blood pressure, splanchnic blood flow, glycemia, and GLP-1 release in healthy older subjects

Effects of variations in intragastric volume on blood pressure and splanchnic blood flow during intraduodenal glucose infusion in healthy older subjects

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