Abstract
Changes in body composition, hormone secretions, and heart function with increased risk of sudden death occur in eating disorders. In this observational clinical study, we evaluated sympathovagal modulation of heart rate variability (HRV) and cardiovascular changes in response to lying-to-standing in patients with anorexia (AN) or bulimia nervosa (BN) to analyze: a) differences in autonomic activity between AN, BN, and healthy subjects; b) relationships between autonomic and cardiovascular parameters, clinical data and leptin levels in patients with eating disorders. HRV, assessed by power spectral analysis of R-R intervals, blood pressure (BP) and heart rate (HR) were studied by tilt-table test in 34 patients with AN, 16 with BN and 30 healthy controls. Autonomic and cardiovascular findings were correlated with clinical data, and serum leptin levels. Leptin levels were lowered in AN vs BN and healthy subjects (p<0.0001), but both AN and BN patients showed unbalanced sympathovagal control of HRV due to relative sympathetic failure, prevalent vagal activity, impaired sympathetic activation after tilting, independently from their actual body weight and leptin levels. No significant correlations were obtained between HRV data vs clinical data, BP and HR findings, and leptin levels in eating disorders. Body mass indices (BMI) (p<0.02), and leptin levels (p<0.04) correlated directly with BP values. Our data showed alterations of sympathovagal control of HRV in eating disorders. These changes were unrelated to body weight and BMI, diagnosis of AN or BN, and leptin levels despite the reported effects of leptin on the sympathetic activity.
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Muñoz MT, Argente J. New concepts in anorexia nervosa. J Pedriatic Endocrinol Metab 2004, 17: 473–80.
Chan JI, Mantzoros CS. Role of leptin in energy-deprivation states: normal human physiology and clinical implications for hypothalamic amenorrhoea and anorexia nervosa. Lancet 2005, 366: 74–85.
St. John-Sutton MG, Plappert T, Crosby L, Douglas P, Mullen J, Reichek N. Effects of reduced left ventricular mass on chambers architecture, load, and function: a study of anorexia nervosa. Circulation 1985, 72: 991–1000.
De Simone G, Scalfi L, Galderisi M, et al. Cardiac abnormalities in young women with anorexia nervosa. Br Heart J 1994, 71: 287–92.
Galetta F, Franzoni F, Prattichizzo F, Rolla M, Santoro G, Pentimone F. Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Health 2003, 32: 416–21.
Roche F, Estour B, Kadem M, et al. Alteration of the QT rate dependence in anorexia nervosa. Pacing Clin Electrophysiol 2004, 27: 1099–104.
Facchini M, Sala L, Malfatto G, Bragato R, Redaelli G, Invitti C. Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiology 2006, 106: 170–6.
McCallum K, Bermudez O, Ohlemeyer C, Tyson E, Portilla M, Ferdman B. How should the clinician evaluate and manage the cardiovascular complications of anorexia nervosa? Eat Disord 2006; 14: 73–80.
Petretta M, Bonaduce D, Scalfi L, et al. Heart rate variability as a measure of autonomic nervous system function in anorexia nervosa. Clin Cardiol 1997, 20: 219–24.
Rechlin T, Weis M, Ott C, Bleichner F, Joraschky P. Alterations of autonomic cardiac control in anorexia nervosa. Biol Psychiatry 1998, 43: 358–63.
Casu M, Patrone V, Gianelli MV, et al. Spectral analysis of R-R interval variability by short-term recording in anorexia nervosa. Eat Weight Disord 2002, 7: 239–43.
Melanson EL, Donahoo WT, Krantz MJ, Poirier P, Mehler PS. Resting and ambulatory heart rate variability in chronic anorexia nervosa. Am J Cardiol 2004, 94: 1217–20.
Cong ND, Saikawa R, Ogawa R, Hara M, Takahashi N, Sakata T. Reduced 24 hour ambulatory blood pressure and abnormal heart rate variability in patients with dysorexia nervosa. Heart 2004, 90: 563–4.
Platisa MM, Nestorovic Z, Damjanovic S, Gal V. Linear and non-linear heart rate variability measures in chronic and acute phase of anorexia nervosa. Clin Physiol Funct Imaging 2006, 26: 54–60.
Neumarker KJ. Mortality and sudden death in anorexia nervosa. Int J Eat Disord 1997, 21: 205–12.
Krantz MJ, Mehler PS. Heart rate variability in women. Arch Intern Med 2006, 166: 247.
Ahima RS, Fliers JS. Leptin. Ann Rev Physiol 2000, 62: 413–37.
Chan JL, Heist K, De Paoli AM, Veldhuis JD, Mantzoros CS. The role of falling leptin levels in the neuroendocrine and metabolic adaptation to short-term starvation in healthy men. J Clin Invest 2003, 111: 1409–21.
Haynes WG, Morgan DA, Walsh SA, Mark AL, Sivitz WI. Receptor-mediated regional sympathetic nerve activation by leptin. J Clin Invest 1997, 100: 270–8.
Paolisso G, Manzella D, Montano N, Gambardella A, Varricchio M. Plasma leptin concentrations and cardiac autonomic nervous system in healthy subjects with different body weights. J Clin Endocrinol Metab 2000, 85: 1810–4.
Tank J, Jordan J, Diedrich A, et al. Bound leptin and sympathetic outflow in nonobese men. J Clin Endocrinol Metab 2003, 88: 4955–9.
Eikelis N, Schlaich M, Aggarwal A, Kaye D, Esler M. Interactions between leptin and the human sympathetic nervous system. Hypertension 2003, 41: 1072–9.
Correia ML, Morgan DA, Sivitz WI, Mark AL, Haynes WG. Leptin acts in the central nervous system to produce dose-dependent changes in arterial pressure. Hypertension 2001, 37: 936–42.
Takabatake N, Nakamura H, Minamihaba O, et al. A novel pathophysiologic phenomenon in cachexic patients with obstructive pulmonary disease: relationship between the circadian rhythm of circulating leptin and the very low-frequency component of heart rate variability. Am J Respir Crit Care Med 2001, 63: 1314–9.
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Guidelines. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996, 17: 354–81.
Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation 1991, 84: 482–91.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, IV ed. Text Revision. Washington, DC: 2000.
Casu M, Cappi C, Patrone V, et al. Sympatho-vagal control of heart rate variability in patients treated with suppressive doses of L-thyroxine for thyroid cancer. Eur J Endocrinol 2005, 152: 819–24.
Pomeranz B, Macaulay RJ, Caudill MA, et al. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol 1985, 248: H151–3.
Lipsitz LA, Mietus J, Moody GB, Goldberger AL. Spectral characteristics of heart rate variability before and during postural tilt.Relations to aging and risk of syncope. Circulation 1990, 81: 1803–10.
Bernardi L, Leuzzi S, Radaelli A, Passino C, Johnston JA, Sleight P. Low-frequency spontaneous fluctuations of R-R interval and blood pressure in conscious humans: a baroreceptor or central phenomenon? Clin Sci (London)1994, 87: 649–54.
Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, Eckberg DL. Human responses to upright tilt: a window on central autonomic integration. J Physiol 1999, 517: 617–28.
Bonaduce D, Marciano F, Petretta M, et al. Effects of converting enzyme inhibition on heart period variability in patients with acute myocardial infarction. Circulation 1994, 90: 108–13.
Calandra C, Musso F, Musso R. The role of leptin in the etiopathogenesis of anorexia nervosa and bulimia. Eat Weight Disord 2003, 8: 130–7.
Monteleone P, Martiadis V, Colurcio B, Maj M. Leptin secretion is related to chronicity and severity of the illness in bulimia nervosa. Psychosom Med 2002, 64: 874–9.
Wu Y, Nozaki T, Inamitsu T, Kubo C. Physical and psychological factors influencing heart rate variability in anorexia nervosa. Eat Weight Disord 2004, 9: 296–9.
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Murialdo, G., Casu, M., Falchero, M. et al. Alterations in the autonomic control of heart rate variability in patients with anorexia or bulimia nervosa: Correlations between sympathovagal activity, clinical features, and leptin levels. J Endocrinol Invest 30, 356–362 (2007). https://doi.org/10.1007/BF03346310
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DOI: https://doi.org/10.1007/BF03346310