Neuroadrenergic dysfunction in obesity: an overview of the effects of weight loss
- 1 February 2010
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Lipidology
- Vol. 21 (1), 21-30
- https://doi.org/10.1097/mol.0b013e3283329c62
Abstract
The prevalence of obesity is rising to epidemic proportions worldwide, and in tandem so is that of type 2 diabetes. Neuroadrenergic abnormalities, comprising increased resting sympathetic nervous system activity and blunted sympathetic neural responsiveness are recognized features of metabolic syndrome obesity, which contribute importantly to both the pathophysiology and adverse clinical prognosis of this high-risk population. Weight loss is recommended as first-line treatment for obesity. This review examines the effects of nonpharmacological weight loss on sympathetic nervous system function under basal and stimulated conditions. Human weight loss trials show that even moderate weight reduction is accompanied by significant attenuation in resting whole-body norepinephrine spillover rate and muscle sympathetic nerve activity, an improvement in cardiac autonomic modulation, and a reversal of blunted sympathetic responsiveness at both peripheral and central nervous system levels. Recent findings underscore the relevance of insulin resistance in mediating blunted sympathetic responsiveness to endogenous hyperinsulinemia induced by glucose ingestion. Impaired insulin transport across the blood–brain barrier may be one mechanism mediating these effects. Weight loss reverses blunted sympathetic responsiveness to glucose, which has implications for postprandial energy expenditure and body weight homeostasis. The autonomic dysfunction of obesity is reversible with weight loss, highlighting the importance of lifestyle intervention as a key therapeutic modality.Keywords
This publication has 92 references indexed in Scilit:
- Association of Hypertension, Diabetes, Dyslipidemia, and Metabolic Syndrome with Obesity: Findings from the National Health and Nutrition Examination Survey, 1999 to 2004Journal of the American College of Surgeons, 2008
- Mediators of sympathetic activation in metabolic syndrome obesityCurrent Hypertension Reports, 2008
- The sympathetic nervous system and the metabolic syndromeJournal of Hypertension, 2007
- Age and Target Organ Damage in Essential Hypertension: Role of the Metabolic SyndromeAmerican Journal of Hypertension, 2007
- Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight LossCirculation, 2006
- Effects of Dietary Weight Loss on Sympathetic Activity and Cardiac Risk Factors Associated with the Metabolic SyndromeJournal of Clinical Endocrinology & Metabolism, 2005
- Risks for All-Cause Mortality, Cardiovascular Disease, and Diabetes Associated With the Metabolic SyndromeDiabetes Care, 2005
- The Effect of Metformin and Intensive Lifestyle Intervention on the Metabolic Syndrome: The Diabetes Prevention Program Randomized TrialAnnals of Internal Medicine, 2005
- Relation Between Cardiac Sympathetic Activity and Hypertensive Left Ventricular HypertrophyCirculation, 2003
- Prevalence and Trends in Obesity Among US Adults, 1999-2000Jama-Journal Of The American Medical Association, 2002