Effect of weight loss on sympatho-vagal balance in subjects with grade-3 obesity: Restrictive surgery versus hypocaloric diet

Antonio E. Pontiroli, Claudia Merlotti, Annamaria Veronelli, Federico Lombardi

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Few and mostly uncontrolled studies indicate that weight loss improves heart rate variability (HRV) in grade-3 obesity. The aim of this study was to compare in grade-3 obesity surgery and hypocaloric diet on clinical and metabolic variables and on autonomic indices of HRV. Twenty-four subjects (body mass index, BMI 45.5 ± 9.13 kg/m2) underwent surgery (n = 12, gastric banding, LAGB) or received hypocaloric diet (n = 12, 1,000-1,200 kg/day). Clinical [BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate] and metabolic variables [glucose, cholesterol, HDL- and LDL-cholesterol, triglycerides, AST and ALT transaminases] and 24-h Holter electrocardiographic-derived HRV parameters [R-R interval, standard deviation of R-R intervals (SDNN); low/high-frequency (LF/HF) ratio, and QT interval] were measured at baseline and after 6 months. The two groups were identical at baseline. BMI (-7.5 ± 3.57 kg/m2, mean ± SD), glucose (-24.1 ± 26.77 mg/dL), SBP (-16.7 ± 22.19 mmHg) and DBP (-6.2 ± 8.56 mmHg) decreased in LAGB subjects (p <0.05) and remained unchanged in controls. At 6 months, SDNN increased in LAGB subjects (+25.0 ± 37.19 ms, p <0.05) and LF/HF ratio diminished (2.9 ± 1.84 vs. 4.9 ± 2.78; p = 0.01), with no change in controls; LF (daytime) and HF (24 h and daytime) increased in LAGB subjects, with no change in controls. Decrease in BMI correlated with SBP and DBP decrease (p <0.05), and DBP decrease correlated with HR decrease (p <0.05) and QT shortening (p <0.05). Weight loss is associated with improvement of glucose metabolism, of blood pressure, and with changes in time and frequency domain parameters of HRV; all these changes indicate recovery of a more physiological autonomic control, with increase in parasympathetic and reduction in sympathetic indices of HRV.

Original languageEnglish
Pages (from-to)843-850
Number of pages8
JournalActa Diabetologica
Issue number6
Publication statusPublished - Dec 2013


  • Bariatric surgery
  • Cardiology
  • Heart rate variability
  • Metabolism
  • Obesity
  • Weight loss

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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