Sympathetic Neural Overdrive in the Obese and Overweight State

Guido Grassi, Annalisa Biffi, Gino Seravalle, Fosca Quarti Trevano, Raffaella Dell'Oro, Giovanni Corrao, Giuseppe Mancia

Research output: Contribution to journalReview articlepeer-review


Nerve traffic recordings (muscle sympathetic nerve traffic [MSNA]) have shown that sympathetic activation may occur in obesity. However, the small sample size of the available studies, presence of comorbidities, heterogeneity of the subjects examined represented major weaknesses not allowing to draw definite conclusions. This is the case for the overweight state. The present meta-analysis evaluated 1438 obese or overweight subjects recruited in 45 microneurographic studies. The analysis was primarily based on MSNA quantification in obesity and overweight, excluding as concomitant conditions hypertension, metabolic syndrome, and other comorbidities. Assessment was extended to the relationships of MSNA with other neuroadrenergic markers, such as plasma norepinephrine and heart rate, anthropometric variables, as body mass index, waist-to-hip ratio, presence/absence of obstructive sleep apnea, and metabolic profile. Compared with normoweights MSNA was significantly greater in overweight and more in obese individuals (37.0±4.1 versus 43.2±3.5 and 50.4±5.0 burts/100 heartbeats, P<0.01). This was the case even in the absence of obstructive sleep apnea. MSNA was significantly directly related to body mass index and waist-to-hip ratio ( r=0.41 and r=0.64, P<0.04 and <0.01, respectively), clinic blood pressure ( r=0.68, P<0.01), total cholesterol, LDL (low-density lipoprotein) cholesterol, and triglycerides ( r=0.91, r=0.94, and r=0.80, respectively, P<0.01) but unrelated to plasma insulin, glucose, and homeostatic model assessment for insulin resistance. No significant correlation was found between MSNA, heart rate, and norepinephrine. Thus, obesity and overweight are characterized by sympathetic overactivity which mirrors the severity of the clinical condition and reflects metabolic alterations, with the exclusion of glucose/insulin profile. Neither heart rate nor norepinephrine appear to represent faithful markers of the muscle sympathetic overdrive.

Original languageEnglish
Pages (from-to)349-358
Number of pages10
JournalHypertension (Dallas, Tex. : 1979)
Issue number2
Publication statusPublished - Aug 2019


  • Adult
  • Aged
  • Anthropometry
  • Body Mass Index
  • Case-Control Studies
  • Female
  • Hemodynamics/physiology
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal/innervation
  • Neural Pathways/physiopathology
  • Obesity/physiopathology
  • Overweight/physiopathology
  • Reference Values
  • Risk Assessment
  • Sympathetic Nervous System/physiopathology


Dive into the research topics of 'Sympathetic Neural Overdrive in the Obese and Overweight State'. Together they form a unique fingerprint.

Cite this