<p>Izvod: UVOD: Metabolički zdrave gojazne osobe su okarakterisane odsustvom metaboličkog sindroma i/ili insulinske rezistencije i sistemske inflamacije. Mali je broj podataka o ulozi aktivnosti autonomnog nervnog sistema u razvoju kardiometaboličkih komplikacija kod gojaznih osoba, kao i o njegovoj vezi sa specifičnom distribucijom masnog tkiva. CILJ: Analiza varijabilnost srčane frekvencije (HRV) kod metabolički zdravih (MHO) i gojaznih osoba sa metaboličkim rizikom (MUO), analiza povezanosti HRV sa metaboličkim faktorima i distribucijom masnog tkiva, kao i analiza uzrasne dinamike HRV kod gojaznih osoba različitih kardiometaboličkih profila. MATERIJAL I METODE: Ukupno 125 gojaznih ispitanika oba pola podvrgnuto je antropometrijskim merenjima u cilju procene mase i distribucije masnog tkiva, izvršena je analiza telesne kompozicije, uzeti su uzorci krvi u cilju određivanja lipidskog i lipoproteinskog statusa, stanja glikoregulacije i nivoa inflamatornih markera, meren je krvni pritisak i procenjena je HRV tokom petominutne digitalne elektrokardiografije. Podaci su statistički obrađeni korišćenjem paketa SPSS 11.5. REZULTATI: HRV mere se nisu razlikovale statistički značajno među MHO i MUO muškarcima. MHO žene su imale više vrednosti RRNN, SDNN, RMSSD, pNN50, LF, HF i TP u odnosu na MUO žene, na čega metabolički profil utiče sa 6,6-11,2%(p˂0,01), predstavljeno kroz parcijalnu deljenu varijansu. Nakon antropometrijskih faktora uzetih u obzir, perzistirale su više vrednosti HF kod MHO žena. Razlika u RRNN, pNN50 i TP između MHO i MUO premenopauzalnih žena (više vrednosti za MHO, p˂0,05) se izgubila nakon kontrole za krvni pritisak. Insulinemija je uticala na pojave razlika u RRNN između MHO i MUO premenopauzalnih žena, parcijalna deljena varijansa 7,6%. SAD kod žena se negativno povezivao sa LF/HF i LFnorm, a pozitivno sa HFnorm, parcijalne deljene varijanse 8,4-11,9% (p˂0,05). Prednji nabor podlaktice kod žena se pozitivno povezivao sa LF i LF/HF, a negativno sa HFnorm (p˂0,01). Visceralna masna masa je predviđala značajno HRV mere muškaraca, parcijalna deljena varijansa 13-34% (p˂0,01). U okviru gornjeg tercila HRV mera RMSSD, pNN50 i LF MUO osoba, HOMA indeks je statistički značajno niži (p˂0,05). Kod MUO osoba SDNN, RMSSD, lnpNN50, lnLF, lnHF i TP značajno su se smanjivali u uzrastu od 19-29 do 40-49 godina. Kod MHO osoba primetna je uzrasna promena HF mere u četvrtoj deceniji života. ZAKLJUČAK: MHO osobe ženskog pola imaju značajno više vrednosti markera varijabilnosti srčane frekvencije u odnosu na MUO. Razlike u HRV merama su uslovljene kriterijumima metaboličke podele, predominantno insulinemijom, vrednostima krvnog pritiska i centralnom masnom masom. Kod žena centralna distribucija masnog tkiva korelira sa smanjenom srčanom simpatičkom aktivnošću dok se periferna distribucija masnog tkiva povezuje obrnuto sa komponentama aktivnosti autonomnog nervnog sistema. Kod muškaraca centralna masna masa, ali ne i periferna, je značajno povezana sa HRV. MUO osobe sa nižom HRV imaju veći stepen insulinske rezistencije, dok HRV ne utiče na insulinsku senzitivnost MHO osoba. Značajniji uzrasno zavisni pad HRV mera primetan je kod MUO osoba, pogađajući obe komponente autonomnog nervnog sistema za razliku od MHO osoba.</p> / <p>Abstract: INTRODUCTION: Metabolically healthy obese (MHO) individuals are characterized by absence of metabolic syndrome and/or insulin resistance and inflammation. Little is known about the role of autonomic nervous system in development of cardiometabolic complications in obese people and about its influence on the specific adipose tissue distribution. AIM: Analysis of the hearth rate variability (HRV) in metabolically healthy (MHO) and unhealthy (MUO) obese people, its connection with adipose tissue distribution, and age dependent dynamics of HRV. MATERIAL AND METHODS: A total of 125 obese patients of both sexes underwent anthropometric measurements in order to assess adipose tissue mass and distribution, body composition was assessed, blood samples were taken in order to analyze parameters of lipid and lipoprotein profile, condition of glycoregulation and inflammatory markers, blood pressure was measured and short term HRV was conducted. Data were statisticaly analyzed using SPSS 11.5. RESULTS: HRV measures did not differ significantly between MHO and MUO men. MHO women had higher values of RRNN, SDNN, RMSSD, pNN50, LF, HF and TP compared to the MUO women, influence of metabolic profile was 6,6-11,2% (p˂0,01), presented through partial shared variance. After controlling for anthropometric factors higher HF persisted in MHO women. Differences in RRNN, pNN50 and TP between MHO and MUO premenopausal women (higher values of MHO, p˂0,05) were lost after controlling for blood pressure. Insulinemia influenced the difference in RRNN between MHO and MUO premenopausal women, partial shared variance 7,6%. SAD in women was connected negatively with the LF/HF and LFnorm, and positively with HFnorm, partial shared variance 8,4-11,9% (p˂0,05). Anterior forearm skinfold in women correlated positively with LF and LF/HF, and negatively with HFnorm (p˂0,01). Visceral fat mass predicted significantly HRV in men, partial shared variance 13-34% (p˂0,01). Within the upper tertile of HRV measures RMSSD, pNN50 and LF in MUO people, HOMA was significantly lower (p˂0,05). In MUO SDNN, RMSSD, lnpNN50, lnLF,lnHF and TP significantly decreased in the period from 19-29 to 40-49 years. In MHO people the change in HF was noticeable in the fourth decade of life. CONCLUSION: MHO women have significantly higher levels of HRV markers comparing to the MUO. The differences in HRV measures are influenced by metabolic criteria used, predominantly by insulinemia, blood pressure and central fat mass. In women, central distribution of adipose tissue correlates with reduced cardiac sympathetic activity, while the connection of peripheral fat mass distribution with components of autonomic nervuos system activity is reverse. In men, central fat mass, but not peripheral, is significantly associated with HRV. MUO people with lower HRV have a higher degree of insulin resistance, while the level of HRV measures does not affect insulin sensitivity in MHO individuals. Significant age-dependent decrease in both ANS representatives of HRV measures was noticed in MUO people, unlike MHO individuals.</p>
| Identifer | oai:union.ndltd.org:uns.ac.rs/oai:CRISUNS:(BISIS)101549 |
| Date | 22 September 2016 |
| Creators | Rastović Marina |
| Contributors | Srdić Galić Biljana, Barak Otto, Stokić Edita, Klašnja Aleksandar, Pavlica Tatjana, Tomić-Naglić Dragana, Sakač Dejan |
| Publisher | Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, University of Novi Sad, Faculty of Medicine at Novi Sad |
| Source Sets | University of Novi Sad |
| Language | Serbian |
| Detected Language | Unknown |
| Type | PhD thesis |
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