The Role of Insulin Sensitivity and Body Mass Index on Orthostatic Intolerance

Year 2022, Volume: 8 Issue: 2, 149 - 155, 31.05.2022

Eviç Zeynep Akgün Deniz Karaayan Gökmen Akgün Kadir Babaoğlu

https://doi.org/10.30934/kusbed.1090066

Abstract

Objective: To assess the effects of insulin sensitivity and anthropometric measurements on orthostatic intolerance syndromes.
Methods: This is a retrospective study. Patients with history of syncope aged between 7-18 years were analyzed according to insulin sensitivity index and anthropometric measurements. Patients were grouped according to the head-up tilt test results (test positive and test negative). Also, patients who had positive tilt tests were divided into four subgroups such as vasodepressor vasovagal syncope (VVS), cardioinhibitory VVS, mixed VVS, and postural orthostatic tachycardia syndrome.
Results: A total of 509 patients were included in the study. The mean age was 13.45 ± 2.82 years, and %64.4 were girls. The tilt test was positive in 214 patients and negative in 295. With the tilt test results, 173 patients were diagnosed with VVS and 41 patients (19 %) with POTS. There were no statistically significant difference between the groups according to the insulin sensitivity indices. In anthropometric measurements, a significant difference was observed between the two groups in height, height standard deviation score (SDS), BMI SDS and BMI p (p =0.008, p= 0.02, p=0.036, p=0.03, respectively).
Conclusion: In our study, while the low BMI and being tall were the predisposing factors for VVS episodes especially in young girls, there was no relationship between the insulin sensitivity indices and positive head-up tilt test result. Providing appropriate treatment by shedding light on factors that cause recurrent syncope can contribute to the quality of life of patients.

Keywords

Syncope, postural tachycardia syndrome, vasovagal syncope, head-up tilt test

İnsülin Duyarlılığı ve Vücut Kitle İndeksinin Ortostatik İntolerans Üzerine Etkileri

Abstract

Amaç: Çalışmanın amacı insülin duyarlılığı ve antropometrik ölçümlerin ortostatik intolerans sendromları üzerindeki etkilerini değerlendirmektir.
Yöntem: Retrospektif bir çalışmadır. 7-18 yaş arası senkop öyküsü ile başvuran hastalarda insülin duyarlılık indeksleri hesaplandı ve antropometrik ölçümlerine değerlendirildi. Hastalar head-up tilt test sonuçlarına göre test pozitif ve test negatif olarak gruplandırıldı. Ayrıca tilt testi pozitif olan hastalar vazodepresör vazovagal senkop (VVS), kardiyoinhibitör VVS, mikst VVS ve postural ortostatik taşikardi sendromu olmak üzere dört alt gruba ayrıldı.
Bulgular: Çalışmaya toplam 509 hasta dahil edildi. Yaş ortalaması 13,45 ± 2,82 yıldı ve %64,4'ü kızdı. Tilt testi 214 hastada pozitif, 295 hastada negatifti. Tilt testi sonuçları ile 173 hastaya VVS ve 41 hastaya (%19) POTS tanısı konuldu. İnsülin duyarlılık indekslerine göre gruplar arasında istatistiksel olarak anlamlı fark yoktu. Antropometrik ölçümlerde boy, boy standart deviasyonu, vücut kitle indeksi (VKİ) standart deviasyonu ve VKİ persentili (sırasıyla p=0,008, p=0,02, p=0,036, p=0,03) açısından iki grup arasında anlamlı farklılık gözlendi.
Sonuç: Çalışmamızda özellikle genç kızlarda düşük VKİ ve uzun boylu olmak vazovagal senkop ataklarına zemin hazırlayan faktörler iken, insülin duyarlılık indeksleri ile pozitif head-up tilt test sonucu arasında ilişki bulunmadı. Tekrarlayan senkoplara neden olan faktörlere ışık tutarak uygun tedavinin sağlanması hastaların yaşam kalitelerine katkı sağlayabilir.

Keywords

Senkop, Postural taşikardi sendromu, Vazovagal senkop, Head-up tilt testi

References

• Stewart JM. Common syndromes of orthostatic intolerance. Pediatrics 2013;131(5):968-980. doi:10.1542/peds.2012-2610
• Shen W-K, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017;136(5):e60-e122. doi:10.1161/CIR.0000000000000499
• Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. - PubMed - NCBI. Accessed April 28, 2020. https://www.ncbi.nlm.nih.gov/pubmed/23122672
• Jarjour IT. Postural Tachycardia Syndrome in Children and Adolescents. Semin Pediatr Neurol 2013;20(1):18-26. doi:10.1016/j.spen.2013.01.001
• Lin J, Zhao H, Ma L, Jiao F. Body mass index is decreased in children and adolescents with postural tachycardia syndrome. Turk J Pediatr 2019;61(1):52-58. doi:10.24953/turkjped.2019.01.009
• Ruiz GA, Calvar C, Hermes R, et al. Insulin sensitivity in young women with vasovagal syncope. Am Heart J 2003;145(5):834-840. doi:10.1016/S0002-8703(02)94707-1
• Yamada T, Yanagimoto S. Dose-Response Relationship between the Risk of Vasovagal Syncope and Body Mass Index or Systolic Blood Pressure in Young Adults Undergoing Blood Tests. Neuroepidemiology 2017;49(1-2):31-33. doi:10.1159/000479698
• 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(5):1810-1814. doi:10.1210/jcem.85.5.6511
• North KE, Rose KM, Borecki IB, et al. Evidence for a gene on chromosome 13 influencing postural systolic blood pressure change and body mass index. Hypertension 2004;43(4):780-784. doi:10.1161/01.HYP.0000118921.66329.da
• Christou GA, Kiortsis DN. The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope. Obes Rev 2017;18(3):370-379. doi:10.1111/obr.12501
• Deveau AP, Sheldon R, Maxey C, Ritchie D, Doucette S, Parkash R. Sex Differences in Vasovagal Syncope: A Post Hoc Analysis of the Prevention of Syncope Trials (POST) I and II. Can J Cardiol 2020;36(1):79-83. doi:10.1016/j.cjca.2019.10.008
• Benarroch EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 2012;87(12):1214-1225. doi:10.1016/j.mayocp.2012.08.013
• Stewart JM, Taneja I, Medow MS. Reduced body mass index is associated with increased angiotensin II in young women with postural tachycardia syndrome. Clin Sci 2007;113(11):449-457. doi:10.1042/CS20070104
• Fu Q, Arbab-Zadeh A, Perhonen MA, Zhang R, Zuckerman JH, Levine BD. Hemodynamics of orthostatic intolerance: implications for gender differences. Am J Physiol Heart Circ Physiol 2004;286(1):H449-457. doi:10.1152/ajpheart.00735.2002
• Sheldon R, Raj SR, Rose MS, et al. Fludrocortisone for the Prevention of Vasovagal Syncope: A Randomized, Placebo-Controlled Trial. J Am Coll Cardiol 2016;68(1):1-9. doi:10.1016/j.jacc.2016.04.030
• Straznicky NE, Lambert EA, Nestel PJ, et al. Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Diabetes 2010;59(1):71-79. doi:10.2337/db09-0934
• Sheldon RS, Sandhu RK. The Search for the Genes of Vasovagal Syncope. Front Cardiovasc Med 2019;6:175. doi:10.3389/fcvm.2019.00175