Impact of Diet‐Induced Weight Loss on the Cardiac Autonomic Nervous System in Severe Obesity

OBJECTIVE: To determine the impact of diet-induced weight loss on cardiac autonomic nervous system modulation and arrhythmias in subjects with severe obesity and the influence of a high-fat or a high-carbohydrate diet regimen on heart rate variability in reduced-obese individuals. RESEARCH METHODS AND PROCEDURES: Eight severely obese subjects (BMI > or = 40.0 kg/m(2)) underwent a 3-month weight loss program followed by a 3-month reduced-weight maintenance regimen. Thereafter, each subject was admitted for an inpatient period of 17 days on two separate occasions. A high-carbohydrate (60%) or high-fat (55%) diet of appropriate energy content for weight maintenance was prescribed during each inpatient phase. Heart rate variability was derived from a 24-hour Holter monitoring system in all subjects during their inpatient stay. Cardiac Holter monitoring was performed at three occasions (baseline, diet phase I, and diet phase II), including the second night of a two overnight calorimetry chamber stay. RESULTS: After the diet regimen, there was a 10% decrease in weight. There were no significant changes in systolic and diastolic blood pressure, arrhythmias, glucose, insulin, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, respiratory exchange ratio, and resting energy expenditure between experiments. Mean heart rate was lower after weight loss compared with baseline (p < 0.001). After weight loss, there was an increase in the parasympathetic indices of heart rate variability showing an increase in cardiac vagal modulation (all p < 0.05). DISCUSSION: Weight loss is associated with significant improvement in autonomic cardiac modulation through enhancement of parasympathetic modulation, which clinically translates into a decrease in heart rate.