Association between central obesity and symptoms of autonomic dysfunction: a cross-sectional study
DOI:
https://doi.org/10.14306/renhyd.29.4.2508Keywords:
Abdominal obesity, Dysautonomia, Autonomic nervous systemAbstract
Introduction: Central obesity is associated with diverse complications, including autonomic symptoms; however, there are several diagnostic criteria for defining central obesity. This study aimed to examine the association between central obesity, using two different definitions, and the presence of autonomic dysfunction symptoms in adults.
Methods: Secondary data analysis using information from an observational, cross-sectional study conducted in the North of Peru, between 2016 and 2017. Autonomic symptoms were assessed using the Survey of Autonomic Symptoms, whereas central obesity was defined based on waist circumference, using two different criteria (International Diabetes Federation [IDF] and the Adult Treatment Panel III [ATP III]). Crude and adjusted (for age, sex, education level, and socioeconomic status) Poisson regression models were created to evaluate the association of interest. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were reported.
Results: A total of 1,609 participants were analyzed, with a mean age of 48.2 years (SD: 10.6) and 810 (50.3%) were women. The prevalence of central obesity was 79.4% (95% CI: 77.3%–81.3%) according to IDF criterion, and 45.5% (95% CI: 43.1%–48.0%) based on ATP III criterion. In multivariable model, central obesity as defined by IDF was significantly associated with urinary leakage (PR = 2.12; 95% CI: 1.22–3.69). A significant but weaker association was observed when applying ATP III criteria (PR = 1.47; 95% CI: 1.10–1.97).
Conclusions: Central obesity, as defined by both IDF and ATP III criteria, was significantly associated with autonomic dysfunction symptoms, particularly urinary leakage.
References
(1) Benarroch EE. "Dysautonomia": a plea for precision. Clin Auton Res. 2021;31(1):27-29. doi: 10.1007/s10286-020-00749-3
(2) Rocha EA, Mehta N, Távora-Mehta MZP, Roncari CF, Cidrão AAL, Elias Neto J. Dysautonomia: A Forgotten Condition - Part 1. Arq Bras Cardiol. 2021;116(4):814-835. doi: 10.36660/abc.20200420
(3) de Azevedo Vieira ARS, Porto-Dantas LB, do Prado Romani FA, Carvalho PS, Pop-Busui R, Pedrosa HC. Autonomic neuropathic symptoms in patients with diabetes: practical tools for screening in daily routine. Diabetol Metab Syndr. 2023;15(1):83. doi: 10.1186/s13098-023-01036-7
(4) Zilliox L, Peltier AC, Wren PA, Anderson A, Smith AG, Singleton JR, et al. Assessing autonomic dysfunction in early diabetic neuropathy: the Survey of Autonomic Symptoms. Neurology. 2011;76(12):1099-105. doi:10.1212/WNL.0b013e3182120147
(5) Angeles-Zurita G, Narro-Fuentes M, Bernabe-Ortiz A. Association between blood glucose levels and autonomic symptoms in Peru. Prim Care Diabetes. 2022;16(5):709-713. doi: 10.1016/j.pcd.2022.08.006
(6) Guarino D, Nannipieri M, Iervasi G, Taddei S, Bruno RM. The Role of the Autonomic Nervous System in the Pathophysiology of Obesity. Front Physiol. 2017;8:665. doi: 10.3389/fphys.2017.00665
(7) World Health Organization. WHO acceleration plan to stop obesity. Geneva, Switzerland: WHO, 2023.
(8) Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020;16(3):177-189. doi: 10.1038/s41574-019-0310-7
(9) Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-52. doi: 10.1161/CIRCULATIONAHA.105.169404
(10) Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-5. doi:10.1161/CIRCULATIONAHA.109.192644
(11) Espinoza-Salinas A, González-Jurado J, Burdiles-Álvarez A, Arenas-Sánchez G, Zafra-Santos E. Autonomous activity behavior and its relationship with obesity. Med Int Mex 2021; 37(4): 572-9. 10.24245/mim.v37i4.3463
(12) Rho BY, Lee SW, Lee YS, Kim SW. Association between overweight and lower urinary tract symptoms in children and adolescents: A systematic review and meta-analysis. J Pediatr Urol. 2025;21(5):1087-1097. 10.1016/j.jpurol.2025.07.005
(13) Shang X, Fu Y, Jin X, Wang C, Wang P, Guo P, et al. Association of overweight, obesity and risk of urinary incontinence in middle-aged and older women: a meta epidemiology study. Front Endocrinol (Lausanne). 2023;14:1220551. doi:10.3389/fendo.2023.1220551
(14) Papadopoulos GE, Balomenou F, Sakellariou XM, Tassopoulos C, Nikas DN, Giapros V, et al. Autonomic Function in Obese Children and Adolescents: Systematic Review and Meta-Analysis. J Clin Med. 2024;13(7):1854. doi:10.3390/jcm13071854
(15) Yu TY, Lee MK. Autonomic dysfunction, diabetes and metabolic syndrome. J Diabetes Investig. 2021;12(12):2108-2111. doi: 10.1111/jdi.13691
(16) Instituto Nacional de Estadística e Informática. Perú: Enfermedades No Transmisibles y Transmisibles 2022. Lima, Perú: INEI, 2023.
(17) Bernabe-Ortiz A, Perel P, Miranda JJ, Smeeth L. Diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM in Peruvian population. Prim Care Diabetes. 2018;12(6):517-525. doi: 10.1016/j.pcd.2018.07.015
(18) American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S20-S42. doi: 10.2337/dc24-S002
(19) World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation (Geneva, 8–11 December 2008). Geneva, Switzerland: WHO, 2011.
(20) Zacche MM, Giarenis I, Thiagamoorthy G, Robinson D, Cardozo L. Is there an association between aspects of the metabolic syndrome and overactive bladder? A prospective cohort study in women with lower urinary tract symptoms. Eur J Obstet Gynecol Reprod Biol. 2017;217:1-5. doi: 10.1016/j.ejogrb.2017.08.002
(21) Lai HH, Helmuth ME, Smith AR, Wiseman JB, Gillespie BW, Kirkali Z, et al. Relationship Between Central Obesity, General Obesity, Overactive Bladder Syndrome and Urinary Incontinence Among Male and Female Patients Seeking Care for Their Lower Urinary Tract Symptoms. Urology;123:34-43. doi: 10.1016/j.urology.2018.09.012
(22) Lee RK, Chung D, Chughtai B, Te AE, Kaplan SA. Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms. BJU Int. 2012;110(4):540-545. doi: 10.1111/j.1464-410X.2011.10819.x
(23) Alkhowaiter S, Alotaibi RM, Alwehaibi KK, Aljohany A, Alruhaimi B, Almasaad M, et al. The Effect of Body Mass Index on the Prevalence of Gastrointestinal Symptoms Among a Saudi Population. Cureus. 2021;13(9):e17751. doi :10.7759/cureus.17751
(24) Ghusn W, Cifuentes L, Campos A, Sacoto D, De La Rosa A, Feris F, et al. Association Between Food Intake and Gastrointestinal Symptoms in Patients With Obesity. Gastro Hep Adv. 2023;2(1):121-128. doi: 10.1016/j.gastha.2022.07.019
(25) Emerenziani S, Guarino MPL, Trillo Asensio LM, Altomare A, Ribolsi M, Balestrieri P, et al. Role of Overweight and Obesity in Gastrointestinal Disease. Nutrients. 2019;12(1):111. doi: 10.3390/nu12010111
(26) Keller N, Zádori J, Lippai B, Szöllősi D, Márton V, Wellinger K, et al. Cardiovascular autonomic and peripheral sensory neuropathy in women with obesity. Front Endocrinol (Lausanne). 2024;15:1386147. doi: 10.3389/fendo.2024.1386147
(27) Rastović M, Srdić-Galić B, Barak O, Stokić E. Association between anthropometric measures of regional fat mass and heart rate variability in obese women. Nutr Diet. 2017;74(1):51-60. doi: 10.1111/1747-0080.12280
(28) Yi SH, Lee K, Shin DG, Kim JS, Kim HC. Differential association of adiposity measures with heart rate variability measures in Koreans. Yonsei Med J. 2013;54(1):55-61. doi: 10.3349/ymj.2013.54.1.55
(29) Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JPH. Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review. Diabetes Ther. 2019;10(6):1995-2021. doi: 10.1007/s13300-019-00693-0
(30) Ministerio de Salud. Documento Técnico: Plan Nacional de Prevención y Control del Sobrepeso y Obesidad en el contexto de la COVID-19, 2022. Lima, Peru: MINSA, 2022.
(31) Lecube A, Azriel S, Barreiro E, et al. Guía Española GIRO: Guía Española del manejo integral y multudisciplinar de la Obesidad en personas adultas: Sociedad Española para el Estudio de la Obesidad (SEEDO), 2024.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Ignacio A. Carballo-Tello, Lucero Magallanes-Horna, Antonio Bernabé-Ortiz

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.





