The influence of age and weight status on cardiac autonomic control in healthy children: A review

doi:10.1016/j.autneu.2014.09.019

Autonomic Neuroscience

Volume 186, December 2014, Pages 8-21

https://doi.org/10.1016/j.autneu.2014.09.019 Get rights and content

Highlights

•
We review the influence of childhood age and obesity on heart rate variability.
•
During infancy parasympathetic activity increases relative to sympathetic activity.
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This trend continues throughout early-to-late childhood but at a reduced rate.
•
Childhood obesity disrupts the normal maturation of cardiac autonomic control.
•
Cardiac parasympathetic activity is decreased in obese children.

Abstract

Heart rate variability (HRV) analyses can provide a non-invasive evaluation of cardiac autonomic activity. How autonomic control normally develops in childhood and how this is affected by obesity remain incompletely understood. In this review we examine the evidence that childhood age and weight status influence autonomic control of the heart as assessed using HRV. Electronic databases (Pubmed, EMBASE and Cochrane Library) were searched for studies examining HRV in healthy children from birth to 18 years who adhered to the Task Force (1996) guidelines. Twenty-four studies met our inclusion criteria. Seven examined childhood age and HRV. A reduction in 24-hour LF:HF was reported from birth to infancy (1 year), while overall HRV (SDNN) showed a marked and progressive increase. From infancy to early-to-late childhood (from 12 months to 15 years) LF:HF ratio was reported to decline further albeit at a slower rate, while RMSSD and SDNN increased. Twenty studies examined the effects of weight status and body composition on HRV. In a majority of studies, obese children exhibited reductions in RMSSD (n = 8/13), pNN50% (n = 7/9) and HF power (n = 14/18), no difference was reported for LF (n = 10/18), while LF:HF ratio was elevated (n = 10/15). HRV changes during childhood are consistent with a marked and progressive increase in cardiac parasympathetic activity relative to sympathetic activity. Obesity disrupts the normal maturation of cardiac autonomic control.

Section snippets

Background

Childhood obesity remains a global public health issue (WHO, 2010). Obesity raises the risk of developing chronic cardiovascular and metabolic disorders (Nguyen et al., 2008) and although previously considered as adult conditions their prevalence is on the rise in children (Whincup et al., 2002). Furthermore, once established in childhood these conditions have been reported to track to adulthood (Raitakari et al., 2003, Whincup et al., 2002). Autonomic dysfunction is prevalent in adults with

Method

The review protocol was carried out in accordance with the Centre for Reviews and Dissemination guidelines (2008).

Influence of childhood age on HRV

Seven case control studies examined the association between childhood age and HRV over a 24-hour period (Supplementary Table 1, QIS range 45–100%). Three employed correlation analyses to evaluate the relationship between childhood age and HRV as continuous variables (Massin and von Bernuth, 1997, Massin et al., 2000, Seppälä et al., 2014). The other four examined HRV in groups of children stratified according to age (Faulkner et al., 2003, Kazuma et al., 2002, Michels et al., 2013, Silvetti et

Explanation of findings

The major findings of this literature review are threefold. First, the HRV changes in infancy (birth to ~ 12 months) are consistent with a marked and progressive increase in cardiac parasympathetic activity (increased RMSSD, HF power) relative to sympathetic activity (reduced LF:HF ratio). Second, during early-to-late childhood this trend appears to continue but at a reduced rate. Finally, a majority of studies reported that parasympathetic activity to the heart is reduced in obese children

Conclusion

The available evidence indicates a marked and progressive increase in cardiac parasympathetic activity relative to sympathetic activity during infancy, which continues from infancy to late childhood albeit at a slower rate and a sex-specific profile. In obese children, reductions in cardiac parasympathetic activity and increases in sympathetic activity are indicated by a majority of studies, although the underlying mechanisms are unclear. The long-term significance of the deleterious childhood

Contributions

ELJE developed the original focus of the review, conducted the article search and quality assessments, and wrote original draft of the manuscript. MJD checked the article eligibility and quality. JPF developed the original focus of the review, analysed the eligible articles and assisted with the preparation of the manuscript. All reviewers approved the final version of the manuscript.

Competing interests

No competing interests to declare.

Funding

ELJE was generously supported by the Department of Applied Science and Health, Coventry University, UK.

Acknowledgements

None.

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Differentiating depression in major depressive disorder and bipolar disorder is challenging in clinical practice. Therefore, reliable biomarkers are urgently needed to differentiate between these diseases. This study's main objective was to assess whether cardiac autonomic function can distinguish patients with unipolar depression (UD), bipolar depression (BD), and bipolar mania (BM).
We recruited 791 patients with mood disorders, including 191 with UD, 286 with BD, and 314 with BM, who had been drug free for at least 2 weeks. Cardiovascular status was measured using heart rate variability (HRV) and pulse wave velocity (PWV) indicators via finger photoplethysmography during a 5-min rest period.
Patients with BD showed lower HRV but higher heart rates than those with UD and BM. The PWV indicators were lower in the UD group than in the bipolar disorder group. The covariates of age, sex, and body mass index affected the cardiovascular characteristics. After adjusting for covariates, the HRV and PWV variations among the three groups remained significant. Comparisons between the UD and BD groups showed that the variable with the largest effect size was the frequency-domain indices of HRV, very low and high frequency, followed by heart rate. The area under the receiver operating characteristic curve (AUC) for each cardiovascular variable ranged from 0.661 to 0.714. The High-frequency index reached the highest AUC.
Limitations.
Cross-sectional design and the magnitude of heterogeneity across participants with mood disorders limited our findings.
Patients with BD, but not BM, had a greater extent of cardiac imbalance than those with UD. Thus, HRV may serve as a psychophysiological biomarker for the differential diagnosis of UD and BD.
Heart rate variability in patients with psychiatric disorders from adolescence to adulthood
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Age is associated with changes in autonomic nervous system activity. These changes are assessed using heart rate variability(HRV) indicators; however, the effect of age on HRV in patients with psychiatric disorders remains unclear. Our study aimed to explore this effect and determine its variance across different lifespans.
Consecutive patients(N = 3315), comprising 1833 patients with psychotic disorders, 1040 with mood disorders, and 442 with anxiety disorders, were recruited. The patients were divided into four age groups: adolescence(10–24 years), early adulthood(25–39 years), middle adulthood(40–59 years), and late adulthood(60+ years). HRV indicators were measured during a 5-min rest period.
The heart rate and HRV indices were higher in the adolescent and early adulthood groups than they were in the middle and late adulthood groups(increased HRV is beneficial for health, while reduced HRV is detrimental). Age and all the HRV indices were negatively correlated(r-values 0.153–0.350, p < 0.001), with these correlation patterns being more evident in the adolescent and early adulthood groups than in the middle and late adulthood groups. Stratified by sex, the low-frequency/high-frequency ratio was higher in men than in women across most age groups(p < 0.05), except the late adulthood group(p = 0.085). Stratified by diagnosis, most HRV variables(except very low-frequency) were lower in the psychotic disorder group than they were in the mood and anxiety disorder groups, especially in middle and late adulthood patients. After adjusting for confounders, the HRV variables were significantly associated with age, while older age was associated with lower HRV.
These results indicate that the substantial reduction in HRV with age in patients with psychiatric disorders. The association remains significant after correction for sex, heart rate, and diagnoses; this may prove useful to clinical practice and further research.
Unveiling the heart of young offenders: Testing the tripartite model of affect regulation in community and forensic male adolescents
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The tripartite model of affect regulation proposes the existence of three emotion regulation systems (i.e., Threat, Drive and Soothing). An unbalanced functioning of these systems associates with greater risk for psychopathology, specifically Conduct Disorder (CD). Youths with CD generally develop in hostile environments, present higher levels of negative emotions and display different emotion regulation patterns when compared to normative peers. Recently, heart rate variability (HRV) has been reported as an accurate index of emotion regulation. However, there is no study exploring specific HRV patterns for each system while comparing community adolescents and young offenders.
This study aimed to explore differences in HRV patterns between community males (n = 97) and male young offenders (n = 99), aged between 14 and 18 years old, when triggering the three systems. Data was collected for resting, reactivity and recovering phases, following standardized experimental procedures.
Results showed that in both samples, the threat and drive systems associated with decreased HRV. Remarkably, while for community males, triggering the soothing system associated with increases in HRV, young offenders displayed decreases in parasympathetic nervous system activity which seems to mirror threat-like physiological responses.
Findings suggest an underdeveloped/suppressed soothing system in young offenders when compared to normative peers.
Heart rate variability in 2014 predicted delayed onset of internalizing problems in 2015 among children affected by the 2011 Great East Japan Earthquake
2022, Journal of Psychiatric Research
Experience of natural disaster was related to an increased risk of long-term child internalizing problems. Initial traumatic experiences are hypothesized to work as disaster-related stresses and sensitize neural circuitry, leading to heightened reactivity to subsequent stressful experiences, which in turn results in delayed onset of internalizing problems. However, empirical evidence is lacking. Thus, we aimed to examine the association between heart rate variability (HRV) and internalizing problems among children exposed to the disaster. The Great East Japan Earthquake Follow-up for Children (GEJE-FC) study followed children aged 4–6 years old and their siblings and parents from three affected prefectures (Miyagi, Fukushima, and Iwate) and one unaffected prefecture (Mie) in Japan over four periods: from August 2012 to June 2013 (= T1), August 2013 to April 2014 (= T2), July 2014 to December 2014 (= T3), and August 2015 to December 2015 (= T4) (n = 155). HRV was assessed at T2 and T3 as a biomarker of autonomic nervous system activity. Child internalizing problems were assessed by caregivers at T3 and T4, using the Child Behavior Checklist. HRV measurements at T2 were not associated with child internalizing problems at T3. However, HRV in low frequency domains at T3 showed an inverse association with child internalizing problems at T4 (B = −1.72, 95% CI = −3.12 to −0.31). The findings indicated that later exacerbation of internalizing problems could be predicted by dysfunction of autonomic nervous system measured by HRV.
HRV patterns associated with different affect regulation systems: Sex differences in adolescents
2021, International Journal of Psychophysiology
Citation Excerpt :
Participants composing the community adolescent sample for study 2 did not overlap with participants recruited for study 1. To evaluate their eligibility for the study, the following exclusion criteria was considered: 1) illiteracy; 2) given not only the reduced parasympathetic activity to the heart but also that obese individuals display disruptions to the normal maturation of the cardiac autonomic control (Eyre et al., 2014), obesity (body mass index (BMI) greater than 30 kg/m2) was considered as an exclusion criteria; 3) since symptoms of both internalizing and externalizing disorders as well as psychopathological syndromes (e.g., anxiety, depression, schizophrenia) have been associated with large reductions in HF-HRV to assorted challenges (particularly emotion evocation; (Beauchaine & Thayer, 2015)), psychopathology and/or presence of psychotic symptoms was also considered as an exclusion criteria; 4) currently under psychological treatment; 5) presence of cardiovascular diseases; 6) presence of visual/hearing impairments or lack of glasses/hearing aid when needed; 7) intake of medication (i.e., antidepressants/antipsychotics; (Alvares et al., 2016)) or other illicit drugs with influence at the cardiovascular system. Of all participants contacted, 12 did not fulfill the inclusion criteria (their age was not included in the required age interval), 45 showed the presence of exclusion criteria (22 for BMI > 30 kg/m2; 10 for presenting psychopathological symptomatology; 6 for being under psychological treatment; 4 for the intake of medication/illicit drugs with influence at the cardiovascular system; 3 for reporting cardiovascular diseases) and 27 were excluded for not completing the data collection procedure.
Evolutionary perspectives of human behavior propose the existence of three emotion regulation systems (i.e., threat, drive and soothing systems). An unbalanced functioning of the systems represents greater risk for emotion dysregulation and psychopathology. In recent years, heart rate variability (HRV) has been reported as an accurate index of emotion regulation, and although adolescence is characterized by multiple neurophysiological, psychological and social changes, there is no study exploring the HRV patterns of each emotion regulation system in this developmental stage. In Study 1, a standardized procedure (SP) aiming to elicit the three different systems was developed and validated by experts (n = 14) and community adolescents (n = 31). In study 2, differences in HRV patterns across the three emotion regulation systems and across sex, were investigated in a sample of community adolescents (n = 155; 70 males), aged between 14 and 18 years old. Results showed that the threat and drive systems were associated with decreases in HRV, while the soothing system was associated with decreased heart rate. Sex differences were found for the activation of the threat system: while males maintained a decreasing trend in HRV indexes, from resting to recovery, females did not show a decrease in HRV during the activation of this system.
Overall, physiological correlates of each specific emotion regulation system corroborate the theoretical assumptions. Moreover, a SP able to trigger each system independently while measuring physiological data is now available and can be used in future research.
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2021, Obesity Research and Clinical Practice
Citation Excerpt :
Our findings showed that parasympathetic activity (RMSSD) was lower in ‘very sedentary’ or ‘obese’ adolescents and seemed more preserved in those classified as ‘moderately active’. These data reinforce prior research indicating that impaired HRV in the youth would be related to obesity [31] and poor physical activity [32]. However, the extent to which the CRF relates to HRV in pediatric age and how the nutritional status modulate this association is yet unknown [29].
This study evaluated the association between cardiorespiratory fitness, abdominal obesity, blood pressure, endothelial function, and autonomic modulation in school-age adolescents exhibiting different levels of habitual physical activity and nutritional status, through a multivariate statistical approach.
101 adolescents aged 15–18 years (54 females) underwent assessments of daily physical activity, body mass index, cardiorespiratory fitness, reactive hyperemia, and heart rate variability. Based on BMI adjusted for age and sex (z-BMI), 21 adolescents were classified as ‘overweight’ (9 girls), and 9 as ‘obese’ (4 girls). The common variation between those variables was assessed through Principal Component Analysis (PCA).
Main axis of common variation of outcomes analyzed defined four principal components (PCs) accounting for 69.7% of overall variance, related to ‘abdominal obesity and blood pressure’ (PC1; eigenvalue = 2.76), ‘cardiorespiratory fitness, endothelial function, and autonomic modulation’ (PC2, eigenvalue = 1.98), ‘cardiorespiratory fitness’ (PC3, eigenvalue = 1.21), and ‘sedentary behavior’ (PC4, eigenvalue = 1.02). Girls reported longer screen time and sedentary behavior than boys. Notwithstanding, in both sexes poorer cardiorespiratory fitness corresponded to lower reactive hyperemia and vagal modulation, irrespective of the nutritional status. Overall, adolescents classified as ‘obese’ and ‘sedentary’ exhibited poorer CRF concomitantly to autonomic and endothelial dysfunctions.
In school-age adolescents, endothelial and autonomic dysfunctions related to poor cardiorespiratory fitness, irrespective of the nutritional status and physical activity level. However, endothelial and autonomic dysfunctions were more prevalent among adolescents combining poor cardiorespiratory fitness, reduced levels of daily physical activity, and overweight/obesity.

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ReviewThe influence of age and weight status on cardiac autonomic control in healthy children: A review

Highlights

Abstract

Section snippets

Background

Method

Influence of childhood age on HRV

Explanation of findings

Conclusion

Contributions

Competing interests

Funding

Acknowledgements

Prev. Med.

Pharmacol. Ther.

Heart Lung

Auton. Neurosci.

Lancet

Auton. Neurosci.

Int. J. Cardiol.

J. Am. Coll. Surg.

J. Auton. Nerv. Syst.

Int. J. Cardiol.

Int. J. Cardiol.

Clin. Sao Paulo

Auton. Neurosci.

Can. J. Cardiol.

Autonomic neural regulation of the immune system: implications for hypertension and cardiovascular disease

Hypertension

The use of short-term analysis of heart rate variability to assess autonomic function in obese children and its relationship with metabolic syndrome

Cardiol. J.

Dysfunction of autonomic nervous system in childhood obesity: a cross-sectional study

PLoS ONE

Allometric scaling of left ventricular mass by body dimensions in males and females

Med. Sci. Sports Exerc.

Systematic Reviews CRDS Guidance for Undertaking Reviews in Health Care

Impact of pubertal development and physical activity on heart rate variability in overweight and obese children in Taiwan

J. Sch. Nurs.

British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood

Stat. Med.

Eurofit: Handbook for the EUROFIT Tests of Physical Fitness

Ethnicity and long-term heart rate variability in children

Arch. Dis. Child.

Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk in Communities

Circulation

Does size matter? Clinical applications of scaling cardiac size and function for body size

Circulation

Interaction between body size and cardiac workload: influence on left ventricular mass during body growth and adulthood

Hypertension

Longitudinal assessment of the effects of oestrogen on blood pressure and cardiovascular autonomic activity in female rats

Clin. Exp. Pharmacol. Physiol.

Stability of respiratory sinus arrhythmia in children and young adolescents: a longitudinal examination

Dev. Psychobiol.

Endotoxin depresses heart rate variability in mice: cytokine and steroid effects

Am. J. Physiol. Regul. Integr. Comp. Physiol.

Echocardiographic examination of cardiac structure and function in elite cross trained male and female Alpine skiers

Br. J. Sports Med.

Relationships between heart rate variability, vascular function, and adiposity in children

Clin. Auton. Res.

Heart rate variability in normotensive healthy children with aging

Clin. Exp. Hypertens.

Heart rate variability: measurement and clinical utility

Ann. Noninvasive Electrocardiol.

Abdominal adiposity is associated with elevated C-reactive protein independent of BMI in healthy nonobese people

Diabetes Care

Heart rate variability and endogenous sex hormones during the menstrual cycle in young women

Exp. Physiol.

Review
The influence of age and weight status on cardiac autonomic control in healthy children: A review