Fida Bacha

Summary Objectives To characterize the determinants of heart rate variability (HRV) in youth with obesity across the glycemia spectrum. Methods A total of 94 adolescents, 15 ± 2.1 years (21 with normal weight, 23 with overweight‐normal glucose tolerance, 26 with prediabetes and 24 with type 2 diabetes [T2D]) underwent an assessment of body composition (dual‐energy x‐ray absorptiometry), 2‐h oral glucose tolerance test with the calculation of indices of glycemia and insulin sensitivity (IS), inflammatory markers (high‐sensitivity C‐reactive protein [hs‐CRP] and tumour necrosis factor‐α [TNF‐α]), and HRV by peripheral arterial tonometry. Results The HRV frequency‐domain index (low‐frequency to high‐frequency ratio [LF/HF]), an estimate of the ratio between sympathetic and parasympathetic activity, increased across the glycemic spectrum, and was highest in T2D compared with the other three groups ( p = 0.004). LF/HF correlated with %body fat ( r = 0.22, p = 0.04); fasting ( r = 0.39, p < 0.001), 2‐h ( r = 0.31, p = 0.004), and area under the curve glucose ( r = 0.32, p = 0.003); hs‐CRP ( r = 0.33, p = 0.002) and TNF‐α ( r = 0.38, p = 0.006). In a linear regression model, fasting glucose ( β = 0.39, p = 0.003) and hs‐CRP ( β = 0.21, p = 0.09) contributed to the variance in Ln LF/HF independent of IS, %body fat, age, sex, race‐ethnicity and Tanner stage ( R 2 = 0.23, p = 0.013). Conclusions Youth with impaired glucose regulation have evidence of cardiac autonomic dysfunction with decreased HRV, and sympathetic overdrive (increased LF/HF). This dysfunction is mainly related to glycemia and systemic inflammation.