ArticleObesity surgery2026
Autonomic Dysfunction and Functional Impairment in Candidates for Metabolic Bariatric Surgery: A High Vulnerability Profile.
Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSevere obesity is associated with autonomic nervous system dysfunction and impaired functional capacity, both independent predictors of perioperative complications and mortality. Heart rate variability (HRV) and functional tests are noninvasive, accessible tools for assessing these conditions. This study aimed to characterize autonomic modulation and functional capacity in bariatric surgery candidates and, innovatively, explore their interrelationship – a critical gap in preoperative risk assessment.
methodsThis cross-sectional study enrolled 100 individuals (age 41.7 ± 9.8 years; body mass index [BMI] 46.9 ± 7.4 kg/m2; 78% women) awaiting metabolic bariatric surgery. HRV was assessed at rest using validated time- and frequency-domain indices. Functional capacity was measured via handgrip strength (HGS), sit-to-stand test, and 6-minute walk test (6MWT). Spearman correlations (ρ) and linear regression models examined associations between domains.
resultsParticipants exhibited a high-vulnerability phenotype: profound autonomic dysfunction (SDNN: 22.2 ± 10.6 ms; LF/HF ratio: 2.8 ± 2.9) and severely impaired functional capacity (6MWT: 404.5 ± 102.0 m, 20% below predicted; HGS: 35.2 ± 10.6 kg). Critically, 6MWT performance correlated significantly with HRV indices (SDNN: p = 0.314, p = 0.001; RMSSD: ρ = 0.206, p = 0.039), and HRV parameters predicted up to 8% of variance in cardiorespiratory fitness (R2 = 0.08, p = 0.003), suggesting shared pathophysiology.
conclusionBariatric surgery candidates demonstrate coexisting autonomic and functional deficits that are physiologically interconnected. Integrated preoperative assessment of these domains enables more accurate risk stratification and targeted prehabilitation strategies. These findings support a paradigm shift toward multidimensional preoperative evaluation to optimize surgical safety and outcomes.
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