Resting energy expenditure and body composition in morbidly obese, obese and control subjects

Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients

Nutritional support in critically ill patients has been acknowledged as a pillar of ICU care, playing a pivotal role in preserving muscle mass, supporting immune function, and promoting recovery during and after critical illness. Providing effective nutritional support requires adapting it to the patient's diagnosis, unique characteristics, and metabolic state to minimize the risks of overfeeding or underfeeding while mitigating muscle loss. This level of care requires a comprehensive nutritional assessment and the establishment of a nutrition-focused protocol. Regular, consistent and detailed nutritional evaluation can influence both therapeutic decisions and clinical interventions, thus ensuring that the specific needs of critically ill patients are met from the acute phase through their entire recovery process. Bioelectrical impedance analysis (BIA) is increasingly recognized as a valuable tool for enhancing nutritional care in critically ill patients. By delivering precise, real-time insights into key aspects of body composition, BIA is thought to provide clinicians with a more comprehensive understanding of the complex physiological changes that occur during critical illness. This narrative review highlights the potential of BIA in offering these precise assessments, facilitating the development of more accurate and personalized nutritional strategies for critically ill patients. If BIA can reliably assess dynamic shifts in hydration and tissue integrity, it holds the promise of further advancing individualized care and optimizing clinical outcomes in this vulnerable population.

No effect of circulating leptin on energy metabolism in normal weight or overweight/obese lactating mothers: The case-control Breastmilk and the Link to Overweight/Obesity and Maternal diet (BLOOM) study

BACKGROUND & AIMS

Pregnancy and lactation are associated with metabolic changes, including alterations in energy metabolism, which are closely linked to body mass and composition due to hormonal status. Therefore, the objective of this study was to investigate the energy metabolism in exclusively or predominantly breastfeeding mothers with normal weight (NW) and overweight/obesity (OW/OB) and evaluate its associations with fasting serum leptin.

METHODS

This cross-sectional BLOOM study was conducted among 39 mothers (n = 19 NW, n = 20 OW/OB) in 15.5 ± 1.2 weeks of lactation. The leptin was analyzed in a blood sample using an enzyme-linked immunosorbent assay, body composition was analyzed by dual-energy X-ray absorptiometry, and resting metabolic rate (RMR) was measured by indirect calorimetry method.

RESULTS

The average RMR for all groups was 1747.5 ± 281.9 kcal/d, with a statistically significant difference between groups (1932.7 ± 222.6 vs. 1550.5 ± 190.6, p < 0.001, respectively in the OW/OB and NW group). The OW/OB mothers had higher oxygen uptake (VO2) and exhaled carbon dioxide (VCO2), but not respiratory quotient (RQ), carbohydrate (CHO%) and lipid oxidation (FAT%). When analyzing correlations stratified by BMI category, we found that serum leptin was correlated with CHO% negatively, and with FAT% positively in the NW but not in OW/OB mothers. Additionally, serum leptin was a significant predictor of RMR, VCO2, VO2, CHO%, and RMR/kg of total body weight. However, after adjusting for confounders, the observed associations were no longer statistically significant (RMR: β = 0.113, 95% CI -0.354-0.319; VO2: β = 0.141, 95% CI -0.462-0.744; VCO2: β = 0.238, 95% CI -0.411-0.888; CHO%: β = -0.146, 95% CI -0.151-0.444; RMR/kg of total body weight: β = -0.294, 95% CI -0.831-0.244).

CONCLUSIONS

Our results did not support the hypothesis that leptin plays a role in regulating energy homeostasis during lactation.

Neural circuits of long-term thermoregulatory adaptations to cold temperatures and metabolic demands

The mammalian brain controls heat generation and heat loss mechanisms that regulate body temperature and energy metabolism. Thermoeffectors include brown adipose tissue, cutaneous blood flow and skeletal muscle, and metabolic energy sources include white adipose tissue. Neural and metabolic pathways modulating the activity and functional plasticity of these mechanisms contribute not only to the optimization of function during acute challenges, such as ambient temperature changes, infection and stress, but also to longitudinal adaptations to environmental and internal changes. Exposure of humans to repeated and seasonal cold ambient conditions leads to adaptations in thermoeffectors such as habituation of cutaneous vasoconstriction and shivering. In animals that undergo hibernation and torpor, neurally regulated metabolic and thermoregulatory adaptations enable survival during periods of significant reduction in metabolic rate. In addition, changes in diet can activate accessory neural pathways that alter thermoeffector activity. This knowledge may be harnessed for therapeutic purposes, including treatments for obesity and improved means of therapeutic hypothermia.

Telomere Length Is Correlated with Resting Metabolic Rate and Aerobic Capacity in Women: A Cross-Sectional Study

This study investigated the associations between relative telomere length (RTL) and resting metabolic rate (RMR), resting fat oxidation (RFO), and aerobic capacity and whether oxidative stress and inflammation are the underlying mechanisms in sedentary women. We also aimed to determine whether the correlations depend on age and obesity. Sixty-eight normal weight and 66 obese women participated in this study. After adjustment for age, energy expenditure, energy intake, and education level, the RTL of all participants was negatively correlated with absolute RMR (RMRAB) and serum high-sensitivity C-reactive protein (hsCRP) concentration, and positively correlated with maximum oxygen consumption (V˙O2max) (all p < 0.05). After additional adjustment for adiposity indices and fat-free mass (FFM), RTL was positively correlated with plasma vitamin C concentration (p < 0.05). Furthermore, after adjustment for fasting blood glucose concentration, RTL was negatively correlated with age and positively correlated with V˙O2max (mL/kg FFM/min). We found that normal weight women had longer RTL than obese women (p < 0.001). We suggest that RTL is negatively correlated with RMRAB and positively correlated with aerobic capacity, possibly via antioxidant and anti-inflammatory mechanisms. Furthermore, age and obesity influenced the associations. We provide useful information for the management of promotion strategies for health-related physical fitness in women.

Resting Energy Expenditure Is Not Altered in Children and Adolescents with Obesity. Effect of Age and Gender and Association with Serum Leptin Levels

In children and adolescents, obesity does not seem to depend on a reduction of resting energy expenditure (REE). Moreover, in this young population, the interactions between either age and obesity or between age and gender, or the role of leptin on REE are not clearly understood. To compare the levels of REE in children and adolescents we studied 181 Caucasian individuals (62% girls) classified on the basis of age- and sex-specific body mass index (BMI) percentile as healthy weight (n = 50), with overweight (n = 34), or with obesity (n = 97) and in different age groups: 8-10 (n = 38), 11-13 (n = 50), and 14-17 years (n = 93). REE was measured by indirect calorimetry and body composition by air displacement plethysmography. Statistically significant differences in REE/fat-free mass (FFM) regarding obesity or gender were not observed. Absolute REE increases with age (p < 0.001), but REE/FFM decreases (p < 0.001) and there is an interaction between gender and age (p < 0.001) on absolute REE showing that the age-related increase is more marked in boys than in girls, in line with a higher FFM. Interestingly, the effect of obesity on absolute REE is not observed in the 8-10 year-old group, in which serum leptin concentrations correlate with the REE/FFM (r = 0.48; p = 0.011). In conclusion, REE/FFM is not affected by obesity or gender, while the effect of age on absolute REE is gender-dependent and leptin may influence the REE/FFM in 8-10 year-olds.

Magnetic Resonance Imaging of Trunk Musculature and Intervertebral Discs in Patients with Spinal Cord Injury with Thoracolumbar Vertebral Fractures: A Prospective Study

Study Design

This study is a prospective clinical study.

Purpose

This study aims to evaluate the characteristics of trunk musculature and intervertebral discs by using magnetic resonance imaging in patients with spinal cord injuries (SCIs) with thoracic and lumbar fractures.

Overview of Literature

Muscle atrophy is an immediate consequence of SCI and is associated with secondary complications. At present, there are limited clinical data on muscle and disc responses to fractures of the thoracic and lumbar spine.

Methods

A total of 51 patients with a mean age of 31.75±10.42 years who suffered traumatic SCI were included in this study. Complete neurological examinations (American Spinal Injury Association grading) and magnetic resonance imaging (MRI) were performed at the time of admission and at 3–6 months after injury to study the neurological status and disc and trunk parameters. The type of management (operative or conservative) was decided on the basis of clinical, radiological, and MRI evaluations, and a robust rehabilitation program was initiated.

Results

Disc parameters including disc angle, skin angle, cross-sectional area (CSA), and disc height and trunk parameters (mean trunk width, mean trunk depth, and CSA of the lumbar muscles) decreased significantly (p <0.001) during the first 3 months after SCI. However, improvements were observed in disc and muscle parameters at the 6-month follow-up, but these parameters did not return to normal levels. Neither initial neurological status (complete vs. incomplete) nor type of management (operative vs. conservative) had a significant effect on these parameters.

Conclusions

Spinal trauma leads to alterations in the morphology of the vertebral column, spinal cord, intervertebral discs, and paraspinal muscles in the initial phase of injury. The extent of these changes may determine the initial neurological deficit and subsequent recovery. Although this study did not identify any statistically significant effect of neurological status or management strategy on these parameters, rehabilitation was found to result in the improvement of these parameters in the later phase of recovery. Future studies are required to evaluate the exact causes of these alterations and the potential benefits of rehabilitation strategies and to minimize these changes.

Resting Energy Expenditure and Substrate Oxidation in Malnourished Patients With Type 1 Glycogenosis

CONTEXT

Type 1a and 1b glycogenosis [glycogen storage disorder (GSD)1a, GSD1b] are rare diseases generally associated with malnutrition. Although abnormal substrate oxidation rates and elevated energy expenditures might contribute to malnutrition, this issue has not been investigated.

OBJECTIVE

To investigate whether abnormal resting energy expenditure (REE) and substrate oxidation rate characterize patients with GSD1.

DESIGN

Cross-sectional study.

SETTING

Outpatient referral center for rare diseases and laboratory of clinical nutrition at the University Hospital of Palermo.

PATIENTS

Five consecutive patients with GSD1 (4 type a, 1 type b; 3 men, 2 women; age range, 19 to 49 years).

MAIN OUTCOME MEASURES

The usual clinical procedures for patients with malnutrition, including REE and basal substrate oxidation rate (both indirect calorimetry), body composition (bioimpedance method), muscle strength (hand-grip test), and the usual laboratory tests, were performed.

RESULTS

Malnutrition was clearly diagnosed in 2 patients (1 GSD1a and 1 GSD1b), with REE elevated in all five patients, and especially, in the two malnourished patients (+124% and +32.1% vs predictive values using Harris-Benedict equations). The two malnourished patients also exhibited lower basal protein oxidation rates (7.7% and 6.6%) than the nourished patients (range, 12.1% to 24.7%), with higher carbohydrate or lipid oxidation rates. Additionally, the two malnourished patients exhibited higher blood concentrations of lactic acid than the nourished patients.

CONCLUSIONS

According to data obtained from our small sample of patients with GSD1, elevated REEs seem to be a common characteristic that might contribute to malnutrition. Low basal protein oxidation rates and elevated blood lactic acid concentrations appear to be associated with malnutrition.

The pathogenesis of obesity

Body fat mass increases when energy intake exceeds energy expenditure. In the long term, a positive energy balance will result in obesity. The worldwide prevalence of obesity has increased dramatically, posing a serious threat to human health. Therefore, insight in the pathogenesis of obesity is important to identify novel prevention and treatment strategies. This review describes the physiology of energy expenditure and energy intake in the context of body weight gain in humans. We focus on the components of energy expenditure and the regulation of energy intake. Finally, we describe rare monogenetic causes leading to an impairment in central regulation of food intake and obesity.

Prediction Equations Overestimate the Energy Requirements More for Obesity-Susceptible Individuals

Predictive equations to estimate resting metabolic rate (RMR) are often used in dietary counseling and by online apps to set energy intake goals for weight loss. It is critical to know whether such equations are appropriate for those susceptible to obesity. We measured RMR by indirect calorimetry after an overnight fast in 26 obesity susceptible (OSI) and 30 obesity resistant (ORI) individuals, identified using a simple 6-item screening tool. Predicted RMR was calculated using the FAO/WHO/UNU (Food and Agricultural Organisation/World Health Organisation/United Nations University), Oxford and Miflin-St Jeor equations. Absolute measured RMR did not differ significantly between OSI versus ORI (6339 vs. 5893 kJ·d⁻¹, p = 0.313). All three prediction equations over-estimated RMR for both OSI and ORI when measured RMR was ≤5000 kJ·d⁻¹. For measured RMR ≤7000 kJ·d⁻¹ there was statistically significant evidence that the equations overestimate RMR to a greater extent for those classified as obesity susceptible with biases ranging between around 10% to nearly 30% depending on the equation. The use of prediction equations may overestimate RMR and energy requirements particularly in those who self-identify as being susceptible to obesity, which has implications for effective weight management.

Is Obesity Associated with Altered Energy Expenditure?

Historically, obese individuals were believed to have lower energy expenditure (EE) rates than nonobese individuals (normal and overweight), which, in the long term, would contribute to a positive energy balance and subsequent weight gain. The aim of this review was to critically appraise studies that compared measures of EE and its components, resting EE (REE), activity EE (AEE), and diet-induced thermogenesis (DIT), in obese and nonobese adults to elucidate whether obesity is associated with altered EE. Contrary to popular belief, research has shown that obese individuals have higher absolute REE and total EE. When body composition (namely the metabolically active component, fat-free mass) is taken into account, these differences between obese and nonobese individuals disappear, suggesting that EE in obese individuals is not altered. However, an important question is whether AEE is lower in obese individuals because of a decrease in overall physical activity or because of less energy expended while performing physical activity. AEE and DIT could be reduced in obese individuals, mostly because of unhealthy behavior (low physical activity, higher intake of fat). However, the current evidence does not support the hypothesis that obesity is sustained by lower daily EE or REE. Future studies, comparing EE between obese and nonobese and assessing potential physiologic abnormalities in obese individuals, should be able to better answer the question of whether these individuals have altered energy metabolism.

Resting energy expenditure in type 2 diabetic patients and the effect of insulin bolus

AIMS

Resting energy expenditure (REE) plays a critical role in the regulation of body weight, with important implications in type 2 diabetes (T2D). However, the relationships between REE and T2D have not been extensively evaluated. We compared REE in persons with diabetes and in persons without diabetes. We also investigated the acute effect of insulin on REE and venous lactate, the latter an indirect measure of neoglucogenetic activity.

METHODS

REE was measured using indirect calorimetry in 14 newly diagnosed, untreated T2D adults and in 14 non-diabetic age-, gender- and body mass index-matched persons. The REE and lactate venous concentrations were also measured in a subgroup of 5 T2D patients in the hour following an IV insulin bolus.

RESULTS

The REE normalized for fat-free mass (FFM) was significantly higher in T2D patients than in the group without diabetes (mean ± SD: 27.6 ± 1.9 vs. 25.8 ± 1.9 kcal/kg-FFM·24h; P=0.02). REE normalized for FFM was correlated with fasting plasma glucose concentration (r=0.51; P=0.005). Following the insulin venous bolus REE (0': 2,048 ± 242; 10': 1,804 ± 228; 20': 1,684 ± 230; 30': 1,634 ± 212; 45': 1,594 ± 179; 60': 1,625 ± 197 kcal/24h; P<0.001) and both glucose (P<0.001) and lactate (P<0.001) concentrations progressively declined in the ensuing hour.

CONCLUSIONS

Patients with diabetes have a higher energy expenditure, likely a consequence of higher gluconeogenetic activity. This study may contribute to recognizing the nature of body weight reduction that occurs in concomitance with poorly controlled diabetes, and of body weight gain as commonly observed when hypoglycemic treatment is started.

The carbohydrate sensitive rat as a model of obesity

BACKGROUND

Sensitivity to obesity is highly variable in humans, and rats fed a high fat diet (HFD) are used as a model of this inhomogeneity. Energy expenditure components (basal metabolism, thermic effect of feeding, activity) and variations in substrate partitioning are possible factors underlying the variability. Unfortunately, in rats as in humans, results have often been inconclusive and measurements usually made after obesity onset, obscuring if metabolism was a cause or consequence. Additionally, the role of high carbohydrate diet (HCD) has seldom been studied.

METHODOLOGY/FINDINGS

Rats (n=24) were fed for 3 weeks on HCD and then 3 weeks on HFD. Body composition was tracked by MRI and compared to energy expenditure components measured prior to obesity.

RESULTS

1) under HFD, as expected, by adiposity rats were variable enough to be separable into relatively fat resistant (FR) and sensitive (FS) groups, 2) under HCD, and again by adiposity, rats were also variable enough to be separable into carbohydrate resistant (CR) and sensitive (CS) groups, the normal body weight of CS rats hiding viscerally-biased fat accumulation, 3) HCD adiposity sensitivity was not related to that under HFD, and both HCD and HFD adiposity sensitivities were not related to energy expenditure components (BMR, TEF, activity cost), and 4) only carbohydrate to fat partitioning in response to an HCD test meal was related to HCD-induced adiposity.

CONCLUSIONS/SIGNIFICANCE

The rat model of human obesity is based on substantial variance in adiposity gains under HFD (FR/FS model). Here, since we also found this phenomenon under HCD, where it was also linked to an identifiable metabolic difference, we should consider the existence of another model: the carbohydrate resistant (CR) or sensitive (CS) rat. This new model is potentially complementary to the FR/FS model due to relatively greater visceral fat accumulation on a low fat high carbohydrate diet.

Relationships between maximal oxygen uptake and endothelial function in healthy male adults: a preliminary study

Aerobic capacity, as indicated by maximal oxygen uptake (VO2 max) has an important role in contrasting the traditional cardiovascular risk factors and preventing cardiovascular morbidity and mortality. It is known that endothelial function, measured as flow-mediated dilation (FMD) of the brachial artery, is strictly linked to atherogenesis and cardiovascular risk. However, the relationship between VO2 max and FMD has not been fully investigated especially in healthy non-obese subjects. This preliminary study cross-sectionally investigated the relationship between VO2 max and FMD in 22 non-obese, healthy sedentary male subjects. Dividing the cohort in two subgroups of 11 subjects each according to the median value of VO2 max, the FMD was significantly lower in the subgroup with lower VO2 max (mean ± sem: 7.1 ± 0.7 vs. 9.5 ± 0.8 %; P = 0.035). Absolute VO2 max (mL min(-1)) was significantly and independently correlated with body fat mass (r = -0.50; P = 0.018) and with FMD (r = 0.44; P = 0.039). This preliminary study suggests that maximal oxygen uptake is independently correlated with endothelial function in healthy non-obese adults. These results are also in agreement with the possibility that improving maximal oxygen uptake may have a favorable effect on endothelial function and vice versa.

High energy expenditure masks low physical activity in obesity

OBJECTIVE

To investigate energy expenditure in lean and obese individuals, focusing particularly on physical activity and severely obese individuals.

DESIGN

Total daily energy expenditure (TDEE) was assessed using doubly labeled water, resting metabolic rate (RMR) by indirect calorimetry, activity energy expenditure (AEE) by difference and time spent in physical activity by multisensor activity monitors.

SUBJECTS

In all, 177 lean, Class I and severely obese individuals (age 31-56 years, body mass index 20-64 kg m(-2)) were analyzed.

RESULTS

All components of energy expenditure were elevated in obese individuals. For example, TDEE was 2404±95 kcal per day in lean and 3244±48 kcal per day in Class III obese individuals. After appropriate adjustment, RMR was similar in all groups. Analysis of AEE by body weight and obesity class indicated a lower AEE in obese individuals. Confirming lower physical activity, obese individuals spent less time engaged in moderate-to-vigorous physical activity (2.7±1.3, 1.8±0.6, 2.0±1.4 and 1.2±1.0 h per day in lean, Class I, Class II and Class III individuals) and more time in sedentary behaviors.

CONCLUSIONS

There was no indication of metabolic efficiency in even the severely obese, as adjusted RMR was similar across all groups. The higher AEE observed in the obese is consistent with a higher cost of activities due to higher body weight. However, the magnitude of the higher AEE (20-25% higher in obese individuals) is lower than expected (weight approximately 100% higher in Class III individuals). Confirming a lower volume of physical activity in the obese, the total time spent in moderate-to-vigorous physical activity and average daily metabolic equivalent of task level were lower with increasing obesity. These findings demonstrate that high body weight in obese individuals leads to a high TDEE and AEE, which masks the fact that they are less physically active, which can be influenced by duration or intensity of activity, than in lean individuals.

Effects of red orange juice intake on endothelial function and inflammatory markers in adult subjects with increased cardiovascular risk

BACKGROUND

Oxidative and inflammatory stresses are involved in the pathogenesis of atherosclerosis. The consumption of fruit and vegetables is associated with improved health and reduced cardiovascular risk. Red oranges have a high content of antioxidant and antiinflammatory substances, but there is a paucity of data concerning their effects on cardiovascular biomarkers in subjects with increased cardiovascular risk.

OBJECTIVE

We investigated the effect of red orange juice intake on endothelial function, oxidative stress, and markers of inflammation in subjects with increased cardiovascular risk.

DESIGN

Nineteen nondiabetic subjects with increased cardiovascular risk (aged 27-56 y) were included in a randomized, placebo-controlled, single-blind crossover study and compared with 12 healthy, nonobese control subjects. In 2 periods of 7 d each with a 3-d interval, each participant alternatively received 500 mL red orange juice/d and 500 mL placebo/d in a random sequence. All measurements were performed in the morning after overnight fasting.

RESULTS

Endothelial function, which was measured as flow-mediated dilation, significantly improved and was normalized (5.7% compared with 7.9%; P < 0.005) after 1 wk of red orange juice consumption. Similarly, concentrations of high-sensitivity C-reactive protein, IL-6, and TNF-α significantly decreased (P < 0.001). Red orange juice had no significant effect on nitric oxide plasma concentrations.

CONCLUSION

A 7-d consumption of red orange juice ameliorates endothelial function and reduces inflammation in nondiabetic subjects with increased cardiovascular risk. This trial was registered at biomedcentral.com as ISRCTN39987296.

Long-term effects of a multidisciplinary treatment of uncomplicated obesity on carotid intima-media thickness

Obesity is associated with well-known cardiovascular risk factors and a lower life expectancy. This study investigated whether nonoperative nutritional treatment of obesity without comorbidities influenced the carotid intima-media thickness (c-IMT) in the long run. Fifty-four subjects of an original cohort of 251 subjects were re-evaluated 10 years after a medical nutritional treatment (MNT) with cognitive-behavioral approach for uncomplicated obesity. Forty subjects were classified as failure (10-year body weight change > 0.5 kg) and 14 (body weight change ≤ 0.5 kg) as a success of the MNT. Ten years after MNT, c-IMT significantly increased (0.06 ± 0.02 mm; P = 0.004) in the failure group and significantly decreased (-0.07 ± 0.03 mm; P = 0.027) in the success group. Ten-year change in c-IMT correlated significantly with 10-year change in body weight (r = 0.28; P = 0.040). Multiple stepwise linear regression analysis demonstrated that age, final BMI, and group (success or failure) influenced independently the 10-year c-IMT. In conclusion, this study is in agreement with the possibility that the successful MNT of obesity may be an effective choice in the long run and seems to indicate that it may be able to reduce the cardiovascular risk as reflected by the change in c-IMT.

New specific equation to estimate resting energy expenditure in severely obese patients

Calculating the estimated resting energy expenditure (REE) in severely obese patients is useful, but there is controversy concerning the effectiveness of available prediction equations (PE) using body weight (BW). We evaluated the efficacy of REE equations against indirect calorimetry (IC) in severely obese subjects and aimed to develop a new equation based on body composition compartments. One hundred and twenty severely obese patients had their REE measured (MREE) by IC and compared to the most commonly used PE (Harris-Benedict (HB), Ireton-Jones, Owen, and Mifflin St. Jeor). In a random sample (n = 60), a new REE equation based on fat-free mass (FFM) was developed and validated. All PE studied failed to estimate REE in severe obesity (low concordance correlation coefficient (CCC) and limits of agreement of nearly 50% of the sample ±10% of MREE). The HB equation using actual BW exhibited good results for all samples when compared to IC (2,117 ± 518 kcal/day by HB vs. 2,139 ± 423 kcal/day by MREE, P > 0.01); these results were blunted when patients were separated by gender (2,771 vs. 2,586 kcal/day, P < 0.001 in males and 1,825 vs. 1,939 kcal/day, P < 0.001 in females). A new resting energy expenditure equation prediction was developed using FFM, Horie-Waitzberg, & Gonzalez, expressed as 560.43 + (5.39 × BW) + (14.14 × FFM). The new resting energy expenditure equation prediction, which uses FFM and BW, demonstrates higher accuracy, precision, CCC, and limits of agreement than the standard PE in patients when compared to MREE (2,129 ± 45 kcal/day vs. 2,139 ± 423 kcal/day, respectively, P = 0.1).The new equation developed to estimate REE, which takes into account both FFM and BW, provides better results than currently available equations.

Glycaemic variability using continuous glucose monitoring and endothelial function in the metabolic syndrome and in Type 2 diabetes

AIMS

Subjects who are at increased risk of developing diabetes may have increased glycaemic variability associated with endothelial dysfunction and possibly subclinical atherosclerosis, which may lead to increased cardiovascular risk observed at the time of diabetes diagnosis. To investigate this hypothesis, we measured endothelial function, carotid intima-media thickness and glycaemic variability using 48-h continuous subcutaneous glucose monitoring in 3 groups of overweight or obese subjects--those without the metabolic syndrome, and those with the metabolic syndrome with or without newly diagnosed Type 2 diabetes.

METHODS

Consecutive subjects, aged 30-65 years with a body mass index >or= 25 kg/m(2) were recruited. Patients were classified as with or without the metabolic syndrome,or as metabolic syndrome with newly diagnosed Type 2 DM. Glycaemic variability was calculated in terms of the coefficient of variation. Endothelial function was measured using brachial artery flow-mediated dilation.

RESULTS

We identified 75 subjects. Mean flow mediated dilation decreased (P < 0.001) and carotid intima-media thickness increased (P < 0.05) across groups. Flow mediated dilation predictors included mean 48-h continuous subcutaneous glucose monitoring values (beta = -0.022; P < 0.005) and the coefficient of variation (beta = -0.10; P = 0.01). Carotid intima-media thickness predictors included age (beta = 0.009; P < 0.001) and flow mediated dilation (beta = -0.014; P = 0.076). Patients re-stratified according to cut-offs for mean 48-h glycaemia and variability demonstrated that subjects with high mean glycaemia but low coefficient of variability had similar flow mediated dilation and carotid intima-media thickness to subjects with low mean glycaemia but high coefficient of variation.

CONCLUSIONS

This study suggests that glycaemic variability influences endothelial function even in non-diabetic subjects. Such variability may explain the increased cardiovascular risk observed in patients prior to developing overt Type 2 diabetes.

Intra-renal hemodynamics and carotid intima-media thickness in the metabolic syndrome

AIMS

Metabolic syndrome (MetS) is associated with increased cardiovascular risk. We hypothesize that early vascular changes are already present at the time of diagnosis of MetS. The relationship of different measures of early vascular impairment with body fat distribution and the natural progression of MetS was examined in newly diagnosed subjects non-pharmacologically treated.

METHODS

246 consecutively enrolled subjects were categorized according to the presence of MetS and type 2 diabetes (T2D). Intra-renal Doppler flow was used to ascertain resistive (RI) and pulsatility (PI) indices as markers of vascular resistance. Carotid intima-media thickness (IMT), cutis-rectis (CR) and rectis-aorta (RA) thicknesses were measured by ultrasonography; RA/CR ratio was used as measure of body fat distribution. Pro-inflammatory cytokines, C-reactive protein, oxidative markers insulin and adiponectin blood concentrations were also measured.

RESULTS

Baseline characteristics demonstrated increasing trends in biochemical, inflammatory, and oxidative parameters from MetS-, MetS+, to MetS+/T2D (p<0.001). After adjusting for age, the same increasing trends across the groups were observed in both sexes in IMT (p<0.001), RI (p<0.001) and PI (p<0.001). IMT correlated with RI (r=0.25; p<0.001), PI (r=0.26; p<0.001), and RA/CR ratio (r=0.43; p<0.001).

CONCLUSIONS

Carotid IMT and intra-renal resistances are elevated at an early stage in MetS and are associated with a dysregulated production of fat-derived hormones and cytokines.

Effects of hypocaloric very-low-carbohydrate diet vs. Mediterranean diet on endothelial function in obese women*

Obesity is a cardiovascular risk factor associated with endothelial dysfunction, but the effect of different weight loss strategies on endothelial function is not known. The effect of diet on endothelial function in two hypocaloric diets, a very-low-carbohydrate diet (A) and a Mediterranean diet (M), was measured by brachial artery flow-mediated dilation (FMD). Design Using a longitudinal, randomized, open study design, subjects were engaged in a 2-month weight loss diet. FMD, inflammatory cytokines [interleukin-6 (IL-6) and tumour necrosis factor-alpha] and a marker of oxidative stress [8-iso-prostaglandin F2alpha (8-iso-PGF2alpha)] were measured in subjects on three occasions: before initiating the diet (T0), after 5-7 days of dieting (T5) and after 2 months of dieting (T60). The very short- and medium-term time points were established to discriminate respectively the effect of the diet itself (T5) from that of weight loss (T60). Twenty overweight/obese but otherwise healthy women (BMI: 27-34.9 kg m(-2); age 30-50 years) completed the study. Results Group A lost more weight (mean +/- SEM; -7.6 +/- 0.8 kg) than group M (-4.9 +/- 0.6 kg, P = 0.014) at T60. The FMD was not significantly different between the two groups at T0 (group A: 12.2 +/- 2.9% vs. group B: 10.3 +/- 2.3%, P = ns). In group A, FMD was significantly reduced at T5 and returned to baseline at T60; in group M, FMD increased at T5 and returned to baseline at T60 (P = 0.007 for diet x time interaction). Serum concentrations of IL-6 and 8-iso-PGF2alpha were not significantly different between the two groups at T0 and increased significantly at T5 only in group A (P < 0.001 and P < 0.005 respectively). Conclusion As endothelial dysfunction is known to be associated with acute cardiovascular events, this study suggests that the cardiovascular risk might be increased in the first days of a very-low-carbohydrate diet.

Differences in daily energy expenditure in lean and obese women: the role of posture allocation

OBJECTIVE

A low resting metabolic rate (RMR) is considered a risk factor for weight gain and obesity; however, due to the greater fat-free mass (FFM) found in obesity, detecting an impairment in RMR is difficult. The purposes of this study were to determine the RMR in lean and obese women controlling for FFM and investigate activity energy expenditure (AEE) and daily activity patterns in the two groups.

METHODS AND PROCEDURES

Twenty healthy, non-smoking, pre-menopausal women (10 lean and 10 obese) participated in this 14-day observational study on free-living energy balance. RMR was measured by indirect calorimetry; AEE and total energy expenditure (TEE) were calculated using doubly labeled water (DLW), and activity patterns were investigated using monitors. Body composition including FFM and fat mass (FM) was measured by dual energy X-ray absorptiometry (DXA).

RESULTS

RMR was similar in the obese vs. lean women (1601 +/- 109 vs. 1505 +/- 109 kcal/day, respectively, P = 0.12, adjusting for FFM and FM). Obese women sat 2.5 h more each day (12.7 +/- 3.2 h vs. 10.1 +/- 2.0 h, P < 0.05), stood 2 h less (2.7 +/- 1.0 h vs. 4.7 +/- 2.2 h, P = 0.02) and spent half as much time in activity than lean women (2.6 +/- 1.5 h vs. 5.4 +/- 1.9 h, P = 0.002).

DISCUSSION

RMR was not lower in the obese women; however, they were more sedentary and expended less energy in activity than the lean women. If the obese women adopted the activity patterns of the lean women, including a modification of posture allocation, an additional 300 kcal could be expended every day.

A low resting metabolic rate is associated with metabolic syndrome

BACKGROUND & AIMS

The metabolic syndrome is associated with central accumulation of fat. Previous studies showed that some obese subjects are characterized by a sparing energy metabolism. The aim of this study was to investigate whether obese subjects with metabolic syndrome have a lower resting metabolic rate than obese subjects without metabolic syndrome.

METHODS

Forty obese subjects were divided into three groups according to the presence of metabolic syndrome and type 2 diabetes; 15 non-obese healthy control subjects were also enrolled. Body composition (bio-impedance analysis) and resting metabolic rate (indirect calorimetry) were performed.

RESULTS

The group with metabolic syndrome exhibited a significantly lower resting metabolic rate adjusted for fat-free mass with respect to the control group and the obese group without metabolic syndrome (respectively: 108+/-3 vs. 118+/-3, p<0.01 and 123+/-3 kJ/kg fat-free mass 24 h, p<0.01; mean+/-sem). The obese group with metabolic syndrome and type 2 diabetes (T2D) had a not different adjusted resting metabolic rate (114+/-6 kJ/kg fat-free mass 24h) with respect to other groups.

CONCLUSIONS

An energy sparing condition seems to characterize non-diabetic obese subjects with metabolic syndrome.

Body composition and resting energy expenditure in patients aged 11 to 21 years with spinal cord dysfunction compared to controls: comparisons and relationships among the groups

OBJECTIVES

To compare body composition in patients aged 11 to 21 years with spinal dysfunction due to spinal cord injury (SCI) and spina bifida (SB) vs. able-bodied control (CTRL) and able-bodied overweight (OW) groups and to examine the relationships between resting energy expenditure (REE) and total lean mass (TLM) in the SCI, SB, CTRL, and OW groups.

METHODS

Two hundred fifteen subjects, including 85 CTRL, 31 OW, 33 SCI, and 66 SB, were evaluated. Body composition was estimated by dual energy x-ray absorptiometry (DXA). Measurements included height, weight, total lean mass (TLM), fat tissue mass (FTM), body mass index (BMI), BMI percentile (BMI%tile), and % fat. Resting energy measurements were obtained in fasting subjects with an open-circuit indirect calorimeter.

RESULTS

There were gender differences in height, weight, BMI, TLM, fat mass, % fat, and REE. The REE in the SCI and SB groups was significantly different from that in the CTRL and OW groups, but no significant difference was found between the SCI and SB groups. The SB group had significantly higher REE/TLM ratios than did the other groups. The % fat was significantly higher in the SB and OW groups as compared to the CTRL and SCI groups. TLM was significantly higher in CTRL and OW groups as compared to SCI and SB groups, with the lowest TLM found in the SB group.

CONCLUSION

Patients aged 11 to 21 years with SB or SCI have significant lean tissue mass deficits by DXA as compared to able-bodied CTRL and OW groups, with the greatest deficits in total lean mass measured in SB. The absolute REE values were significantly reduced in both SCI and SB groups in association with their lean tissue deficits. Interestingly, REE/TLM ratios were remarkably constant in the CTRL, OW, and SCI groups but significantly elevated in the SB group. One would expect an even greater degree of adiposity in the SB group if their REE/TLM ratios were not elevated relative to those without congenital paralysis.

Body cell mass measured by total body potassium in normal-weight and obese men and women

OBJECTIVE

Total body potassium (TBK) concentration is linearly correlated with the size of the body cell mass (BCM). The aim of this study was to compare BCM in normal-weight and obese individuals.

METHODS

271 individuals (207 males, 64 females), 20 to 67 years of age, participated in this study. Subjects were separated by body mass index (BMI): BMI < 25 kg/m(2) (BMI-L) and BMI > 25 kg/m(2) (BMI-H). (40)K was assessed using a whole-body counter and BCM was calculated.

RESULTS

BCM and TBK were significantly greater in men, with a trend to be greater in women in BMI-H compared to men in BMI-L. TBK/body weight was significantly lower, while TBK/height was significantly greater for men and women in BMI-H compared to men and women in BMI-L. Fat-free mass (FFM) was significantly greater for men in BMI-H, with no significant differences in FFM between the two groups of women.

CONCLUSIONS

The healthy obese subjects in the present study had a greater BCM than the non-obese subjects. These results indicate that it is important to assess BCM in obese individuals because it could influence the type of weight loss regimen that will be used in order to preserve BCM.

Low relative resting metabolic rate and body weight gain in adult Caucasian Italians

OBJECTIVE

To investigate the relationship between resting metabolic rate (RMR) and subsequent changes in body size and degree of fatness in a group of adult Caucasian Italians.

DESIGN

Prospective, longitudinal, observational study.

SUBJECTS

In total, 155 subjects (72 males and 83 females, age range: 18-55 y; BMI: 17.5-63.4 kg/m2) were evaluated. In total, 43 (26 m and 17 f; BMI: 28.9+/-1.1 kg/m2, mean+/-s.e.m.) of them were reassessed 10-12 y later.

MEASUREMENTS

Anthropometric and body composition (bioimpedance analysis) parameters and RMR (indirect calorimetry) were taken at baseline and after 10-12 y.

RESULTS

Subjects (15 m, 8 f) who gained body weight (arbitrarily defined as a change in body weight > or = 5 kg) had baseline BMI (29.9+/-1.8 vs 28.0+/-1.4; P = NS) and body composition in terms of fat mass (FM%) and fat-free mass (FFM kg) comparable to those of the subjects (11 m, 9 f) whose body weight remained stable. Baseline RMR was significantly lower in subjects who gained weight than in those who did not (108+/-2.1 vs 122+/-3.1 kJ/kg-FFM 24 h; P < 0.001), although it did not differ significantly between the two groups (119+/-2 vs 121+/-2 kJ/kg-FFM 24 h; P = NS) 10-12 y later. Baseline RMR was inversely correlated to both change in body weight (r = -0.57; P < 0.001) and FM (r = -0.50; P < 0.001).

CONCLUSION

A low RMR normalized for FFM appears to be associated with body weight gain in the long run in adult Caucasian Italians.

Prediction of basal metabolism from organ size in the rat: relationship to strain, feeding, age, and obesity

Use of the weight of various organs and tissues together with their specific metabolic activity for prediction of basal metabolism (BM) seems to be promising. In this study we compared the use of this method with those based on simple or multiple regression analyses. We observed that 97.4% of differences in BM in a group of nine adult male Wistar rats weighing 273–517 g could be accounted for by changes in tissue and organ weights. BM measured in lean Zucker and Sprague-Dawley rats did not diverge from the prediction of the model by >1.6%. According to the organ-based model as well as multiple regression analyses, but not simple regression analyses, BM was increased 18–21% in young rats, decreased 6–7% in food restricted/refed rats, and decreased 19–21% in aged rats. Only with obese rats did the predictions of the two methods diverge. The main reason for this discrepancy seems to be the way adipose tissue size and metabolism are taken into account.

Influences of obesity and weight loss on thyroid hormones. A 3-3.5-year follow-up study on obese subjects with surgical bilio-pancreatic by-pass

The effects of changing body size, energy intake and substrate oxidation on serum T4, FT4, T3, FT3 and TSH were investigated in ten morbidly obese subjects (4 men/6 women; age: 37 +/- 6 years; BMI: 53.8 +/- 6.5 kg/m2; mean +/- SD) who had undergone a surgical bilio-pancreatic by-pass in order to reduce their body weight. The starting value of serum FT3 was inversely related to the BMI (r = -0.63; p < 0.05). After 1-3 months, all the subjects were losing weight and their intake of carbohydrates was almost negligible; at this time a significant reduction of T3 (-14.6%; p < 0.0001), T4 (-19.5%; p < 0.0001), and FT3 (-10.5%; p < 0.001) was observed. Nine to 16 months after surgery, all the subjects were still losing weight, although there was no carbohydrate restriction; T3, T4, and FT3 were lower than prior to surgery but were beginning to increase. Finally, after 36-42 months the body weight of all the patients had been stable for at least the previous six months (final BMI: 32.9 +/- 4.1) and their body composition, as assessed by bio-impedance, was almost normal; only the concentrations of FT3 proved to be significantly lower than the basal value (-11.2%; p < 0.03). The change in FT3 proved to be independently influenced by the degree of fat malabsorption but not by changes in any of the physical characteristics considered. All values were always in the normal range; FT4 and TSH did not change significantly during the whole period of study. The final concentrations of TSH proved to be independently related to the postabsorptive protein oxidation (g/24h) (TSH = 2.37-0.018* protein oxidation). These results would suggest that nutritional factors have some influence on the blood levels of thyroid hormones, especially of FT3, while the removal of obesity does not seem to have any independent effect in the long-run.