SARS-CoV-2 exposures among healthcare workers in New York City

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on hospitals, including the occupational health departments in charge of handling healthcare worker (HCW) staffing during high rates of exposure and infection of HCWs. HCWs who were exposed to a patient or community member infected with SARS-CoV-2 were required to isolate from work for a minimum of 14 days from the date of exposure.

Aims

This study was aimed to assess the relative risk of SARS-CoV-2 infection following different types of workplace and community exposures.

Methods

We analyzed the details of workplace and community exposures of HCWs to SARS-CoV-2 at Montefiore Medical Center in New York between 22 June 2020 and 22 November 2020.

Results

Of 562 HCW SARS-CoV-2 exposures analyzed, 218 were from the community and 345 were from the workplace. Twenty-nine per cent of community exposures resulted in infection, which was significantly greater than workplace exposure infection (2%). Household community exposures resulted in a larger frequency of infection than non-household community exposures. Of the seven infections after workplace exposures, five had qualifying exposures to a co-worker and two were exposed to an infected patient during a non-aerosolized procedure.

Conclusions

HCW exposure to SARS-CoV-2 continues to present staffing challenges to healthcare systems. Even with deviations from standard personal protective equipment protocol, workplace exposures resulted in low frequencies of infection. In our study, the primary source of HCW infection was exposure in the community. Our findings support investing in efforts to educate around continued masking and social distancing in the community in addition to interventions targeted at addressing vaccine hesitancy.

Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines

OBJECTIVE

To assess the clinical usefulness of published guidelines for the use of orlistat, by studying whether weight loss >/=2.5 kg during a 4 week dietary lead-in period, and weight losses of >/=5% after 12 weeks and >/=10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years.

DESIGN

A retrospective analysis of pooled data from 2 multicentre, randomised, placebo-controlled clinical trials with similar design.

SETTING

Twenty-nine centres throughout Europe.

PARTICIPANTS

Two hundred and twenty men and women (BMI 28-43 kg/m(2)) who completed 2 years of treatment.

INTERVENTION

After a 4 week hypocaloric diet plus placebo, 2 years of treatment with orlistat 120 mg tid, plus a hypocaloric diet for the first year and a weight maintenance diet in year two.

MAIN OUTCOME MEASURES

Weight loss and obesity-related risk factor changes.

RESULTS

Weight loss >/=5% body weight after 12 weeks of diet plus orlistat therapy was a good indicator of 2 year weight loss, whereas weight loss of >/=2.5 kg during the 4 week lead-in and >/=10% after 6 months did not add significantly to the prediction of 2 year outcomes. Patients who lost >/=5% of their weight at 12 weeks (n=104, 47.3%) lost significantly more weight after 2 years than others: -11.9% (95% confidence interval (CI) -13.4% to -10.3%) vs -4.7% (-5.7% to -3.7%) (P=0.0001), and had significantly greater reductions in total cholesterol, LDL-cholesterol, triglycerides, glucose, insulin, and blood pressure. Among those who achieved >/=5% weight loss at 12 weeks, the overall health benefits were not significantly greater in patients who went on to lose >/=10% body weight at 6 months compared with those who did not achieve >/=10% weight loss by month 6.

CONCLUSIONS

Of the criteria currently suggested for assessing response to orlistat treatment, weight loss of >/=5% at 12 weeks accurately predicts sustained improvements in weight and major risk factors at 2 years, while other suggested criteria are less useful.

Metabolic and hemodynamic responses to exercise in subcutaneous adipose tissue and skeletal muscle

This study evaluated the effect of standardized bicycle exercise on metabolism and blood flow in abdominal ( aSAT) and femoral subcutaneous adipose tissue ( fSAT) and skeletal muscle in eleven women and nine men. Using microdialysis, the respective tissues were perfused with Ringer's solution (+ 50 mM ethanol) and dialysate [ethanol], [glycerol], [lactate] and [pyruvate] were measured in order to estimate blood flow (ethanol dilution technique), lipolysis and glycolysis, respectively. At rest, blood flow tended to be higher in the respective tissues of women when compared to men. During exercise, blood flow was increased significantly in fSAT and muscle, but not in aSAT. Dialysate [glycerol] was increased two- to three-fold in aSAT and fSAT, similarly in men and women. However, in muscle, dialysate [glycerol] was increased five-fold in women and four-fold in men without reaching a steady state in women. Corrected for blood flow, the increase in lipolysis was greater in muscle than in fSAT, and greater in fSAT than in aSAT, and in muscle the increase was greater for women compared with men. Dialysate [lactate] and [lactate]/[pyruvate] ratio were much more increased in muscle compared with aSAT and fSAT. It is concluded that lipids stored in muscle are rather used than lipids stored in adipose tissue for fueling the energy metabolism of muscle during exercise. During exercise, lipid mobilization is much greater in women than in men.

Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults

BACKGROUND

Orlistat is a gastrointestinal lipase inhibitor that reduces dietary fat absorption by approximately 30%, promotes weight loss, and may reduce the risk of developing impaired glucose tolerance and type 2 diabetes in obese subjects.

OBJECTIVE

To test the hypothesis that orlistat combined with dietary intervention improves glucose tolerance status and prevents worsening of diabetes status more effectively than placebo.

METHODS

We pooled data from 675 obese (body mass index, 30-43 kg/m2) adults at 39 US and European research centers in 3 randomized, double-blind, placebo-controlled multicenter clinical trials. Subjects received placebo plus a low-energy diet during a 4-week lead-in period. On study day 1, the diet was continued, and subjects were randomized to receive placebo 3 times a day (n=316) or treatment with orlistat, 120 mg 3 times a day (n=359), for 104 weeks. A standard 3-hour oral glucose tolerance test was performed on day 1 and at the end of treatment.

MAIN OUTCOME MEASURES

The categorical assessment of glucose tolerance status (normal, impaired, diabetic) and changes in status from randomization to end of treatment were the primary efficacy measures. The secondary measures were fasting and postchallenge glucose and insulin levels.

RESULTS

The mean length of follow-up was 582 days. Subjects who were treated with orlistat lost more weight (mean +/- SEM, 6.72 +/- 0.41 kg from initial weight) than subjects who received placebo (3.79+/-0.38 kg; P<.001). A smaller percentage of subjects with impaired glucose tolerance at baseline progressed to diabetic status in the orlistat (3.0%) vs placebo (7.6%) group. Conversely, among subjects with impaired glucose tolerance at baseline, glucose levels normalized in more subjects after orlistat treatment (71.6%) vs placebo (49.1%; P=.04).

CONCLUSIONS

The addition of orlistat to a conventional weight loss regimen significantly improved oral glucose tolerance and diminished the rate of progression to the development of impaired glucose tolerance and type 2 diabetes.

Orlistat in the long-term treatment of obesity in primary care settings

OBJECTIVE

To evaluate the long-term efficacy and tolerability within primary care settings of orlistat, a gastrointestinal lipase inhibitor, for the treatment of obesity.

DESIGN

Randomized, double-blind, placebo-controlled, multicenter study.

PARTICIPANTS

A group of 796 obese patients (body mass index, 30-44 kg/m2), treated with placebo 3 times a day (TID), 60 mg of orlistat TID, or 120 mg of orlistat TID, in conjunction with a reduced-energy diet for the first year and a weight-maintenance diet during the second year.

SETTING

Seventeen primary care centers in the United States.

MAIN OUTCOME MEASURES

Changes in body weight and obesity-related disease risk factors.

RESULTS

Patients treated with orlistat lost significantly more weight (7.08 +/- 0.54 and 7.94 +/- 0.57 kg for the 60-mg and 120-mg orlistat groups, respectively) than those treated with placebo (4.14 +/- 0.56 kg) in year 1 (P<.001) and sustained more of this weight loss during year 2 (P<.001). More patients treated with orlistat lost 5% or more of their initial weight in year 1 (48.8% and 50.5% of patients in the 60-mg and 120-mg groups, respectively) compared with placebo (30.7%; P<.001), and approximately 34% of patients in the orlistat groups sustained weight loss of 5% or greater over 2 years compared with 24% in the placebo group (P<.001). Orlistat produced greater improvements than placebo in serum lipid levels and blood pressure and was well tolerated, although treatment resulted in a higher incidence of gastrointestinal events.

CONCLUSIONS

This long-term study indicates that orlistat is an effective adjunct to dietary intervention in the treatment of obesity in primary care settings.

Use of bioelectrical impedance analysis measurements as an evaluation for participating in sports

Bioelectrical impedance analysis (BIA) has potential in the area of sports and exercise as a method for evaluating body composition in groups of athletes. BIA probably holds less promise for detecting small changes in percentage fat within an individual. Available data in athletes have indicated an urgent need to control for testing conditions such as hydration, temperature, glycogen stores, and preceding diet and exercise. There are almost no data available for female athletes, but acceptable results have been reported in males when conditions are well controlled. There is, however, a tendency for BIA to overestimate percentage body fat, and more so in African American athletes. BIA is also potentially useful for assessing the hydration status in wrestlers, but it is advisable to use untransformed BIA measurements rather than to convert resistance measurements to body fat because of the questionable hydration status in these athletes. Untransformed results are potentially useful in evaluating the clinical status of athletes at risk for abnormal hydration because of extreme dieting practices.

Relationship between insulin sensitivity and plasma leptin concentration in lean and obese men

Alterations in the production of or the sensitivity to leptin, the protein encoded by the ob gene, cause obesity and diabetes in rodents. We evaluated the isolated relationship between leptin and insulin sensitivity in lean and obese humans. Three groups of subjects who were carefully matched for either insulin sensitivity (determined by the modified intravenous glucose tolerance test and minimal model analysis) or adiposity (determined by hydrodensitometry) were studied: 1) lean insulin-sensitive men (percentage body fat, 15 +/- 1%); 2) lean insulin-resistant men (percentage body fat, 16 +/- 1%), matched on percentage body fat and fat mass with the lean insulin-sensitive group; and 3) obese insulin-resistant men (percentage body fat, 31 +/- 3), matched on insulin sensitivity with the lean insulin-resistant group. Basal plasma leptin concentrations were significantly lower in the lean insulin-sensitive than in the lean insulin-resistant men (1.90 +/- 0.4 vs. 4.35 +/- 1.21 ng/ml, P < 0.05) despite identical body composition. Plasma leptin in the obese men (9.27 +/- 1.4 ng/ml) was significantly higher than values in the two lean groups (P < 0.01). Marked alterations in plasma glucose and insulin concentrations induced by glucose and tolbutamide injection did not cause any change in plasma leptin levels. These results demonstrate that insulin resistance is associated with elevated plasma leptin levels independent of body fat mass. However, plasma insulin itself does not acutely regulate leptin production.

Validity of a new portable indirect calorimeter: the AeroSport TEEM 100

The purpose of this study was to compare oxygen uptake (VO2) values collected with a new portable indirect calorimeter (AeroSport TEEM 100 Metabolic Analysis System) against a more traditional large calorimeter system that has been reported to be valid and reliable (SensorMedics 2900 Metabolic Measurement Cart). Minute ventilations ranging from rest up to heavy exercise were compared with simultaneous measurements from a 120-1 Tissot gasometer. Each of the three TEEM 100 pneumotachs were tested. Three hundred and sixty-one separate ventilation tests were performed using the low-flow, medium-flow, and high-flow heads of the portable calorimeter. For each of the pneumotachs, the correlation between the portable calorimeter values and the gasometer values exceeded r = 0.94. The standard error of estimate for the low-medium- and high-flow pneumotach were 5.96, 4.89 and 9.0%, respectively, expressed relative to the mean gasometer value. Simultaneous measurements of VO2 using the portable calorimeter and the SensorMedics 2900 unit were compared during rest and at work rates starting at zero watts, increasing by 25 W to 150 W. Each work rate was of 4 min duration. The average of data from minutes 3 and 4 were used in all analyses. There was very close agreement between the two metabolic measurement systems. Except at the 100-W work rate, where the VO2 difference was small (3.9%), yet statistically significant, all of the other differences in VO2 were small and non-significant. The scatter plot of VO2 for the SensorMedics versus the portable Aero-Sport calorimeter revealed close agreement; the correlation was r = 0.96, (SEE = 3.95%).(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome

Women with PCO have a unique but poorly characterized disorder of insulin action. Obese (n = 16) and nonobese (n = 14) PCO women and age- and weight-matched normal, nondiabetic ovulatory women (obese, n = 15; nonobese, n = 17) had insulin action determined in vivo with sequential multiple insulin dose euglycemic clamps and in isolated abdominal adipocytes to clarify the mechanisms of insulin resistance. PCO resulted in significant increases in the ED50 insulin for glucose utilization in vivo (P less than 0.001) and in adipocytes (P less than 0.01), without significant changes in adipocyte insulin-binding sites. PCO also resulted in significant decreases in maximal insulin-stimulated rates of glucose utilization in vivo (P less than 0.01) and in adipocytes (P less than 0.01). Obesity resulted in smaller decreases in insulin sensitivity than PCO (ED50 insulin, P less than 0.001 in vivo and P less than 0.05 in adipocytes), but greater decreases in insulin responsiveness (Vmax, P less than 0.001 in vivo and in adipocytes). The ED50 insulin for suppression of HGP was increased only in obese PCO women (P less than 0.001), and the interactions between PCO and obesity on this parameter were statistically significant. No significant correlations between androgen or estrogen levels and adipocyte insulin binding or action were found. Because insulin binding was not changed, we conclude that the major lesion causing insulin resistance in PCO is a striking decrease in insulin sensitivity secondary to a defect in the insulin receptor and/or postreceptor signal transduction. PCO also is associated with modest but significant decreases in glucose transport. These defects in insulin action appear to represent intrinsic abnormalities that are independent of obesity, metabolic derangements, body fat topography, and sex hormone levels. Conversely, changes in hepatic insulin sensitivity appear to be acquired with obesity.

Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome

Women with PCO have a unique but poorly characterized disorder of insulin action. Obese (n = 16) and nonobese (n = 14) PCO women and age- and weight-matched normal, nondiabetic ovulatory women (obese, n = 15; nonobese, n = 17) had insulin action determined in vivo with sequential multiple insulin dose euglycemic clamps and in isolated abdominal adipocytes to clarify the mechanisms of insulin resistance. PCO resulted in significant increases in the ED50 insulin for glucose utilization in vivo (P less than 0.001) and in adipocytes (P less than 0.01), without significant changes in adipocyte insulin-binding sites. PCO also resulted in significant decreases in maximal insulin-stimulated rates of glucose utilization in vivo (P less than 0.01) and in adipocytes (P less than 0.01). Obesity resulted in smaller decreases in insulin sensitivity than PCO (ED50 insulin, P less than 0.001 in vivo and P less than 0.05 in adipocytes), but greater decreases in insulin responsiveness (Vmax, P less than 0.001 in vivo and in adipocytes). The ED50 insulin for suppression of HGP was increased only in obese PCO women (P less than 0.001), and the interactions between PCO and obesity on this parameter were statistically significant. No significant correlations between androgen or estrogen levels and adipocyte insulin binding or action were found. Because insulin binding was not changed, we conclude that the major lesion causing insulin resistance in PCO is a striking decrease in insulin sensitivity secondary to a defect in the insulin receptor and/or postreceptor signal transduction. PCO also is associated with modest but significant decreases in glucose transport. These defects in insulin action appear to represent intrinsic abnormalities that are independent of obesity, metabolic derangements, body fat topography, and sex hormone levels. Conversely, changes in hepatic insulin sensitivity appear to be acquired with obesity.

Postprandial thermogenesis at rest and postexercise before and after physical training in lean, obese, and mildly diabetic men

To determine the independent impact of physical training on postprandial thermogenesis at rest and after 1 hour of cycling at 100 W, 10 lean (15% +/- 1% body fat), 10 obese (33% +/- 2% fat), and six obese diet-controlled, type II diabetic men (34% +/- 4% fat) underwent 12 weeks of vigorous cycle ergometer training (4 h/wk at approximately 70% of maximum oxygen consumption [VO2max]) while maintaining body weight and composition. Body weight was held constant by refeeding the energy expended in each training session. Cardiorespiratory fitness increased by approximately 27%, but body weight and fat did not change. Before and at least 4 days after the last exercise session, energy expenditure was measured for 3 hours under four conditions: (1) rest, no meal; (2) rest, after a 720-kcal mixed meal; (3) postexercise after 1 hour cycling, no meal; and (4) postexercise, meal after exercise. The thermic effect of food was calculated as postprandial minus postabsorptive energy expenditure at rest and postexercise (kcal/3 h). Before and after training, the thermic effect of food during rest was lower in obese than in lean men, and lower in diabetic than in obese men (P less than .05). Thermogenesis was improved after short-term exercise in obese and diabetic men compared with that at rest, but was not normalized (P less than .05 for lean v obese, diabetic men). A significant effect of training on thermogenesis was due to a small but significant increase after training for diabetic men under the postexercise condition. Thus, while short-term exercise enhances but does not normalize thermogenesis in obese and diabetic men, long-term exercise training leading to increased cardiorespiratory fitness, in the absence of changes in body composition, leads to a small increase in thermogenesis in diabetic men, which manifests only after a short period of exercise.

Reliability of the measurement of postprandial thermogenesis in men of three levels of body fatness

To determine the reliability of the measurement of postprandial thermogenesis by indirect calorimetry and to clarify further the relationship of obesity to thermogenesis in men, the thermic effect of a 720-kcal, mixed liquid meal was compared in 13 lean men (mean +/- SEM, 11.2% +/- 1.4% body fat), 10 average men (22.4% +/- 1.6% body fat), and 12 obese men (33.4% +/- 1.6% body fat) on two occasions. Resting metabolic rate (RMR) was measured for 3 hours: (1) in the fasted state, and (2) after a 720-kcal mixed liquid meal, on two occasions. The thermic effect of the meal, calculated as the postprandial energy expenditure minus the fasting RMR (kcal/3h), was greater for the lean and average men than for the obese men during both trials (P less than .001), but was only marginally different between the lean and average groups (P = .16). The mean values for the two trials were similar and the measurement of thermogenesis was highly reproducible with a reliability coefficient of r = .932 (P less than .001). Across all groups, thermogenesis correlated strongly with percent body fat (r = -.64, P less than .01), but within the average men, thermogenesis was uncorrelated with percent body fat (r = .09) but highly correlated with the glucose response to the meal (r = -.75, P less than .05). Thus, factors other than body fatness, such as insulin sensitivity, may determine thermogenesis within this heterogeneous middle group.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of exercise mode and intensity on postprandial thermogenesis in lean and obese men

To characterize further the impact of exercise before a meal on thermogenesis, the effects of exercise intensity and mode and the duration of the effect of exercise on the thermic effect (TEF) of a 720-kcal mixed meal were compared in 10 lean and 10 obese men (16 +/- 1 vs. 34 +/- 2% fat). In study A, TEF (kcal/3 h) was significantly greater for the lean than the obese men during rest and immediately after 1 h of cycling at 50 and 100 W. TEF was significantly greater after both exercise intensities than during rest for the obese men, but exercise had no effect on TEF in the lean men. In study B, TEF was significantly greater for the lean than the obese men during rest and immediately after 1 h of leg cycling at an O2 consumption of 1.09 l/min but only marginally different after 1 h of arm exercise at the same O2 consumption (P = 0.15). For the obese men, TEF was greater after arm than leg cycling and greater after leg cycling than at rest (P less than 0.01), but TEF was not different among the three conditions for the lean men. In study C, TEF was compared at rest and immediately and 24 h after 1 h of cycling at 100 W. TEF was greater for the lean than the obese men under all conditions (P less than 0.05). For the obese but not the lean men, TEF was greater both immediately after and on the day after exercise than at rest (P less than 0.01). Thus, acute exercise improves but does not normalize the blunted TEF in obesity; a minimally intense bout of exercise is needed to improve TEF; exercise mode alters thermogenesis in the obese men, even at a fixed intensity; and TEF in the obese men is enhanced for as long as 24 h after exercise.

Independent effects of obesity and insulin resistance on postprandial thermogenesis in men

The putative blunted thermogenesis in obesity may be related to insulin resistance, but insulin sensitivity and obesity are potentially confounding factors. To determine the independent effects of obesity and insulin resistance on the thermic effect of food, at rest and after exercise, lean and obese men were matched at two levels of insulin sensitivity determined by insulin-stimulated glucose disposal (milligrams per kilogram fat-free mass [FFM] per minute) during the euglycemic, hyperinsulinemic (40 mU/m2.min) clamp: 5.4 mg/kg FFM for the lean and obese groups with low insulin sensitivity, and 8.1 mg/kg FFM for the groups with high insulin sensitivity. The two lean groups were matched for percent fat (approximately 15 +/- 1% fat), as were the two obese groups (approximately 33 +/- 2% fat). Energy expenditure was measured for 3 h in the fasting state and for 3 h after a 720-kcal mixed meal, each at rest and immediately after 1 h of cycling at 100 W. The thermic effect of food (TEF) was calculated as the postprandial minus fasting energy expenditure (kcal/3 h) during rest and after exercise. During rest, TEF was blunted by both obesity (24 +/- 5 and 34 +/- 6 kcal/3 h for obese groups with low and high insulin sensitivity vs. 56 +/- 6 and 74 +/- 6 kcal/3 h for the lean groups with low and high insulin sensitivity; P less than 0.01 lean vs. obese) and insulin resistance (insulin-resistant less than insulin-sensitive, at both levels of obesity; P less than 0.01). After exercise, TEF was also impaired in the obese (47 +/- 6 and 44 +/- 5 kcal/3 h for the insulin-resistant and -sensitive groups) and in the lean insulin-resistant (55 +/- 5 kcal/3 h), compared with the lean insulin-sensitive men (71 +/- 3 kcal/3 h), P less than 0.01. Compared with rest, TEF after exercise was improved, but not normalized, in both obese groups (P less than 0.05), but unchanged in the lean groups. These results suggest that both insulin resistance and obesity are independently associated with impaired TEF at rest, but the responsiveness of thermogenesis to exercise before a meal is related to the obese state and not independently to insulin resistance per se.

Effect of exercise training on insulin sensitivity and glucose metabolism in lean, obese, and diabetic men

To clarify the impact of vigorous physical training on in vivo insulin action and glucose metabolism independent of the intervening effects of concomitant changes in body weight and composition and residual effects of an acute exercise session, 10 lean, 10 obese, and 6 diet-controlled type II diabetic men trained for 12 wk on a cycle ergometer 4 h/wk at approximately 70% of maximal O2 uptake (VO2max) while body composition and weight were maintained by refeeding the energy expended in each training session. Before and 4-5 days after the last training session, euglycemic hyperinsulinemic (40 mU.m2.min-1) clamps were performed at a plasma glucose of 90 mg/dl, combined with indirect calorimetry. Total insulin-stimulated glucose disposal (M) was corrected for residual hepatic glucose output. Body weight, fat, and fat-free mass (FFM) did not change with training, but cardiorespiratory fitness increased by 27% in all groups. Before and after training, M was lower for the obese (5.33 +/- 0.39 mg.kg FFM-1.min-1 pretraining; 5.33 +/- 0.46 posttraining) than for the lean men (9.07 +/- 0.49 and 8.91 +/- 0.60 mg.kg FFM-1.min-1 for pretraining and posttraining, respectively) and lower for the diabetic (3.86 +/- 0.44 and 3.49 +/- 0.21) than for the obese men (P less than 0.001). Insulin sensitivity was not significantly altered by training in any group, but basal hepatic glucose production was reduced by 22% in the diabetic men. Thus, when intervening effects of the last exercise bout or body composition changes were controlled, exercise training per se leading to increased cardiorespiratory fitness had no independent impact on insulin action and did not improve the insulin resistance in obese or diabetic men.

Physiologic responses to playing a video game

The displacement of sports and other physical activities by television and video may contribute to the associations among television viewing, obesity, and reduced physical fitness. Because video games are widely played by children and adolescents, we assessed the metabolic and cardiovascular responses to video game playing. Heart rate, blood pressure, and oxygen consumption were measured serially over 30 minutes in 32 males and females aged 16 to 25 years (mean +/- SEM, 20 +/- 1 years) while they played the "Ms Pac-Man" video game under standard laboratory conditions and compared with measurements made in a standing but inactive position. Playing the video game significantly increased heart rate, systolic and diastolic blood pressure, and oxygen consumption. Energy expenditure increased from 6.08 +/- 0.24 kJ/min while the subjects stood inactive to 10.94 +/- 0.49 kJ/min while they played. The increase in metabolic rate and cardiovascular stimulation was similar in magnitude to mild-intensity exercise.

Estimation of extracellular and total body water by multiple-frequency bioelectrical-impedance measurement

This study evaluated a new technology of bioelectrical-impedance (BI) measurement that makes use of multiple frequencies (5, 50, and 100 kHz) for estimation of extracellular and total body water. In 36 healthy males, resistance and reactance at three frequencies were compared with extra-cellular water (ECW) and total body water (TBW) determined by isotope dilution. ECW was best predicted by resistance measured at 5 kHz, corrected for height and weight (R = 0.930, SEE = 1.94 L) whereas TBW was best predicted by resistance at 100 kHZ and weight (R = 0.947, SEE = 2.64 L). Cross-validation analysis on two randomly selected subsets (n = 18 each) indicated that the prediction equations were reproducible and valid. Thus, BI at dual frequencies is valid for determination of body-water compartments and may be useful in the nutritional assessment of patients in whom body water and hydration is of clinical concern.

Thermic effect of a meal over 3 and 6 hours in lean and obese men

Controversy regarding defective postprandial thermogenesis in obesity may partly be due to methodological factors such as duration of measurement. To clarify further the role of blunted thermogenesis in obesity, the thermic effect of food was compared in seven lean (mean +/- SEM, 15.7% +/- 1.5% body fat, by densitometry) and seven obese men (37.3% +/- 3% fat) over 3 and 6 hours. The groups were matched for age (35 +/- 2 and 33 +/- 2 years for the lean and obese groups; range, 25 to 39 years), fat-free mass (FFM), and aerobic fitness. Resting metabolic rate (RMR) was measured by indirect calorimetry for 6 hours on two mornings, in randomized order: (1) after a 720-kcal liquid mixed meal, which was 24% protein, 21% fat, and 55% carbohydrate; and (2) in the postabsorptive state. The thermic effect of food, calculated as postprandial minus postabsorptive RMR, was significantly greater for the lean than obese men for the first 3 hours of measurement (67 +/- 6 v 49 +/- 3 kcal/3 hours; P less than .01). During the second 3 hours, the thermic effect of food was marginally, but not significantly, greater for the lean than obese men (34 +/- 8 v 20 +/- 4 kcal/3 hours; P = .10, NS). Over the entire 6 hours, the thermic effect of food was significantly greater for the lean than obese men (100 +/- 12 v 69 +/- 5 kcal/6 hours; P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Resting metabolic rate and postprandial thermogenesis in polycystic ovarian syndrome

To determine whether the high frequency of obesity in women with polycystic ovary syndrome (PCO) is related to a defect in energy expenditure, resting metabolic rate (RMR) and the thermic response to a standard meal were compared in 10 obese PCO women, nine obese but otherwise normal women, and 11 lean women. All groups were matched with respect to age and fat-free mass and the two obese groups were matched for degree of obesity. RMR was measured by indirect calorimetry for 3 h on two days: (1) in the postabsorptive state; and (2) after a 720 kcal (3014 kJ) liquid mixed meal. The thermic effect of food, calculated as 3 h postprandial minus fasting RMR, was significantly greater for the lean [52.9 +/- 5.5 kcal/3 h (221 +/- 23 kJ/3 h)] than the obese [17.2 +/- 5.1 kcal/3 h (72 +/- 21 kJ/3 h)] and the PCO women [22.8 +/- 5.2 kcal/3 h (95 +/- 22 kJ/3)], P less than 0.001). The thermic effect of food was negatively related to percent body fat (r = -0.694, P less than 0.001). Resting metabolic rate did not differ significantly among the three groups, and was strongly related to fat-free mass (r = 0.687, P less than 0.001). These results confirm previous reports of blunted thermogenesis in obese individuals, but provide no evidence of altered resting metabolic rate or postprandial thermogenesis in women with PCO compared with normal women of similar degree of obesity.

Comparison of thermic effects of constant and relative caloric loads in lean and obese men

Controversy regarding defective thermic effect of food (TEF) in obesity might be related to differences among studies in the caloric loads. To clarify further the role of blunted thermogenesis in obesity, responses to the same absolute caloric load (720 kcal) and a relative load, which was 35% of each subject's resting metabolic rate (RMR), were compared in 11 lean (L) and 11 obese (O) men. The relative load was slightly larger for O than L (752 +/- 27 vs 683 +/- 21 kcal; means +/- SEM, NS). TEF, calculated as 3-h postprandial minus fasting RMR, was greater for L than O for both the 720-kcal (69 +/- 4 vs 31 +/- 3 kcal/3 h, p less than 0.01) and relative loads (64 +/- 4 vs 37 +/- 3 kcal/3 h, p less than 0.01). For L, TEF was greater for the 720-kcal load than for the relative load whereas for O, TEF was greater for the relative than for the 720-kcal meal. However, expressed as a percent of the calories ingested, TEF for the absolute and relative meals was identical for each group, in both cases lower for O (4.2 +/- 0.4% vs. 4.7 +/- 0.3%) than for L (9.7 +/- 0.4% vs 9.3 +/- 0.8%); p less than 0.01. These results demonstrate the impact on thermogenesis of the basis on which the meal is dosed and provide further evidence for defective thermogenesis in obesity.

Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome

Hyperinsulinemia secondary to a poorly characterized disorder of insulin action is a feature of the polycystic ovary syndrome (PCO). However, controversy exists as to whether insulin resistance results from PCO or the obesity that is frequently associated with it. Thus, we determined in vivo insulin action on peripheral glucose utilization (M) and hepatic glucose production (HGP) with the euglycemic glucose-clamp technique in obese (n = 19) and nonobese (n = 10) PCO women and age- and body-composition-matched normal ovulatory women (n = 11 obese and n = 8 nonobese women). None had fasting hyperglycemia. Two obese PCO women had diabetes mellitus, established with an oral glucose tolerance test; no other women had impairment of glucose tolerance. However, the obese PCO women had significantly increased fasting and 2-h glucose levels after an oral glucose load and increased basal HGP compared with their body-composition-matched control group. There were statistically significant interactions between obesity and PCO in fasting glucose levels and basal HGP (P less than .05). Steady-state insulin levels of approximately 100 microU/ml were achieved during the clamp. Insulin-stimulated glucose utilization was significantly decreased in both PCO groups whether expressed per kilogram total weight (P less than .001) or per kilogram fat free mass (P less than .001) or when divided by the steady-state plasma insulin (l) level (M/l, P less than .001). There was residual HGP in 4 of 15 obese PCO, 0 of 11 obese normal, 2 of 10 nonobese PCO, and 0 of 8 nonobese normal women. The metabolic clearance rate of insulin did not differ in the four groups. We conclude that 1) PCO women have significant insulin resistance that is independent of obesity, changes in body composition, and impairment of glucose tolerance, 2) PCO and obesity have a synergistic deleterious effect on glucose tolerance, 3) hyperinsulinemia in PCO is not the result of decreased insulin clearance, and 4) PCO is associated with a unique disorder of insulin action.

Impact of body fat mass and percent fat on metabolic rate and thermogenesis in men

To clarify further the independent relationships of body composition parameters to energy expenditure, resting metabolic rate (RMR) and postprandial thermogenesis were studied in four groups who were matched for absolute fat mass (study 1) and relative fatness (study 2). In study 1, five lean [group A, 15.4 +/- 0.6% (+/- SE) body fat] and five obese men (group B, 25.0 +/- 0.9% fat) were matched on body fat mass (13.0 +/- 0.9 vs. 14.4 +/- 0.8 kg, respectively). Fat-free mass (FFM) and total weight were greater for group A than B. RMR was measured for 3 h in the fasted state and after a 720-kcal mixed meal. RMR was greater for group A than B (1.38 +/- 0.08 vs. 1.14 +/- 0.04 kcal/min, P less than 0.05). The thermic effect of food, calculated as 3 h postprandial minus fasting RMR, was greater for group A than B (65 +/- 6 vs. 23 +/- 9 kcal/3 h; P less than 0.05). In study 2, two groups (n = 6 men/group) were matched for percent body fat (33 +/- 1% fat for both) but differed in lean, fat, and total weights: 50.8 +/- 3.1 kg FFM for the lighter (group C) vs. 68.0 +/- 2.8 kg FFM for the heavier (group D) group, P less than 0.05. RMR was lower for group C than D (1.17 +/- 0.06 vs. 1.33 +/- 0.04 kcal/min, P less than 0.05), but the thermic effect of food was not significantly different (31 +/- 3 vs. 20 +/- 6 kcal/3 h).(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise and obesity

Exercise training in obese patients increases cardiorespiratory fitness, reduces cardiovascular disease risk factors, and increases caloric expenditure; however, significant exercise is required to induce changes in body composition in the absence of caloric restriction, particularly for people whose exercise capacity may initially be limited. Unless a large amount of lean tissue is lost by concomitant dietary restriction, it is unlikely that resting metabolism is altered by exercise, either long-term, or acutely after each workout. The thermic effect of food is negatively related to body fat content. Exercise prior to a meal improves the blunted thermic response to food in the obese but does not normalize it completely. It is noteworthy that physical activity is self-determined and is the only component of energy expenditure that is under volitional control. Exercise alone, without caloric restriction, is probably insufficient to yield significant fat loss except in individuals who are extremely motivated, whereas the combination of modest caloric restriction and physical training of different modes may be necessary to induce favorable changes in body composition.

Lean body mass estimation by bioelectrical impedance analysis: a four-site cross-validation study

This study validated further the bioelectrical impedance analysis (BIA) method for body composition estimation. At four laboratories densitometrically-determined lean body mass (LBMd) was compared with BIA in 1567 adults (1069 men, 498 women) aged 17-62 y and with 3-56% body fat. Equations for predicting LBMd from resistance measured by BIA, height, weight, and age were obtained for the men and women. Application of each equation to the data from the other labs yielded small reductions in R values and small increases in SEEs. Some regression coefficients differed among labs but these differences were eliminated after adjustment for differences among labs in the subjects' body fatness. All data were pooled to derive fatness-specific equations for predicting LBMd: the resulting R values ranged from 0.907 to 0.952 with SEEs of 1.97-3.03 kg. These results confirm the validity of BIA and indicate that the precision of predicting LBM from impedance can be enhanced by sex- and fatness-specific equations.

Body composition, not body weight, is related to cardiovascular disease risk factors and sex hormone levels in men

To clarify the independent relationships of obesity and overweight to cardiovascular disease risk factors and sex steroid levels, three age-matched groups of men were studied: (i) 8 normal weight men, less than 15% body fat, by hydrostatic weighing; (ii) 16 overweight, obese men, greater than 25% body fat and 135-160% of ideal body weight (IBW); and (iii) 8 overweight, lean men, 135-160% IBW, but less than 15% fat. Diastolic blood pressure was significantly greater for the obese (mean +/- SEM, 82 +/- 2 mmHg) than the normal (71 +/- 2) and overweight lean (72 +/- 2) groups, as were low density lipoprotein levels (131 +/- 9 vs. 98 + 11 and 98 + 14 mg/dl), the ratio of high density lipoprotein to total cholesterol (0.207 +/- 0.01 vs. 0.308 +/- 0.03 and 0.302 +/- 0.03), fasting plasma insulin (22 +/- 3 vs. 12 +/- 1 and 13 +/- 2 microU/ml), and the estradiol/testosterone ratio (0.076 +/- 0.01 vs. 0.042 +/- 0.02 and 0.052 +/- 0.02); P less than 0.05. Estradiol was 25% greater for the overweight lean group (40 +/- 5 pg/ml) than the obese (30 +/- 3 pg/ml) and normal groups (29 +/- 2 pg/ml), P = 0.08, whereas total testosterone was significantly lower in the obese (499 +/- 33 ng/dl) compared with the normal and overweight, lean groups (759 +/- 98 and 797 +/- 82 ng/dl). Estradiol was uncorrelated with risk factors and the estradiol/testosterone ratio appeared to be a function of the reduced testosterone levels in obesity, not independently correlated with lipid levels after adjustment for body fat content. Furthermore, no risk factors were significantly different between the normal and overweight lean groups. We conclude that (a) body composition, rather than body weight per se, is associated with increased cardiovascular disease risk factors; and (b) sex steroid alterations are related to body composition and are not an independent cardiovascular disease risk factor.

TOBEC methodology for body composition assessment: a cross-validation study

The accuracy of prediction equations for estimating lean body mass (LBM) from total-body electrical conductivity (TOBEC) was examined by cross-validation. Two samples of adults, aged 18-35 yr, were drawn from separate geographic locations. LBM was determined by densitometry and TOBEC was measured with TOBEC II instrument. LBM and TOBEC were highly correlated in both samples (r = 0.96 and 0.97). Cross-validation of LBM prediction equations was accomplished by exchanging equations and comparing predicted LBM values. There was a mean difference of 0.974 kg LBM between the two equations (p less than 0.0001). Thus, data from 157 subjects were pooled and one equation was developed that incorporated height (cm), sex (males = 0, females = 1), and the zero-, first-, and second-order Fourier coefficients (FC0, FC1, and FC2) of the TOBEC phase value: LBM, kg = -36.410 + (-1.324 X sex) + (0.01185 X (FC1(0.5)xht)) + (12.347 X FC2(0.5)) + (0.0627 X FC0)-(0.9232 X FC2) This equation, developed from 157 subjects, accounted for 96% of the variability in LBM and had a standard error of estimate of 2.17 kg LBM.

Comparison of indirect calorimetric measurements of resting energy expenditure with a ventilated hood, face mask, and mouthpiece

This study compared three techniques for indirect calorimetric measurement of resting energy expenditure: ventilated canopy, face mask, mouthpiece plus noseclips. A total of 18 healthy men and women underwent all three measurement techniques in three consecutive 20-min measurement periods in a Latin square design. No significant effects were found for either period or method with respect to oxygen consumption, respiratory exchange ratio, and caloric expenditure. Oxygen consumption was (mean +/- SD) 250 +/- 45, 251 +/- 47, and 254 +/- 49 mL/min for hood, mask, and mouthpiece, respectively (ns). The respiratory exchange ratio was lower for the hood (0.809 +/- 0.051) than mask (0.837 +/- 0.043) and mouthpiece (0.847 +/- 0.045) but this difference was not statistically significant (p = 0.07). Calculated caloric expenditure was 1.20 +/- 0.22, 1.21 +/- 0.22, and 1.23 +/- 0.23 kcal/min for hood, mask, and mouthpiece, respectively (ns). Thus, in healthy individuals similar results are obtained by the three methods and the face mask and mouthpiece are acceptable alternatives to the ventilated hood for estimation of resting energy expenditure.

Echocardiographic mitral valve prolapse in ballet dancers: a function of leanness

To determine the prevalence of mitral valve prolapse in ballet dancers by echocardiography and to establish which anthropometric measurements best predict the presence of mitral valve prolapse, we compared 44 professional dancers (22 men and 22 women) with 52 controls (24 men and 28 women). Forty-eight percent (21 of 44) of dancers had echocardiographic mitral valve prolapse compared with 10% (5 of 52) of controls (p less than 0.01). The dancers weighed less than the controls and had significantly smaller bony diameters and body circumferences. However, only ponderal index was predictive of mitral valve prolapse in both dancers and controls. Thus, echocardiographic mitral valve prolapse is associated with low body weight relative to height and neither to ballet dancing nor to a distinct body habitus. Echocardiographic mitral valve prolapse may represent a normal variant in the majority of asymptomatic, thin subjects without auscultatory findings.

Thermic effects of food and exercise in lean and obese men of similar lean body mass

The thermic effect of food at rest, during 30 min of cycle exercise, and postexercise with two sequences of exercise and meal (before or after exercise) was compared in eight lean (mean +/- SE, 12.8 +/- 0.7% body fat) and eight obese men (29.7 +/- 0.6% fat) to determine whether exercise before or after a meal enhances thermogenesis. The groups were matched for age, height, and lean body mass (LBM) in order to study the relationship between thermogenesis and body fat independent of LBM. Metabolic rate was measured by indirect calorimetry on five mornings, in randomized order, after an overnight fast. Treatments on respective days were 1) 3-h rest, no meal; 2) 3-h rest after a 750-kcal mixed meal (14% protein, 31% fat, 55% carbohydrate); 3) during and 3 h after 30 min of cycling, no meal; 4) during and 3 h after 30 min of cycling, meal 30 min before exercise; and 5) 3 h after 30 min of cycling, meal immediately after exercise. The thermic effect of food, which is the fed minus fasted caloric expenditure, was significantly greater for the lean than the obese men under the resting (mean +/- SE 53 +/- 5 vs. 26 +/- 5 kcal over 3 h for the lean and obese groups, P less than 0.01), exercise (26 +/- 4 vs. 4 +/- 2 kcal over 30 min, P less than 0.01), and both postexercise conditions. However, for the lean men the thermic effect of food was significantly greater for the meal-before-exercise than the resting and the meal-after-exercise conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma lactate and ventilation thresholds in trained and untrained cyclists

Six trained male cyclists and six untrained sedentary men were studied to determine whether the plasma lactate threshold (PLT) and ventilation threshold (VT) occur at the same work rate in both fit and unfit populations. The PLT was determined from a marked increase in plasma lactate concentration ([La]) and VT from a nonlinear increase in expired minute ventilation (VE) during incremental leg-cycling tests; work rate was increased 30 W every 2 min until volitional exhaustion. The trained subjects' mean VO2 max (63.8 ml O2 X kg-1 X min-1) and VT (65.8% VO2 max) were significantly higher (P less than 0.05) than the untrained subjects' mean VO2max (35.5 ml O2 X kg-1 X min-1) and VT (51.4% VO2 max). The trained subjects' mean PLT (68.8% VO2 max) and VT did not differ significantly, but the untrained subjects' mean PLT (61.6% VO2 max) was significantly higher than their VT. The trained subjects' mean peak [La] (10.5 mmol X l-1) did not differ significantly from the untrained subjects' mean peak [La] (11.5 mmol X l-1). However, the time of appearance of the peak [La] during passive recovery was inversely related to VO2 max. These results suggest that variance in lactate diffusion and/or removal processes between the trained and untrained subjects may account in part for the different relationships between the VT and PLT in each population.

Left ventricular hypertrophy in athletes: an exercise-echocardiographic study

Left ventricular dimensions measured by M-mode echocardiography of 10 distance runners and 10 wrestlers were compared to 10 sedentary controls at rest and during 12 min of semisupine, graded bicycle ergometer exercise. At rest, runners and wrestlers demonstrated greater left ventricular mass compared to controls (mean values, 311.8 and 325.9 vs 215.9 g, respectively: P less than 0.05). In wrestlers, this was due to increased left ventricular septal (13.5 mm) and posterior wall thickness (12.9 mm) compared to controls (9.1 and 10.1 mm, respectively: P less than 0.05). In runners, this was due to increased left ventricular end-diastolic dimension (55.8 mm) compared to controls (49.7 mm) (P less than 0.05). During exercise, the different patterns noted at rest among the three groups in left ventricular dimensions and function persisted and were preserved: runners maintained a higher end-diastolic dimension compared to wrestlers and controls and greater shortening dimension compared to wrestlers. Absolute changes in left ventricular parameters from rest to exercise were not significantly different among the three groups.

CONCLUSIONS

1) different patterns of left ventricular hypertrophy exist among different types of athletes, with mainly increased wall thickness in primarily statically trained athletes and increased volume in dynamically trained athletes; and 2) these differences observed at rest persist during moderate-intensity, semisupine ergometer exercise and have direct functional significance, thereby emphasizing the differences found in cardiac dimensions among different types of athletes.

Thermic effect of food at rest, during exercise, and after exercise in lean and obese men of similar body weight

The thermic effect of food at rest, during 30 min of cycle ergometer exercise, and after exercise was studied in eight lean (mean +/- SEM, 10 +/- 1% body fat, hydrostatically-determined) and eight obese men (30 +/- 2% body fat). The lean and obese mean were matched with respect to age, height, weight, and body mass index (BMI) to determine the relationship between thermogenesis and body composition, independent of body weight. All men were overweight, defined as a BMI between 26-34, but the obese had three times more body fat and significantly less lean body mass than the lean men. Metabolic rate was measured by indirect calorimetry under four conditions on separate mornings, in randomized order, after an overnight fast: 3 h of rest in the postabsorptive state; 3 h of rest after a 750-kcal mixed meal (14% protein, 31.5% fat, and 54.5% carbohydrate); during 30 min of cycling and for 3 h post exercise in the postabsorptive state; and during 30 min of cycling performed 30 min after the test meal and for 3 h post exercise. The thermic effect of food, which is the difference between postabsorptive and postprandial energy expenditure, was significantly higher for the lean than the obese men under the rest, post exercise, and exercise conditions: the increments in metabolic rate for the lean and obese men, respectively, were 48 +/- 7 vs. 28 +/- 4 kcal over 3 h rest (P less than 0.05); 44 +/- 7 vs. 16 +/- 5 kcal over 3 h post exercise (P less than 0.05); and 19 +/- 3 vs. 6 +/- 3 kcal over 30 min of exercise (P less than 0.05). The thermic effect of food was significantly negatively related to body fat content under the rest (r = -0.55), post exercise (r = -0.66), and exercise (r = -0.58) conditions. The results of this study indicate that for men of similar total body weight and BMI, body composition is a significant determinant of postprandial thermogenesis; the responses of obese are significantly blunted compared with those of lean men.

Estimation of human body composition by electrical impedance methods: a comparative study

This study 1) further validated the relationship between total body electrical conductivity (TOBEC) and densitometrically determined lean body mass (LBMd) and 2) compared with existing body composition techniques (densitometry, total body water, total body potassium, and anthropometry) two new electrical methods for the estimation of LBM: TOBEC, a uniform current induction method, and bioelectrical impedance analysis (BIA), a localized current injection method. In a sample of 75 male and female subjects ranging from 4.9 to 54.9% body fat the correlation between LBMd and LBM predicted from TOBEC by use of a previously developed regression equation was extremely strong (r = 0.962), thus confirming the validity of the TOBEC method. LBM predicted from BIA by use of prediction equations provided with the instrument also correlated with LBMd (r = 0.912) but overestimated LBM compared with LBMd in obese subjects. However, no such systematic error was apparent when new prediction equations derived from this heterogeneous sample of subjects were applied. Thus the TOBEC and BIA methods, which are based on the differing electrical properties of lean tissue and fat and which are convenient, rapid, and safe, correlate well with more cumbersome human body composition techniques.

Energy depot replenishment in rats during refeeding after fasting: effect of exercise

The effect of progressive moderate exercise on body weight gain, visceral and muscle protein stores, and thyroid hormone levels during an 8-day refeeding period after 65 h of starvation was studied in 2-month-old male Sprague-Dawley rats. Twenty-four animals were divided into three groups and acclimated for 5 days while being fed with ordinary Purina Chow. After the fasting phase, a group of rats was killed in order to provide base-line information concerning fasting-induced changes in body composition; a sedentary group was fed Purina Chow ad libitum; and a treadmill-exercised group was pair fed with the sedentary rats. During the refeeding phase, the exercised animals regained significantly less weight than the sedentary animals (p less than 0.001), but the two groups did not differ significantly with respect to visceral, muscle, eviscerated carcass, and skin protein. Total body fat content was lower in the exercised than the sedentary group. The thyroid hormone levels were not significantly different for the two refed groups. These results indicate that exercise during refeeding may alter the pattern of body weight gain during refeeding after fasting such that the replenishment of adipose tissue stores is reduced without compromising the restoration and growth of lean tissue.

Thermic effect of food during graded exercise in normal weight and obese men

The thermic effect of food during incremental cycle ergometer exercise was compared in six normal weight and six obese men (mean +/- SEM 104 +/- 5% and 160 +/- 11% ideal body weight, respectively). Graded exercise tests were performed after a 12-h fast and 60 min after the start of a 910 kcal mixed meal, on separate days. The thermic of food during exercise, which is the fed minus the fasting oxygen consumption (VO2), was significantly greater for the normal than the obese men at submaximal intensities from O (unloaded cycling) to 100 W (p less than 0.05). The mean slope of the regressions of VO2 (ml . min-1) on power output (W), which reflects the rate of increase in energy expended relative to increases in external work performed, did not differ significantly between the fed and fasting conditions for either group, but the mean (+/- SEM) intercept was significantly higher for the normal, but not the obese men, in the fed than the fasting state (599 +/- 53 versus 497 +/- 47 ml O2 . min-1 for the normal men and 819 +/- 126 versus 821 +/- 145 ml O2 . min-1 for the obese men). These results indicate that the thermic effect of food during exercise, which is virtually absent in the obese men, does not increase significantly across submaximal power outputs for the normal men and therefore does not reflect a significant reduction in efficiency.

Thermic effects of food and exercise in lean and obese women

The thermogenic responses of ten lean and ten moderately obese women to food, exercise, and food plus exercise were measured using open circuit respirometry for five minutes every half hour for four hours under six conditions: during five minutes of bicycle exercise at a workload of 300 kpm/min with and without eating a 910 kcal mixed meal; cycling at a workload just below the anaerobic threshold with and without food; and at rest with and without food. Over the four-hour period, the thermic effect of food at rest was similar for the lean and obese groups: 50 kcal and 47 kcal, respectively. Eating before exercise increased the exercise metabolic rate by 11% for the lean women and by 4% for the obese women (P less than 0.005). Exercise potentiated the thermic effect of food for the lean women but nor for the obese women: the thermic effect of food was 2.54 times greater during exercise than at rest for the lean group, but only 1.01 times greater for the obese women (P less than 0.005). This reduced response to the combined stimulus of food plus exercise may constitute a subtle metabolic factor associated with obesity.