Expenditure and storage of energy in man

The effect of a 5-month endurance-training programme on physical activity: evidence for a sex-difference in the metabolic response to exercise

The effect of a 5-month endurance training programme on physical activity and average daily metabolic rate (ADMR) was studied. Subjects were 16 males and 16 females preparing for a half marathon. Total physical activity, measured using an accelerometer, had increased by 62% and 63% after 20 weeks in males and females, respectively. Physical activity during the non-exercise part of the day did not change although in males it tended to increase (15%, NS). The ADMR had increased significantly in males after 8 and 20 weeks (+2.3 and +3.3 MJ.day-1, respectively, P less than 0.05) and exceeded the net energy expenditure for endurance-training three to four times. In females no significant increase in ADMR was found (+1.5 and +1.3 MJ.day-1, after 8 and 20 weeks, respectively). In females the change in ADMR could be largely attributed to the net cost of running itself and a small increase (10%) in resting metabolic rate during the time of day they were awake. In males a discrepancy was observed between the increase of ADMR and the expenditure due to exercise and non-exercise activities. We suggest exercise stimulates habitual physical activity and diet-induced thermogenesis in males but not in females.

Does variation in palatability affect the postprandial response in energy expenditure?

The impact of variation in palatability on diet- and sucrose-induced thermogenesis was studied in two experiments with 24 healthy young normal-weight subjects, 12 men and 12 women. In the first study, subjects received at random in duplicate either a normal liquid test meal (2,000 kJ, 12% protein, 33% fat, 55% carbohydrate), or an iso-energetic test meal made highly unpalatable with kinin. The difference in palatability did not have a significant impact on postprandial metabolism. In the second study subjects received at random either a palatable sucrose solution (900 kJ), an iso-energetic standard sucrose solution, or an iso-energetic unpalatable sucrose solution. Kinin and a citrus flavour were used to vary palatability. Postprandial energy expenditure over a period of 150 min was not significantly affected by differences in palatability. A separate control experiment to assess the effect of kinin on energy expenditure was carried out in eight subjects. Kinin had no significant effect on energy expenditure over a period of 120 min after ingestion.

Deceleration in cumulative food intake curves, changes in body temperature and diet-induced thermogenesis

In order to assess the relationship between the shape of the cumulative food intake curve and a reflection of internal processes, eating behaviour, postprandial thermogenesis, and skin and core temperature of normal weight restrained and unrestrained eating women and of obese restrained eating women were recorded during four-course solid food lunches, eaten in a laboratory setting (respiration chamber) at a constant ambient temperature of 22 degrees C. The skin temperature (upper arm, upper leg, liver proximity) and core temperature were measured constantly from one hour prior to until two hours after the lunch. Normal weight unrestrained eaters displayed decelerated cumulative food intake curves and an increase in the liver temperature data of 0.8-1.5 degrees C, from the beginning of the meal onwards, remaining high until 60-90 minutes after the meal was consumed. The postprandial thermogenesis of normal weight unrestrained eaters was on average 8.1 +/- 1.3%, calculated over two and a half hours from the beginning of the meal. Overweight and normal weight restrained eaters displayed linear cumulative food intake curves, almost no changes in skin and core temperatures and a postprandial thermogenesis of 4.2 +/- 0.3% and 4.8 +/- 0.7%, calculated over two and a half hours from the beginning of the meal onwards. In conclusion, deceleration in cumulative food intake curves is positively correlated with a temperature increase in the skin in the proximity of the liver, and with postprandial thermogenesis.

The effects of short-term carbohydrate overfeeding and prior exercise on resting metabolic rate and diet-induced thermogenesis

In 10 young, normal-weight subjects, the effects were investigated of carbohydrate overfeeding and prior glycogen-depleting exercise on resting metabolic rate (RMR) and diet-induced thermogenesis (DIT). Subjects were kept on controlled diets in a crossover design for two periods of 8 days, with a 1-week interval in between. During the last 4 days of each period, additional carbohydrates were added to the subjects' diet. The carbohydrate overfeeding started at 15% in excess of the energy requirements on day 1 and increased to 60% on day 4. At the beginning and the end of the carbohydrate overfeeding periods, RMR and DIT were measured, respectively, for 1 and 3.5 hours using a ventilated hood system. In one of the 8-day periods, on evenings before the energy exchange measurements, subjects performed a maximum work capacity test on a cycle ergometer, and then cycled for a total of approximately 80 minutes at fixed percentages of their maximum work capacity. Carbohydrate overfeeding did not affect RMR, but increased DIT significantly, on average by 39%. Glycogen-depleting exercise the day before increased RMR significantly by, on average, 9% and increased DIT (P = .08), on average, by 23%. The impact of exercise on RMR was less when carbohydrate overfeeding was administered, but there was no significant interaction effect of carbohydrate overfeeding and exercise on RMR or DIT. It is concluded that both prior glycogen-depleting exercise and an antecedent diet high in carbohydrates may influence RMR or DIT.

Alcohol and its acute effects on resting metabolic rate and diet-induced thermogenesis

The impact of alcohol (ethanol) on resting energy expenditure of male non-obese volunteers was determined in two studies. In the first study the thermic effect of alcohol on resting metabolic rate (RMR) was assessed in ten male non-obese volunteers. In the second study the impact of alcohol on diet-induced thermogenesis (DIT) was determined in twelve male non-obese volunteers. Energy expenditure was measured with a ventilated-hood system. RMR was measured for 60 min with the subjects in a fasting state. In the first study subjects received in random order 20 g alcohol in concentrations of 75, 180 and 300 ml/l water respectively. After measurement of the RMR the thermic effect of alcohol was measured for 90 min. In the second study volunteers received in random order and in duplicate either a meal of food (2 MJ) plus an alcoholic aperitif (20 g alcohol in a 180 ml/l solution) or an isoenergetic meal of food alone (2.55 MJ) plus a placebo aperitif containing no alcohol. DIT was measured for 240 min. Alcohol induced a significant thermic effect, which varied between 0.22 and 0.30 kJ/min. No systematic difference in DIT was observed among the different concentrations. DIT was not significantly affected by the ingestion of alcohol. Total DIT was 219 (SE 14) kJ for the alcohol treatment and 185 (SE 20) kJ for the control treatment. The results do not support the suggestion that alcohol is less efficiently used as an energy source in comparison with, for example, fats and carbohydrates.

Indirect calorimetry: methodological and interpretative problems

The technique of indirect calorimetry is now widely used to examine rates of energy production and substrate oxidation in humans. Although the basic principles of indirect calorimetry are well established, it is important to recognize that there are several potential pitfalls in the methodology and data interpretation that must be appreciated to properly understand and apply the results derived from this technique. In particular, one must recognize that the fundamental measurement provided by indirect calorimetry is the net disappearance rate of a substrate regardless of the metabolic interconversions that the substrate may undergo before its disappearance from its metabolic pool. Under most circumstances, direct oxidation represents the major route by which a substrate disappears from its metabolic pool, and the two terms are often used interchangeably. However, under conditions when rates of gluconeogenesis, ketogenesis, or lipogenesis are elevated, the presumed equivalence between oxidation and disappearance may no longer apply, even though the actual measurements derived from indirect calorimetry remain valid. When indirect calorimetry is combined with other in vivo metabolic techniques (e.g., the insulin clamp or radioisotope turnover methods) it can provide a powerful tool for noninvasively examining complex metabolic processes.

Metabolic and clinical consequences of changing from high-glucose to high-fat regimens in parenterally fed newborn infants

To evaluate the metabolic and clinical consequences of changing from high-glucose to high-fat regimens during initiation of parenteral nutrition, we performed 22 studies in 11 newborn infants (birth weight (mean +/- SD) 2.54 +/- 0.54 kg, gestational age 37 +/- 3 weeks, postnatal age 8 +/- 3 days) maintained in a constant thermal environment. In a paired design, two isoproteinic (2.4 +/- 0.2 gm/kg/day) and isocaloric (64 +/- 6 kcal/kg/day) regimens differing by source of energy (high glucose vs high lipid) were infused on consecutive days. Environmental and body temperatures were recorded during a 4-hour period, and 24-hour urinary excretions of catecholamines, nitrogen, and C peptide were measured. Despite constant incubator and average skin temperatures, the rectal and interscapular temperatures rose significantly when the high-glucose regimen was changed to a high-lipid regimen. The specific locations of these changes in body temperature suggested brown fat activation. A significant drop in nitrogen retention (63 +/- 9% vs 56 +/- 10%) during the lipid infusion could be further evidence of a metabolic adaptation to the rapid change in energy substrates.

Energy expenditure in children with type I diabetes: evidence for increased thermogenesis

The aim of the study was to assess whether increased energy expenditure causes the negative energy balance (tissue catabolism) commonly seen in children with insulin dependent (type I) diabetes. Resting metabolic rate and thermogenesis induced by adrenaline were measured in five healthy children and 14 children with type I diabetes who were all free of clinical signs of late complications of diabetes mellitus but differed in their degree of glycaemic control (in eight glycated haemoglobin concentration was less than 10% and in the six others greater than or equal to 10%). When compared with the control subjects children with type I diabetes had normal resting metabolic rates but their urinary nitrogen excretion was significantly raised (11.5 (SD 5.4) mg/min in those with glycated haemoglobin concentration less than 10%, 11.6 (5.2) mg/min in those with concentration greater than or equal to 10% v 5.4 (3.0) mg/min in control subjects). During the infusion of adrenaline the diabetic children showed a threefold and sustained increase in thermogenesis and disproportionate increases in the work done by the heart, in lipid oxidation rate, and in plasma concentrations of glucose, free fatty acids, and ketone bodies. The increased thermogenic effect of adrenaline did not correlate with the degree of glycaemic control. Increased thermogenesis may explain the tissue wasting commonly seen in children with type I diabetes during intercurrent stress.

Thermogenesis in humans during overfeeding with medium-chain triglycerides

To test whether excess dietary energy as medium-chain triglycerides (MCT) affects thermogenesis differently from excess dietary energy as long chain triglycerides (LCT), ten male volunteers (ages 22 to 44) were overfed (150% of estimated energy requirement) liquid formula diets containing 40% of fat as either MCT or LCT. Each patient was studied for one week on each diet in a double-blind, crossover design. Resting metabolic rate (RMR) did not change during either week of overfeeding. The thermic response to food (TEF) was greater on day 1 following a meal (1,000 kcal) containing MCT than following an isocaloric meal containing LCT (8 +/- .8% v 5.8 +/- .8% of ingested energy; P less than .05). Moreover, the TEF observed after a 1,000 kcal meal containing MCT increased significantly to 12% (+/- 1.3%) overfeeding. The TEF of the 1,000 kcal meal containing LCT was unchanged by five days of LCT overfeeding (6.6 +/- 1.0% of ingested energy). Energy expenditure during a 20-hour continuous enteral infusion of the diet on day 7 was also significantly higher with the MCT diet than with the LCT diet (15.7 +/- 1.7% v 7.3 +/- .9% of ingested energy; P less than .05). Our results demonstrate that excess dietary energy as MCT stimulates thermogenesis to a greater degree than does excess energy as LCT. This increased energy expenditure, most likely due to lipogenesis in the liver, provides evidence that excess energy derived from MCT is stored with a lesser efficiency than is excess energy derived from dietary LCT.

Genetic effect in resting and exercise metabolic rates

Two studies dealing with the contribution of the genotype in individual differences for resting metabolic rate (RMR), thermic effect of a 4.2 MJ carbohydrate meal (TEM), and energy cost of submaximal exercise are reported. The genetic effect for RMR and TEM was studied in 31 pairs of parent-child, 21 pairs of dizygotic (DZ) twins, and 37 pairs of monozygotic (MZ) twins, whereas the heritability of the energy cost of submaximal exercise was determined from data on 22 pairs of DZ twins and 31 pairs of MZ twins. The heritability of RMR reached approximately 40% of the variance remaining after adjustment for age, gender, and fat-free mass, (FFM). The genetic effect for TEM was equivalent to at least 40% to 50% of the variation in the energy expended during four hours after the meal test. A highly significant genetic effect was found for fasting plasma glucose (greater than .72), but the results for fasting plasma insulin are unclear. No significant genetic variance was seen for the glucose and insulin response to the carbohydrate meal. Finally, heritability for the metabolic rate during cycle exercise was high (greater than or equal to .46) at low power output, but it became nonsignificant when the energy cost reached about 6 times the RMR.

Prostaglandins, brown fat and weight loss

In obesity, a situation is created in which energy intake exceeds energy expenditure. The three components of energy expenditure are resting metabolism, physical activity, and thermogenesis. Increasing attention is being paid to the role of impaired energy expenditure in obesity. Evidence indicates that impairment in activity of the sympathetic nervous system, which stimulates thermogenic processes, contributes to the etiology of obesity. In addition, insulin resistance, a well-recognized metabolic consequence of obesity, appears to interfere with feeding-related, insulin-mediated increases in thermogenesis in brown adipose tissue. This thermogenic defect results in reduced energy buffering by brown adipose tissue leading to deficient energy expenditure and an increased efficiency in weight gain. A unique weight loss program, The Princeton Metabolic Diet Program, is presented. The Program stimulates metabolism by stimulating the sympathetic nervous system and correcting insulin resistance, thereby enhancing thermogenesis in brown adipose tissue. Methods include: 1) alternating diet composition and caloric intake and, 2) the use of nutritional metabolic stimulants. This type of non-toxic therapy, directed at correcting biochemical defects, will enhance metabolic mechanisms and induce weight loss.

Storage and expenditure of energy in obesity and their implications for management

We have seen in the past 20 years intensive investigation of the responses of the obese and the lean to caloric intake and to various environmental stresses. Although there is much discrepancy of results, the following are obvious: Obesity is not a clear-cut syndrome, and individuals differ significantly in their genetic subtypes and in the stages, type, and degree of their metabolic disturbances. A difference in the facultative component of the thermogenic effect of food can explain some of the variation. This in turn is closely related to insulin resistance, which bears a close relationship to subtypes of hypertension and hyperlipidemias. The greatest scope for clinical intervention lies in these fields. Both the obese and the lean subjects are adapted to retain dietary fat independently of the energy needs. The high ratio of fat to carbohydrate in the western diet and, increasingly in that of the east, is cause for concern.

Weight loss leads to a marked decrease in nonresting energy expenditure in ambulatory human subjects

The extent to which the resting and nonresting components of 24-hour energy expenditure decrease after weight reduction has not been prospectively assessed in ambulatory, weight-stable, reduced-obese humans. Accordingly, 24-hour energy expenditure was estimated as the weight-stabilizing (+/- 50 g/d) daily caloric intake of a defined liquid diet in a cross-sectional study of ten reduced-obese subjects after a 23.2% +/- 9.4% weight loss and 18 obese subjects at baseline weight. A regression analysis demonstrated an 18% decrease in the mean daily energy requirement of the reduced-obese subjects compared with that of subjects of the same relative body weight who had never dieted. Strong linear relationships were noted between estimated 24-hour energy expenditure and fat-free mass (FFM), and between resting metabolic rate (RMR) and FFM in the subjects at baseline weight. In six reduced-obese men, the 24-hour energy expenditure was only 75.7% +/- 5.6% of the value predicted by regression analysis for the decreased FFM. In these six subjects the RMR was 97.4% +/- 7.5% of that predicted for the decreased FFM, suggesting that essentially all the energy savings relative to FFM in the reduced-obese state occurred in nonresting energy expenditure. In a subsequent group of seven subjects studied longitudinally before and after a 21.5% +/- 2.3% weight loss, the decrease in nonresting energy expenditure accounted for 582 +/- 276 kcal/d or 71% of the decrease in estimated 24-hour energy expenditure. These data suggest a decrease in the nonresting energy expenditure of ambulatory reduced-obese individuals, which is greater than previously appreciated.(ABSTRACT TRUNCATED AT 250 WORDS)