Impact of regional and total body composition and hormones on resting energy expenditure in overweight postmenopausal women

The association of appetite and hormones (leptin, ghrelin, and Insulin) with resting metabolic rate in overweight/ obese women: a case-control study

Objective

Low resting metabolic rate (RMR), as a risk factor for weight gain and obesity, can be influenced by many factors. Empirical research has confirmed the role of appetite and related hormones in obesity and energy intake. This study aimed to investigate the relationship between appetite and related hormones in overweight or obese Iranian women with normal and hypo RMR.

Methods

This case–control study was conducted on 42 Iranian adult women (21 cases, and 21 controls), aged 18–48 years. An impedance body analyzer was used to obtain the body composition and an indirect calorimeter was used to assess the RMR. The Flint questionnaire was used to assess appetite, dietary intake, and physical activity were assessed by FFQ and IPAQ questionnaires respectively, and ELISA kits were used to assess leptin, ghrelin, and insulin hormones.

Results

The results of the study demonstrated a negative association between ghrelin hormone level (β = -0.34, 95%CI = -61.70,-3.86, P-value = 0.027) and RMR, and a positive association between insulin hormone level (β = 0.48, 95%CI = 9.38–34.35, P-value = 0.001) and RMR. Also, results of the appetite questionnaire showed that, in general, both appetite (β = 0.32, 95%CI = -0.10–2.99 P-value = 0.044) and hunger variable (β = 0.30, 95%CI = 0.04–5.87, P-value = 0.047) have a positive association with RMR. There was no significant association between leptin levels and RMR.

Conclusion

It is evident that appetite and related hormones have a potential role in promoting a normal RMR.

The Diagnostic-Measurement Method-Resting Energy Expenditure Assessment of Polish Children Practicing Football

Establishing the amount of energy needed to cover the energy demand of children doing sport training and thus ensuring they achieve an even energy balance requires the resting energy expenditure (REE) to be estimated. One of the methods that measures REE is the indirect calorimetry method, which may be influenced by many factors, including body composition, gender, age, height or blood pressure. The aim of the study was to assess the correlation between the resting energy expenditure of children regularly playing football and selected factors that influence the REE in this group. The study was conducted among 219 children aged 9 to 17 using a calorimeter, a device used to assess body composition by the electrical bioimpedance method by means of segment analyzer and a blood pressure monitor. The results of REE obtained by indirect calorimetry were compared with the results calculated using the ready-to-use formula, the Harris Benedict formula. The results showed a significant correlation of girls’ resting energy expenditure with muscle mass and body height, while boys’ resting energy expenditure was correlated with muscle mass and body water content. The value of the REE was significantly higher (p ≤ 0.001) than the value of the basal metabolic rate calculated by means of Harris Benedict formula. The obtained results can be a worthwhile suggestion for specialists dealing with energy demand planning in children, especially among those who are physically active to achieve optimal sporting successes ensuring proper functioning of their body.

Effects of Short-Term Fasting and Different Overfeeding Diets on Thyroid Hormones in Healthy Humans

Background: A greater decrease in 24-hour energy expenditure (EE) during fasting and a smaller increase in 24-hour EE during low-protein overfeeding (metabolic "thrifty" phenotype) predict weight gain. As thyroid hormones (TH) are implicated in energy intake and metabolism, we assessed whether: (i) TH concentrations are altered by 24-hour fasting or overfeeding diets with varying protein content and (ii) diet-related changes in TH correlate with concomitant changes in EE. Methods: Fifty-eight euthyroid healthy subjects with normal glucose regulation underwent 24-hour dietary interventions including fasting, eucaloric feeding, and five overfeeding diets in a crossover design within a whole-room indirect calorimeter to measure the 24-hour EE. Overfeeding diets (200% of energy requirements) included three diets with 20% protein, one diet with 3% protein (low-protein overfeeding diet [LPF]: 46% fat), and one diet with 30% protein (high-protein overfeeding diet [HPF]: 44% fat, n = 51). Plasma free thyroxine (fT4), free triiodothyronine (fT3), and fibroblast growth factor 21 (FGF21) concentrations were measured after overnight fast the morning of and after each diet. Results: On average, fT4 increased by 8% (+0.10 ng/dL, 95% confidence interval [CI 0.07-0.13], p < 0.0001) and fT3 decreased by 6% (-0.17 pg/mL [CI -0.27 to -0.07], p = 0.001) after 24-hour fasting, whereas both fT4 and fT3 decreased by 5% (-0.07 ng/dL [CI -0.11 to -0.04], p < 0.0001) and 4% (-0.14 pg/mL [CI -0.24 to -0.04], p = 0.008) following HPF, respectively. Greater decreases in fT3 after HPF are associated with larger decreases in FGF21 (r = 0.40, p = 0.005). Following LPF, the mean fT3 increased by 6% (+0.14 pg/mL [CI 0.05-0.2], p = 0.003) with no change in fT4 (p = 0.7). No changes in TH were observed after normal-protein overfeeding diets (all p > 0.1). No associations were observed between TH concentrations and diet-related changes in 24-hour EE during any diet (all p > 0.07). Conclusions: Acute (200%) short-term (24 hours) changes in food intake induce small changes in TH concentrations only after diets with low (0% fasting and 3% protein overfeeding) or high (30% protein overfeeding) protein content. The fT3-FGF21 association after high-protein overfeeding suggests a role for TH in inhibiting FGF21 secretion by the liver during protein excess. These results indicate that TH are involved in protein metabolism; however, they do not mediate the short-term EE response to diets that characterize the metabolic phenotypes and determine the individual susceptibility to weight gain.

UCP2, SHBG, Leptin, and T3 Levels are Associated with Resting Energy Expenditure in Obese Women

OBJECTIVE

The aim of this study was to investigate the association of Sex Hormone Binding Globulin (SHBG) with leptin, Triidothyronine (T3), and Uncoupling Protein 2 (UCP2) in obese women with low and normal Resting Energy Expenditure (REE) and to determine the role of these factors in the regulation of REE in obese women.

METHOD

A total 49 subjects (25-50 years old) were selected. Anthropometric and body composition parameters and resting energy expenditure were measured. Fasting circulating leptin, T3, SHBG and UCP2 levels were measured. Subjects were divided into three groups: Group І (BMI>30 and low resting energy expenditure, 16 subjects), group II (BMI>30 and normal resting energy expenditure, 17 subjects), and group ІІІ (control group, 16 non-obese subjects).

RESULT

It was found that obese subjects who had higher SHBG and leptin levels were at risk for high levels of UCP2. A significant association was found between T3 and REE. Obese subjects with higher concentrations of UCP2 and SHBG had decreased resting energy expenditure. A significant association was observed between SHBG and leptin in group І (r=0.90, p<0.0001) and group ІІ (r=0.83, p<0.0001). Moreover, a significant association was found between T3 and SHBG in group І (r=-0.69, P=0.003).

CONCLUSION

Changes of the UCP2, leptin, and thyroid hormone (T3) levels may be related to SHBG levels. Thus, lower leptin and T3 levels may decrease SHBG in obese women. Therefore, lower SHBG, leptin, T3 and UCP2 levels may decrease the REE level in obese women.

Factors influencing basal metabolism of Czechs of working age from South Moravia

OBJECTIVE

Basal metabolic rate (BMR) is the main part of the total body energy expenditure. The value of BMR is individual and depends on a lot of factors. The goal of the research was to discover the influence of anthropometric parameters, age and gender, on changes of the BMR values.

METHODS

A total of 177 individuals of Czech Caucasian origin from South Moravia (BMI 27.3 ± 7.88 kg/m²) aged 18-55 (117 women, 60 men) were included in the study. Selected anthropometric characteristics were measured using a stadiometer (SECA 213) and bioelectrical impedance analysis (Inbody 230). BMR was measured by indirect calorimetry (Cortex Metalyzer 3B). The measured values were statistically evaluated by the regression analysis and least square method (LSM).

RESULTS

From the following results that the factors that influence the BMR value statistically significantly (p &lt; 0.05) are: age, gender, body mass index, total body water, and percent of body fat.

CONCLUSION

Body fat and age have both an indirect impact on the basal metabolic rate of the Czech population in working age. However, BMI and the total body water were discovered to have a direct influence on the BMR.

Are increases in skeletal muscle mass accompanied by changes to resting metabolic rate in rugby athletes over a pre-season training period?

Optimising dietary energy intake is essential for effective sports nutrition practice in rugby athletes. Effective dietary energy prescription requires careful consideration of athletes' daily energy expenditure with the accurate prediction of resting metabolic rate (RMR) important due to its influence on total energy expenditure and in turn, energy balance. This study aimed to (a) measure rugby athletes RMR and (b) report the change in RMR in developing elite rugby players over a rugby preseason subsequent to changes in body composition and (c) explore the accurate prediction of RMR in rugby athletes. Eighteen developing elite rugby union athletes (age 20.2 ± 1.7 years, body mass 101.2 ± 14.5 kg, stature 184.0 ± 8.4 cm) had RMR (indirect calorimetry) and body composition (dual energy x-ray absorptiometry) measured at the start and end of a rugby preseason ∼14 weeks later. There was no statistically significant difference in RMR over the preseason period (baseline 2389 ± 263 kcal·day^-1 post 2373 ± 270 kcal·day^-1) despite a significant increase in lean mass of +2.0 ± 1.6 kg (P < 0.01) and non-significant loss of fat mass. The change in RMR was non-significant and non-meaningful; thus, this study contradicts the commonly held anecdotal perception that an increase in skeletal muscle mass will result in a significant increase in metabolic rate and daily energy needs. Conventional prediction equations generally under-estimated rugby athletes' measured RMR, and may be problematic for identifying low energy availability, and thus updated population-specific prediction equations may be warranted to inform practice.

Relationship between estrogen and body composition, energy, and endocrine factors in obese women with normal and low REE

OBJECTIVE

The aim of this study was to investigate the relationship between estrogen and leptin, thyroid (T3), Uncoupling Protein2 (UCP2), sex hormone binding globulin (SHBG), and resting energy expenditure(REE) in obese subjects with normal and low REE, and to investigate the relationship of estrogen with body composition and energy intake.

METHOD

A total 49 subjects (25-50 years old) were selected. Anthropometric measurements, body composition, and resting energy expenditure were measured. Fasted circulating leptin, T3, SHBG and UCP2 levels were also measured. Subjects were divided to three groups: BMI > 30 and low resting energy expenditure (group I, n = 16), BMI > 30 and normal resting energy expenditure (group II, n = 17), and non-obese women as the control group (group III, n = 16).

RESULT

A significant association was observed between estrogen and REE in obese women with normal REE. There was a significant association between estrogen and leptin in groups I (β = 0.98, p < .0001), and II (β = 0.84, P < .0001). However, no significant association was observed between estrogen and T3 and UCP2 protein in the three groups. Regression analyses demonstrated no correlation between fat mass, percent fat mass, and plasma estrogen. Plasma estrogen was not correlated with caloric intake or macronutrients of the diet.

CONCLUSION

Estrogen has been shown to affect metabolism and hemostasis in obesity and increases resting energy expenditure via leptin. Production of UCP2 in PBMC is not affected by estrogen.

Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults

PURPOSE

Low resting metabolic rate (RMR) and high carbohydrate reliance at rest are associated with weight gain, but are highly variable in obese individuals. This study determined the relationship of total and segmental body composition and adiposity hormones with RMR and respiratory exchange ratio (RER) in overweight and obese adults.

METHODS

In 49 men (n = 23) and premenopausal women (n = 26) [mean ± SD; age = 35.0 ± 8.9 years; body mass index (BMI) = 33.6 ± 5.2 kg·m^-2; percent body fat (%fat) = 40.0 ± 8.0%], RMR and RER were evaluated using indirect calorimetry. Total and segmental body composition [fat mass (FM), percent fat (%fat), lean mass (LM), visceral adipose tissue (VAT)] were estimated using dual-energy X-ray absorptiometry. Fasted blood and saliva samples were analyzed for insulin, leptin, estradiol, and cortisol.

RESULTS

In men (M) and women (W), RMR significantly correlated (p < 0.05) with FM (M: R = 0.535; W: R = 0.784) and LM (M: R = 0.645; W: R = 0.867). Of the segmental measures, trunk LM (M: R = 0.593; W: R = 0.879; p < 0.05) and leg LM (M: R = 0.664; W: R = 0.821; p < 0.05) had the strongest correlations with RMR. In men, but not women, RER significantly correlated with FM (R = 0.449; p = 0.032), trunk FM (R = 0.501; p = 0.015), and VAT (R = 0.456; p = 0.029). In men, RMR positively correlated with cortisol (R = 0.430, p = 0.040) and estradiol (R = 0.649, p = 0.001) and RER positively correlated with insulin (R = 0.525, p = 0.010). In women, RMR positively correlated with insulin (R = 0.570, p = 0.006), but RER was not significantly correlated with hormones (p > 0.05).

CONCLUSIONS

Segmental evaluation of body composition, specifically in the lower extremities and abdomen, may be an effective and efficient way to evaluate metabolic status. Sex-specific evaluations are also imperative.

Gender- and Age-Specific REE and REE/FFM Distributions in Healthy Chinese Adults

Basic data on the resting energy expenditure (REE) of healthy populations are currently rare, especially for developing countries. The aims of the present study were to describe gender- and age-specific REE distributions and to evaluate the relationships among glycolipid metabolism, eating behaviors, and REE in healthy Chinese adults. This cross-sectional survey included 540 subjects (343 women and 197 men, 20–79 years old). REE was measured by indirect calorimetry and expressed as kcal/day/kg total body weight. The data were presented as the means and percentiles for REE and the REE to fat-free mass (FFM) ratio; differences were described by gender and age. Partial correlation analysis was used to analyze the correlations between REE, tertiles of REE/FFM, and glycolipid metabolism and eating behaviors. In this study, we confirmed a decline in REE with age in women (p = 0.000) and men (p = 0.000), and we found that men have a higher REE (p = 0.000) and lower REE/FFM (p = 0.021) than women. Furthermore, we observed no associations among glycolipid metabolism, eating behaviors, and REE in healthy Chinese adults. In conclusion, the results presented here may be useful to clinicians and nutritionists for comparing healthy and ill subjects and identifying changes in REE that are related to aging, malnutrition, and chronic diseases.

Effects of Levothyroxine Replacement or Suppressive Therapy on Energy Expenditure and Body Composition

BACKGROUND

Thyrotropin (TSH)-suppressive doses of levothyroxine (LT4) have adverse effects on bone and cardiac function, but it is unclear whether metabolic function is also affected. The objective of this study was to determine whether women receiving TSH-suppressive LT4 doses have alterations in energy expenditure or body composition.

METHODS

This study was a cross-sectional comparison between three groups of women: 26 women receiving chronic TSH-suppressive LT4 doses, 80 women receiving chronic replacement LT4 doses, and 16 untreated euthyroid control women. Subjects underwent measurements of resting energy expenditure (REE), substrate oxidation, and thermic effect of food by indirect calorimetry; physical activity energy expenditure by accelerometer; caloric intake by 24-hour diet recall; and body composition by dual X-ray absorptiometry.

RESULTS

REE per kilogram lean body mass in the LT4 euthyroid women was 6% lower than that of the LT4-suppressed group, and 4% lower than that of the healthy control group (p = 0.04). Free triiodothyronine (fT3) levels were directly correlated with REE, and were 10% lower in the LT4 euthyroid women compared with the other two groups (p = 0.007). The groups of subjects did not differ in other measures of energy expenditure, caloric intake, or body composition.

CONCLUSIONS

LT4 suppression therapy does not adversely affect energy expenditure or body composition in women. However, LT4 replacement therapy is associated with a lower REE, despite TSH levels within the reference range. This may be due to lower fT3 levels, suggesting relative tissue hypothyroidism may contribute to impaired energy expenditure in LT4 therapy.

Relative contribution of organs other than brain to resting energy expenditure is consistent among male power athletes

We have previously shown that resting energy expenditure (REE) adjusted by fat-free mass (FFM) in male college athletes remains consistent regardless of FFM. The FFM comprises internal organs with high metabolic activity, such as liver and brain, which account for 60 to 80% of REE in adults. The purpose of the present study is to examine the contribution of internal organs to the REE of the FFM fraction among male power athletes. The study included 37 American male college football players. REE was measured by indirect calorimetry and body composition was measured by dual energy X-ray absorptiometry (DXA). Mass of brain, liver, and kidneys was measured by MRI and mass of heart was estimated by echocardiography. Normal levels of thyroid hormone (triiodothyronine: T3) were confirmed in all subjects prior to the analysis. Multiple regression analysis was used to assess the influence of FFM, fat mass (FM), T3, and mass of organs on variance of REE. Average body weight and FFM were 81.2±11.3 kg and 67.7±7.4 kg, respectively. The relative contributions of liver, kidneys, and heart to REE were consistent regardless of FFM, while the REE of brain was negatively correlated with FFM (r=-0.672, p<0.001). Only FFM and T3 were found to be independent factors influencing REE. These results suggest that a steady contribution of internal organs other than the brain is the major reason for the consistency of the REE/FFM ratio in male power athletes.

Efficacy of WBV as a modality for inducing changes in body composition, aerobic fitness, and muscular strength: a pilot study

The purpose of this pilot study was to evaluate the effectiveness of whole body vibration (WBV) training as a modality for inducing changes in body composition, cardiovascular condition, and muscular strength in sedentary postmenopausal women. WBV training was compared with other training regimens, ie, aerobic training and circuit resistance training, commonly used to promote weight loss, cardiovascular conditioning, and muscular strength. Postmenopausal women (aged 48–60 years) were randomly assigned to WBV training, circuit resistance training, or aerobic training. Participants trained three times per week for 8 weeks. The training regimens were progressive in nature, with increases in training intensity and duration occurring throughout the 8-week period. Body composition was assessed using dual-energy X-ray absorptiometry analyses. A modified Bruce treadmill protocol was used to assess aerobic capacity (VO_2peak) and time to peak exhaustion. Upper and lower body strengths were determined by one repetition maximum (1-RM) chest and leg presses, respectively. Variables were analyzed using separate 3 (exercise mode) × 2 (time) repeated-measures analysis of variance with effect sizes due to the small sample size. No significant main effects or interactions were seen for any body composition variable; however, moderate to large effect sizes (η²=0.243 and η²=0.257) were detected regarding interactions for percent body fat and lean body mass favoring aerobic training and circuit resistance training. For VO_2peak, no significant main effects or interactions were detected (time, η²=0.150; P=0.11; time × group, η²=0.139; P=0.30); but a significant time effect was observed for time to peak exhaustion (η²=0.307; P=0.017). A significant interaction for upper body strength (η²=0.464; P=0.007), and main effect for time in lower body strength (η²=0.663; P=0.0001) was detected. Post hoc analysis indicated a significant increase in upper body strength for circuit resistance training (P=0.023) and a decrease for WBV training (P=0.015). Our results indicate that WBV may not be an effective alternative to traditional training with regard to body composition or aerobic capacity, but could have a positive impact on lower body strength.

Peripheral signalling involved in energy homeostasis control

The alarming prevalence of obesity has led to a better understanding of the molecular mechanisms controlling energy homeostasis. Regulation of energy intake and expenditure is more complex than previously thought, being influenced by signals from many peripheral tissues. In this sense, a wide variety of peripheral signals derived from different organs contributes to the regulation of body weight and energy expenditure. Besides the well-known role of insulin and adipokines, such as leptin and adiponectin, in the regulation of energy homeostasis, signals from other tissues not previously thought to play a role in body weight regulation have emerged in recent years. The role of fibroblast growth factor 21 (FGF21), insulin-like growth factor 1 (IGF-I), and sex hormone-binding globulin (SHBG) produced by the liver in the regulation of body weight and insulin sensitivity has been recently described. Moreover, molecules expressed by skeletal muscle such as myostatin have also been involved in adipose tissue regulation. Better known is the involvement of ghrelin, cholecystokinin, glucagon-like peptide 1 (GLP-1) and PYY(3-36), produced by the gut, in energy homeostasis. Even the kidney, through the production of renin, appears to regulate body weight, with mice lacking this hormone exhibiting resistance to diet-induced obesity. In addition, the skeleton has recently emerged as an endocrine organ, with effects on body weight control and glucose homeostasis through the actions of bone-derived factors such as osteocalcin and osteopontin. The comprehension of these signals will help in a better understanding of the aetiopathology of obesity, contributing to the potential development of new therapeutic targets aimed at tackling excess body fat accumulation.

Resting energy expenditure in young adults born preterm--the Helsinki study of very low birth weight adults

Background

Adults born preterm with very low birth weight (VLBW; <1500g) have higher levels of cardiovascular and metabolic risk factors than their counterparts born at term. Resting energy expenditure (REE) could be one factor contributing to, or protecting from, these risks. We studied the effects of premature birth with VLBW on REE.

Methodology/Principal Findings

We used indirect calorimetry to measure REE and dual x-ray absorptiometry (DXA) to measure lean body mass (LBM) in 116 VLBW and in 118 term-born control individuals (mean age: 22.5 years, SD 2.2) participating in a cohort study. Compared with controls VLBW adults had 6.3% lower REE (95% CI 3.2, 9.3) adjusted for age and sex, but 6.1% higher REE/LBM ratio (95% CI 3.4, 8.6). These differences remained similar when further adjusted for parental education, daily smoking, body fat percentage and self-reported leisure time exercise intensity, duration and frequency.

Conclusions/Significance

Adults born prematurely with very low birth weight have higher resting energy expenditure per unit lean body mass than their peers born at term. This is not explained by differences in childhood socio-economic status, current fat percentage, smoking or leisure time physical activity. Presence of metabolically more active tissue could protect people with very low birth weight from obesity and subsequent risk of chronic disease.

Obesity and thyroid function

A moderate elevation of thyrotropin (TSH) concentrations, which is associated with triiodothyronine (T3) values in or slightly above the upper normal range, is frequently found in obese humans. These alterations seem rather a consequence than a cause of obesity since weight loss leads to a normalization of elevated thyroid hormone levels. Elevated thyroid hormone concentrations increase the resting energy expenditure (REE). The underlying pathways are not fully understood. As a consequence of the increased REE, the availability of accumulated energy for conversion into fat is diminished. In conclusion, the alterations of thyroid hormones in obesity suggest an adaptation process. Since rapid weight loss is associated with a decrease of TSH and T3, the resulting decrease in REE may contribute towards the difficulties maintaining weight loss. Leptin seems to be a promising link between obesity and alterations of thyroid hormones since leptin concentrations influence TSH release.

Grade of adiposity affects the impact of fat mass on resting energy expenditure in women

Body fat mass (FM) adds to the variance in resting energy expenditure (REE). However, the nature and extent of this relationship remains unclear. Using a database of 1306 women and a linear regression model, we systematically analysed the contribution of FM to the total variance in REE at different grades of adiposity (ranges of body %FM). After adjusting for age, the relative contribution of FM on REE variance increased from low ( ≤ 10 %FM) to normal (>10– ≤ 30 %FM) and moderately elevated (>30– ≤ 40 %FM) grades of adiposity but decreased sharply at high (>40– ≤ 50 %FM) and very high (>50 %FM) grades of adiposity according to the ratio between regression coefficients. These data suggest that the specific metabolic rate of fat tissue is reduced at high adiposity. This should be considered when REE is normalized for FM in obesity.

Relationship between blood adipocytokines and resting energy expenditure in young and elderly women

It has been demonstrated in a previous study that resting energy expenditure (REE) is associated with adiponectin levels in the blood. However, body composition was not taken into consideration in that study. The purpose of the present study was to again investigate the relationship between blood adipocytokines and REE, adjusted by body composition, in both young and elderly women. REE and blood adipocytokines were measured in 115 young (age: 22.3+/-2.1 y, BMI: 21.3+/-1.9 kg/m(2)) and 71 elderly (63.4+/-6.5 y, 22.9+/- 2.3 kg/m(2)) women. Dual energy X-ray absorptiometry was used to measure percent body fat. Fat mass and fat free mass (FFM) were calculated. REE (kcal/d and kcal/kg BW/d) was lower in elderly women than in young women, but no significant difference was observed in REE, expressed as kcal/kg FFM/d, between the two groups. Although elderly women had a higher percent body fat and higher serum leptin concentrations than young women, plasma adiponectin concentrations did not differ between young and elderly women. In elderly women, REE (kcal/d) was significantly and inversely correlated with plasma adiponectin concentration (r=-0.386, p<0.001), but REE expressed per kilogram of BW or FFM was not significantly correlated. Furthermore, no significant correlation was observed between REE (kcal/d) and concentrations of plasma adiponectin or serum leptin, after adjusting for potential confounders such as body composition and hormones, in either age group. These results suggest that adipocytokines do not influence REE in adult women.

Plasma concentrations of free triiodothyronine predict weight change in euthyroid persons

BACKGROUND

Factors that influence energy metabolism and substrate oxidation, such as thyroid hormones (THs), may be important regulators of body weight.

OBJECTIVE

We investigated associations of THs cross-sectionally with obesity, energy expenditure, and substrate oxidation and prospectively with weight change.

DESIGN

Euthyroid, nondiabetic, healthy, adult Pima Indians (n = 89; 47 M, 42 F) were studied. Percentage body fat (%BF) was measured by using dual-energy X-ray absorptiometry; sleeping metabolic rate (SMR), respiratory quotient, and substrate oxidation rates were measured in a respiratory chamber. Thyroid-stimulating hormone (TSH), free thyroxine (T(4)), free triiodothyronine (T(3)), and leptin concentrations were measured in fasting plasma samples.

RESULTS

TSH, but neither free T(3) nor free T(4), was associated with %BF and leptin concentrations (r = 0.27 and 0.29, respectively; both: P <or= 0.01). In multiple regression analyses adjusted for age, sex, fat mass, and fat-free mass, free T(3) was a positive predictor of SMR (P = 0.02). After adjustment for age, sex, %BF, and energy balance, free T(3) was a negative predictor of 24-h respiratory quotient (P < 0.05) and a positive predictor of 24-h lipid oxidation rate (P = 0.006). Prospectively, after an average follow-up of 4 +/- 2 y, the mean increase in weight was 3 +/- 9 kg. Baseline T(3) concentrations were associated with absolute and annual percentage of changes in weight (r = -0.27, P = 0.02, and r = -0.28, P = 0.009, for the age- and sex-adjusted associations, respectively).

CONCLUSIONS

In euthyroid Pima Indians, lower free T(3) but not free T(4) concentrations were an independent predictor of SMR and lipid oxidation and a predictor of weight gain. This finding indicates that control of T(4)-to-T(3) conversion may play a role in body weight regulation.

Additional anthropometric measures may improve the predictability of basal metabolic rate in adult subjects

BACKGROUND

The most commonly used predictive equation for basal metabolic rate (BMR) is the Schofield equation, which only uses information on body weight, age and sex to derive the prediction. However, because body composition is a key influencing factor, there will be error in calculating an individual's basal requirements based on this prediction.

OBJECTIVE

To investigate whether adding additional anthropometric measures to the standard measures can enhance the predictability of BMR and to cross-validate this within a separate subgroup.

DESIGN

Cross-sectional study of 150 Caucasian adults from Scotland, with a body mass index range of 16.7-49.3 kg/m(2). All subjects underwent measurement of BMR, body composition, and 148 also had basic skinfold and circumference measures taken. The resultant equation was tested in a subgroup of 39 obese males.

RESULTS

The average difference between the predicted (Schofield equation) and measured BMR was 502 kJ/day. There was a slight systematic bias in this error, with the Schofield equation underestimating the lowest values. The average discrepancy between predicted and actual BMR was reduced to 452 kJ/day, with the addition of fat mass, fat-free mass, an overall 10% improvement on the Schofield equation (P=0.054). Using an equation derived from principal components analysis of anthropometry measurements similarly decreased the difference to 458 kJ/day (P=0.039). Testing the equation in a separate group indicated a 33% improvement in predictability of BMR, compared to the Schofield equation.

CONCLUSIONS

In the absence of detailed information on body composition, utilizing anthropometric data provides a useful alternative methodology to improve the predictability of BMR beyond that achieved from the standard Schofield prediction equation. This should be confirmed in more individuals, both within the obese and normal weight category.

Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine

BACKGROUND

Basal metabolic rate (BMR) is the largest component of daily energy demand in Western societies. Previous studies indicated that BMR is highly variable, but the cause of this variation is disputed. All studies agree that variation in fat-free mass (FFM) plays a major role, but effects of fat mass (FM), age, sex, and the hormones leptin, triiodothyrionine (T3), and thyroxine (T4) remain uncertain.

OBJECTIVE

We partitioned the variance in BMR into within- and between-subject effects and explored the roles of FFM, FM, bone mineral content, sex, age, and circulating concentrations of plasma leptin, T3, and T4.

DESIGN

This was a cross-sectional study of 150 white adults from northeast Scotland, United Kingdom.

RESULTS

Only 2% of the observed variability in BMR was attributable to within-subject effects, of which 0.5% was analytic error. Of the remaining variance, which reflected between-subject effects, 63% was explained by FFM, 6% by FM, and 2% by age. The effects of sex and bone mineral content were not significant (P > 0.05). Twenty-six percent of the variance remained unexplained. This variation was not associated with concentrations of circulating leptin or T3. T4 was not significant in women but explained 25% of the residual variance in men.

CONCLUSIONS

Our data confirm that both FFM and FM are significant contributors to BMR. When the effect of FM on BMR is removed, any association with leptin concentrations disappears, which suggests that previous links between circulating leptin concentrations and BMR occurred only because of inadequate control for the effects of FM.

Lower resting metabolic rate in the elderly may not be entirely due to changes in body composition

OBJECTIVE

To investigate whether or not the lower resting metabolic rate (RMR) in the elderly is entirely due to changes in body composition.

DESIGN

Cross-sectional data of 132 female (age 69.9+/-5.5 y, body mass index (BMI) 26.5+/-4.0 kg/m(2)) and 84 male (age 68.9+/-5.1 y, BMI 26.1+/-2.8 kg/m(2)) participants of the longitudinal study on nutrition and health status in an aging population of Giessen, Germany, as well as that of 159 young women (age 24.8+/-3.0 y, BMI 21.1+/-2.5 kg/m(2)) and 67 young men (age 26.8+/-3.4 y, BMI 23.3+/-2.4 kg/m(2)) were analysed. RMR was measured by indirect calorimetry after an overnight fast and body composition was estimated by bioelectrical impedance analysis and predictive equations from the literature. Analysis of covariance was used to adjust RMR for body composition, body fat distribution and smoking habits. Additionally, RMR that is to be expected theoretically, was calculated on the basis of the subjects' body composition and the specific metabolic rate of the different organs and was compared to measured RMR.

RESULTS

Compared to young subjects adjusted RMR was significantly lower in elderly women (5432+/-82 vs 5809+/-70 kJ/day, P<0.01) and men (6971+/-99 vs 7558+/-121 kJ/day, P<0.001). In both elderly women and men, measured RMR was markedly lower than calculated RMR (-625+/-404, -515+/-570 kJ/day). By contrast, measured and calculated RMR were nearly the same in young men (159+/-612 kJ/day); in young women the difference between measured and calculated RMR was only -300+/-457 kJ/day. In both sexes, these differences are significantly larger in the elderly when compared to young adults.

CONCLUSION

These results support the point of view that the decline in RMR with advancing age cannot be totally due to changes in body composition.

Energy expenditure in African American and white boys and girls in a 2-y follow-up of the Baton Rouge Children's Study

BACKGROUND

Previously reported race and sex differences in energy expenditure (EE) may play a role in body fat gain.

OBJECTIVE

The purpose of the study was to determine the relations between race, sex, Tanner stage, and EE.

DESIGN

We conducted a 2-y follow-up study of EE in 114 African American (AA) and white girls and boys aged 12.7 +/- 0.1 y ( +/- SE), who were stratified as obese or lean and were part of the Baton Rouge Children's Study. Total daily EE (TDEE) was measured by using doubly labeled water. Resting metabolic rate (RMR) and thermic effect of food were measured by using indirect calorimetry.

RESULTS

White children had significantly higher TDEE and RMR than did AA children when fat-free mass was considered. Boys had significantly higher TDEE and RMR than did girls, even after adjustment for differences in size. TDEE and RMR were significantly higher in obese children, as a result of their greater fat-free mass and body fat, than in lean children. Activity-related EE did not differ significantly between obese and lean children. There was a strong relation between initial and 2-y TDEE and RMR. There was a significant decrease in activity-related EE in both racial groups. AA children had significantly more lean limb mass than did white children.

CONCLUSIONS

Average TDEE did not change over 2 y, but RMR increased significantly, and activity-related EE decreased significantly. Differences in trunk and limb lean mass of white and AA children may explain some of the ethnic differences in EE. The decrease in physical activity over 2 y may contribute to the risk of obesity.

Obesity and endocrine disease

Several endocrine abnormalities are reported in obesity. Some of these abnormalities are considered as causative factors for the development of obesity, whereas others are considered to be secondary effects of obesity and usually are restored after weight loss. Thyroid hormones usually are normal in obesity, with the exception of T3 which is elevated. Prolactin is normal but prolactin response to different stimuli is blunted. GH is low and GH response to stimuli is blunted. IGF-I levels are normal or elevated. Cortisol, ACTH, and urine free cortisol levels are usually normal; however, a hyperresponsiveness of the HPA axis with increased cortisol and ACTH response to stimulatory tests is observed in centrally obese individuals. Total testosterone and SHBG levels are low, but free testosterone levels are usually normal in obese men. LH and FSH levels usually are normal and estrogens are elevated. Norepinephrine levels are elevated, whereas epinephrine levels are low or normal. Aldosterone levels are elevated but renin activity is usually normal. Parathyroid hormone levels are elevated with normal serum calcium levels and increased urine calcium levels. Monogenic mutations that result in severe obesity have been described in several individuals. Also, several endocrine diseases have obesity as one their clinical manifestations. Hypothyroidism, Cushing's syndrome, GH and testosterone deficiency, polycystic ovarian syndrome, insulinoma, hypothalamic lesions, and genetic syndromes often present with obesity. In most of these conditions, appropriate treatment of the primary disease results in weight loss. In addition, the fat cell has been found to be an endocrine organ that produces several peptides that are bioactive and participate in the regulation of adipocyte function.

The prediction of resting energy expenditure in type 2 diabetes mellitus is improved by factoring for glycemia

BACKGROUND

Predictive equations have been reported to overestimate resting energy expenditure (REE) for obese persons. The presence of hyperglycemia results in elevated REE in obese persons with type 2 diabetes, and its effect on the validity of these equations is unknown.

OBJECTIVE

We tested whether (1) indicators of diabetes control were independent associates of REE in type 2 diabetes and (2) their inclusion would improve predictive equations.

DESIGN

A cross-sectional study of 65 (25 men, 40 women) obese type 2 diabetic subjects. Variables measured were: REE by ventilated-hood indirect calorimetry, body composition by bioimpedance analysis, body circumferences, fasting plasma glucose (FPG) and hemoglobin A(1c). Data were analyzed using stepwise multiple linear regression.

RESULTS

REE, corrected for weight, fat-free mass, age and gender, was significantly greater with FPG>10 mmol/l (P=0.017) and correlated with FPG (P=0.013) and hemoglobin A(1c) as percentage upper limit of normal (P=0.02). Weight was the main determinant of REE. Together with hip circumference and FPG, it explained 81% of the variation. FPG improved the predictability of the equation by >3%. With poor glycemic control, it can represent an increase in REE of up to 8%.

CONCLUSION

Our data indicate that in a population of obese subjects with type 2 diabetes mellitus, REE is better predicted when fasting plasma glucose is included as a variable.

Metabolically active components of fat-free mass and resting energy expenditure in humans: recent lessons from imaging technologies

Imaging technologies, i.e. magnetic resonance imaging (MRI), computer tomography (CT) and dual-energy X-ray absorptiometry (DEXA), are precise and accurate techniques used to study lean body mass and adipose tissue distribution. CT and MRI can also be used to assess metabolically active components of fat-free mass (FFM). (Throughout this article, metabolic activity is defined with respect to oxidative metabolism.) To date a total of 116 in vivo measurements of organ masses (OM), in combination with the measurement of resting energy expenditure (REE), have been reported. These data suggest that MRI- or CT-derived OM explains part (approximately 5-10%) of the interindividual variance in REE. The data also suggest that REE can be reconstructed from detailed body composition analysis. Calculating REE from the sum of individual OM multiplied by a constant organ tissue-respiration rate showed a high correlation between calculated and measured REE, with only small and non-significant differences of 83-96 kJ d-1. In addition to CT- and MRI-derived OM, data are available of 244 obese and non-obese subjects regarding the association between regional components of lean body mass (LBM, assessed by DEXA) and REE. These results suggest that measurement of LBM distribution also provides the opportunity to adjust for the non-linearity of REE on body mass. Assessment of metabolically active components of FFM or LBM may also add to our understanding of malnutrition-, obesity- and disease states-related variance in REE. There is need for (1) standardization of imaging technology in body composition research; (2) reference data on detailed body composition, also including more recent autopsy data; (3) reducing the number of assumptions in model-based predictions; and (4) a combination of imaging technologies with in vivo measurements of individual OM respiration.

A longitudinal study of resting energy expenditure relative to body composition during puberty in African American and white children

BACKGROUND

Body composition and resting energy expenditure (REE) have not been examined longitudinally during puberty.

OBJECTIVE

The purpose of this longitudinal study was to examine the influence of pubertal maturation on REE relative to body composition in African American and white children.

DESIGN

The study included 92 white and 64 African American children (mean age at baseline: 8.3 and 7.9 y, respectively) from Birmingham, AL. The children had 2-5 annual measurements of fat mass (FM), lean mass (LM), and REE. The Tanner stages of the children ranged from 1 to 5. Mixed-model repeated-measures analyses were used to test the change in REE relative to body composition with increasing Tanner stage among ethnic and sex groups.

RESULTS

LM increased from Tanner stage 1 to subsequent stages. FM relative to LM decreased from Tanner stage 1 to stages 3, 4, and 5 but not from stage 1 to stage 2. The African American children had relatively higher limb LM and lower trunk LM than did the white children. REE declined with Tanner stage after adjustment for ethnicity, sex, FM, and LM. This decline was significant from Tanner stage 1 to stages 3, 4, and 5 but not to Tanner stage 2. After adjustment for age, Tanner stage, FM, and LM or LM distribution, REE was significantly higher in white than in African American children (by approximately 250 kJ/d).

CONCLUSION

In a large sample of children at various Tanner stages, we found an ethnic difference in REE after adjustment for age, Tanner stage, FM, and LM that was not explained by the difference in LM distribution.

Age-related decrease in resting energy expenditure in sedentary white women: effects of regional differences in lean and fat mass

BACKGROUND

Lean mass and resting energy expenditure (REE) decrease with age. However, it is unknown whether age-related changes in regional lean and fat mass are responsible for the age-related decrease in REE.

OBJECTIVE

Our objective was to determine how regional lean and fat mass vary with age and whether age is independently related to REE after adjustment for regional fat and lean mass.

DESIGN

The study was a cross-sectional evaluation of 58 white women aged 23-77 y. Regional and whole-body lean and fat mass were measured by dual-energy X-ray absorptiometry, subcutaneous abdominal tissue (SAT) and intraabdominal adipose tissue (IAF) by computed tomography, and REE by ventilated-canopy indirect calorimetry.

RESULTS

Independent of other significant correlates, age was significantly and independently associated with greater IAF (beta = 0.49) and less leg lean mass (beta = -0.35). IAF (r = -0.28) and IAF:SAT (r = -0.31) correlated negatively with REE. REE was negatively associated with greater age (beta = -0.42), independent of changes in lean and fat mass in different parts of the body. By contrast, trunk lean (beta = 0.27) and leg fat (beta = 0.27) mass were associated with greater REE independent of age and other body-composition variables.

CONCLUSIONS

These results suggest that trunk lean mass (presumably primarily organ tissue) is relatively resistant to age-related changes in body composition, whereas muscle mass, especially leg muscle, tends to be lost. These data also suggest that the age-related decreases in REE are not fully explained by changes in body composition.

Relationships of age, menopause and central obesity on cardiovascular disease risk factors in Chinese women

OBJECTIVE

To evaluate the inter-relationships of age- and menopause- related changes of general obesity and body fat distribution and their independent effects on cardiovascular risk factors.

DESIGN

Cross-sectional study.

SUBJECTS

One-hundred and thirty-six premenopausal and 193 postmenopausal Chinese women with body mass index (BMI) < 30 kg/m2.

MEASUREMENTS

Anthropometric surrogates of general obesity (BMI, total body fat percentage) and central obesity (waist-to-hip ratio, centrality index) were measured. Blood pressure, 75 g oral glucose tolerance test, glycosylated hemoglobin A1c and lipid profiles were also measured.

RESULTS

Significant correlation coefficients between age, general obesity, central obesity and cardiovascular disease risk factors were noted. Through the menopausal transition, the BMI and total body fat percentage were increased significantly. After adjustments for age and BMI, the postmenopausal women showed higher android fat percentage, centrality index, glycosylated hemoglobin A1c, serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol and atherogenic indices than the premenopausal women. In multiple stepwise regression models, age exerted independent effects on oral glucose tolerance test 2 h plasma glucose level, systolic and diastolic blood pressure, total cholesterol level, and LDL cholesterol. Menopause was an independent variable in relation to the changes of glycosylated hemoglobin A1c, total and LDL cholesterol levels, triglyceride levels and atherogenic indices. The centrality index was the major independent variable of all the cardiovascular disease risk factors, except total and LDL cholesterol level. However, the variation of total body fat percentage had no independent effect on any cardiovascular disease risk factors.

CONCLUSION

Through the aging and menopausal effects, women will increase total body fat content, favoring the central body fat distribution. Age, menopause and central obesity were all independent and significant factors to the cardiovascular disease risk factors in Chinese women.

Racial differences in energy expenditure and aerobic fitness in premenopausal women

BACKGROUND

Aerobic fitness, or maximal oxygen uptake (f1.gif" BORDER="0">O(2)max), and energy expenditure (EE) may be lower in African Americans than in whites.

OBJECTIVE

The objective of this study was to compare sleeping EE (SEE), resting EE (REE), free-living total EE (TEE), and f1.gif" BORDER="0">O(2)max in African American and white women after adjustment for body composition and free-living activity-related energy expenditure (AEE).

DESIGN

Eighteen African American and 17 white premenopausal women were matched for weight, percentage body fat, and age. SEE and REE were measured in a room calorimeter and f1.gif" BORDER="0">O(2)max was measured on a treadmill. Fat-free mass (FFM) and fat mass (FM) (4-compartment model), AEE (doubly labeled water and SEE), and regional lean tissue (dual-energy X-ray absorptiometry) were used as adjustment variables in SEE, REE, TEE, and f1.gif" BORDER="0">O(2)max comparisons.

RESULTS

The African American women had significantly more limb lean tissue and significantly less trunk lean tissue than did the white women. The African American women also had significantly lower SEE (6.9%), REE (7.5%), TEE (9.6%), and f1.gif" BORDER="0">O(2)max (13.4%) than did the white women. Racial differences persisted after adjustment for f1.gif" BORDER="0">O(2)max, AEE, FFM, and limb lean tissue but disappeared after adjustment for trunk lean tissue. The f1.gif" BORDER="0">O(2)max difference was independent of all body-composition variables and of AEE.

CONCLUSIONS

African American women had lower aerobic fitness than did white women, independent of differences in lean tissue or AEE. Diminished racial differences in SEE, REE, and TEE after adjustment for trunk lean tissue suggest that low EE in African American women is mediated by low volumes of metabolically active organ mass.

Comparison of resting energy expenditure measurements by ventilated canopy and by respiration chamber

The study compared measurements of resting energy expenditure (REE) by two methods, namely the commercially available ventilated canopy (Medgraphics CCM system) and the respiration chamber. Thirty-five healthy subjects of both sexes with a wide weight range (BMI 18-33.8 kg m-2) were measured on both systems. The linear regression equation was REEcanopy = 0.66 x REEresp.cham. + 61.1 (kJ h-1), and the corresponding SEE% was 8.6%. The correlation was high (r = 0.89). However, the mean REE measured using the ventilated canopy was 41 kJ h-1 (13%) lower than that using the respiration chamber (P < 0.01). The Medgraphics CCM canopy system seems valid for measurements of REE. However, the REE results measured by the canopy were systematically lower than when measured by the respiration chamber, but can be converted by the equation given with an accuracy error of 9%.

Is there evidence for an age-related reduction in metabolic rate?

To determine whether the age-related reduction in basal metabolic rate (BMR) is explained by a quantitative and/or qualitative change in the components of lean tissue, we conducted a cross-sectional study in groups of young (n = 38, 18-35 yr) and older (n = 24, 50-77 yr) healthy individuals. BMR was measured by indirect calorimetry. Body composition was obtained by using dual-energy X-ray absorptiometry (DEXA), which permitted four compartments to be quantified [bone mineral mass, fat mass (FM), appendicular lean tissue mass (ALTM), and nonappendicular lean tissue mass (NALTM)]. Absolute BMR and ALTM were lower, whereas FM was significantly higher in the older, compared with young, subjects. BMR, adjusted for differences in FM, ALTM, and NALTM, was significantly lower in the older subjects by 644 kJ/day. In separate regression analyses of BMR on body compartments, older subjects had significantly lower regression coefficients for ALTM and NALTM, compared with young subjects. Hence, the age-related decline in BMR is partly explained by a reduction in the quantity, as well as the metabolic activity, of DEXA-derived lean tissue components.

Energy requirements and physical activity of older free-living African-Americans: a doubly labeled water study

We examined daily energy requirements and determinants of physical activity in older, free-living African-American women (n = 37; age, 64 +/- 8 yr) and men (n = 28; age, 64 +/- 7 yr). Total daily energy expenditure and its components [i.e. resting metabolic rate (RMR) and physical activity energy expenditure] were determined using doubly labeled water and indirect calorimetry. Body composition from dual energy x-ray absorptiometry, maximal oxygen consumption from a graded treadmill test, and leisure time physical activity from a structured interview were determined. Total daily energy expenditure adjusted for body composition was lower (P < 0.05) for women (2198 +/- 621 kcal/d) than for men (2633 +/- 669 kcal/d) due to a lower RMR (1431 +/- 240 vs. 1576 +/- 259 kcal/d; P = 0.07) and physical activity energy expenditure (548 +/- 559 vs. 794 +/- 603 kcal/d; P = 0.19), respectively. The physical activity level ratio (i.e. total daily energy expenditure/RMR) was not different from Food and Agriculture Organization/World Health Organization/United Nations University recommendations (i.e. 1.51) for women (1.51 +/- 0.25), but was higher for men (1.71 +/- 0.32). The strongest correlates with physical activity energy expenditure were age for women (r = -0.44; P < 0.01) and maximal oxygen consumption for men (r = 0.39; P < 0.05). These data show that daily energy requirements are significantly lower in African-American women compared to men, primarily due to lower levels of physical activity energy expenditure. Furthermore, lower levels of cardiovascular fitness in men and advancing age in women are associated with lower physical activity energy expenditure.

Relationship between resting metabolic rate and the composition of the fat-free mass

Although a low resting metabolic rate (RMR) has been shown to be a risk factor for future weight gain, little is known about the mechanisms determining its level. We tested the hypothesis that the composition of the fat-free mass (FFM) is a main determinant of RMR. If this hypothesis is true, a regression model including internal organ masses as independent variables should explain a larger fraction of the variance in RMR than is explained using only FFM as a predictor. We measured fat mass by hydrodensitometry, liver and kidney volumes by computed tomography (CT), heart mass by echocardiography, muscle mass by dual-energy x-ray absorptiometry (DEXA), and RMR by calorimetry in 40 subjects. FFM and fat mass explained 83% of the variability in RMR (standard error of the estimate [SEE], 420 kJ/d) in a multiple regression analysis. Combinations of organ and muscle masses performed as well as but not better than stepwise multiple regression models. The fact that the composition of the lean mass could not improve the prediction of RMR in comparison to the traditional FFM-fat mass model suggests that the weight of internal organs is not a main determinant of RMR. This may indicate that the variability in RMR is associated with variation in energy expenditure per kilogram of tissue of the individual organs.

Gender differences in energy expended during activities and in daily energy expenditure of elderly people

Gender effects on energy expended during light seated activities, walking, cycling, and sleep and their consequences on daily energy expenditure (EE) were examined in 11 men and 15 women aged 66.4 +/- 7.1 yr. Two open-circuit whole body calorimeters were used for EE measurements, except for cycling, during which EE was measured separately with the use of a face mask. Lean body mass (determined using H218O dilution method), fat mass, usual physical activity level, and activity intensity (e.g., walking speed and cycling power output) were taken as covariates in the analysis of EE variations before studying gender effects. Sleeping metabolic rate (SMR) and daily EE, adjusted for differences in all covariates, were 11.2 (P = 0.005) and 8.7% (P = 0.071) lower in women than in men, respectively. No gender-related differences were found in the various physical activity EEs above SMR (e.g., gross EE-SMR) [light seated activities (P = 0.790), walking (P = 0.263), and cycling (P = 0.287)] and daily physical activity EE above SMR (P = 0.587) after adjustment for differences in all covariates. Therefore, the lower adjusted daily EE of women could be related to their lower SMR, the most reliable criterion of whole body metabolic rate.

The endocrinology of obesity

Numerous endocrine alterations are associated with obesity (Table 1). The majority of the alterations are secondary to obesity and must be considered simply associated and potentially in the pathogenesis of the complications of obesity. The discovery of new endocrine peptides such as leptin that signal body fat content will increase our understanding of the regulation of body fat content. As a result, therapies will most certainly be developed that are directly targeted at the alterations in endocrine function.