Human energy expenditure: advances in organ-tissue prediction models

Energy Costs of 37 Physical Activities in Chinese Children and Adolescents Aged 9-17 Years with Obesity

BACKGROUND/OBJECTIVE

Obtaining data on the energy expenditure of physical activity (PA) in children and adolescents with obesity is crucial for promoting health in this population through exercise. However, relevant research is limited. This study aimed to determine the energy expenditure characteristics of 37 diverse PAs in children and adolescents with obesity and examine the association between obesity and energy expenditure (EE) characteristics within this cohort.

METHODS

Three hundred and ninety-seven children and adolescents with obesity aged 9-17 performed various PAs. PA intensity, EE, and body fat (BF) percentage were measured.

RESULTS

The resting oxygen uptake (VO2) and resting energy expenditure (REE) of children and adolescents with obesity were 4.23 (3.72-4.84) ml/kg/min and 0.020 (0.018-0.023) kcal/kg/min, respectively, with significant differences between boys and girls (p < 0.05). The metabolic equivalent of task (MET) values for the PAs ranged from 1.12 to 8.14 METs. Regression analyses revealed an inverse association with age, BMI, and percentage BF increased, with resting VO2, REE, and average PA energy expenditure (PAEE) during PAs.

CONCLUSIONS

(1) Resting VO2 was lower in children and adolescents with obesity than those with normal weight and higher than in adults. (2) Of the measured PA intensities, 8 were light, 17 were moderate, and 5 were vigorous intensity. (3) The increase in the degree of obesity and age further decreased VO2 and EE both at rest and during PA. Our results can provide precise guidance for the exercise of children and adolescents with obesity and serve as a reference for the development of physical activity guidelines and compendiums. Future research should further diversify the types of PAs measured.

Toxicity assessment of 3-O-[6-deoxy-3-O-methyl-β-D-allopyranosyl-(1 → 4)-β-D-oleandropyranosyl]-17β-marsdenin isolated from Gongronema latifolium leaf on selected brain and kidney function indices in mice

The safety of bioactive compounds, especially those isolated from medicinal plants, is a major concern for health authorities, pharmaceutical industries, and the public. Of recent, anti-tumor pregnane glycosides were isolated from Gongronema latifolium leaf, of which the toxicity of one, 3-O-[6-deoxy-3-O-methyl-β-D-allopyranosyl-(1 → 4)-β-D-oleandropyranosyl]-17β-marsdenin (3DMAOM), has not been evaluated. This study, therefore, evaluated the effects of 3DMAOM on selected brain and kidney function indices in mice. Female Swiss albino mice were randomly administered 5% dimethyl sulphoxide and different doses of 3DMAOM (0.5, 1, 2, and 4 mg/kg body weight) for fourteen (14) days, and their blood, brains, and kidneys were collected for biochemical analysis. There was no significant alteration in the activities of alkaline phosphatase (ALP), acetylcholinesterase, creatine kinase, Na+/K+-ATPase, Ca2+/Mg2+-ATPase, and Mg2+-ATPase in the brain of the treated groups compared to control. Also, no significant changes in the activities of ALP, gamma-glutamyltransferase, Na+/K+-ATPase, Ca2+/Mg2+-ATPase, and Mg2+-ATPase in the kidney of the treated groups compared to control. The plasma concentrations of Na+, K+, Cl-, PO43-, creatinine, and urea of mice were not significantly altered at all doses of the 3DMAOM compared to controls. However, the plasma concentration of Ca2+ was significantly reduced (p < 0.05) at all doses of the 3DMAOM, and the plasma concentration of uric acid was significantly reduced (p < 0.05) at 2 mg/kg body weight of the 3DMAOM compared to controls. These findings suggest that 3DMAOM isolated from Gongronema latifolium leaf may not adversely affect brain function but may affect calcium ion homeostasis in subjects.

Resting Energy Expenditure Equations Have Lower Accuracy for Adolescents with Overweight/Obesity Versus Healthy-Weight Adolescents

Objective: The objectives of the study were (1) to assess whether resting energy expenditure (REE) equations have comparable validity for adolescents with overweight/obesity vs. adolescents with healthy weight and (2) to examine determinants of measured REE in adolescents with overweight/obesity vs. adolescents with healthy weight. Methods: Ten equations were used to predict REE for 109 adolescents (70% males; 36.7% with overweight/obesity); 95% equivalence testing was used to assess how well each equation agreed with the criterion measure of indirect calorimetry. Linear regression models were fitted to examine how much REE variance was accounted for by age, sex, race, fat-free mass (FFM), and fat mass. Results: For adolescents with healthy weight, all ten equations were significantly equivalent to the criterion measure within ±8.4% (p < 0.05), whereas for participants with overweight/obesity, only three equations were equivalent within the same range (p < 0.05). Controlling for age, sex, race, fat mass, and FFM accounted for 74% of REE variance. FFM explained the greatest amount (26%) of variance in REE, while weight status itself explained an additional 22%. Conclusions: Prediction equations tend to be more accurate for adolescents with healthy weight than adolescents with overweight/obesity unless the original sample specifically included participants with overweight/obesity. Determinants of REE are similar regardless of weight status.

Mice Lacking Mrs2 Magnesium Transporter are Hypophagic and Thin When Maintained on a High-Fat Diet

Genes regulating body fat are shared with high fidelity by mice and humans, indicating that mouse knockout (KO) phenotyping might identify valuable antiobesity drug targets. Male Mrs2 magnesium transporter (Mrs2) KO mice were recently reported as thin when fed a high-fat diet (HFD). They also exhibited increased energy expenditure (EE)/body weight and had beiged adipocytes that, along with isolated hepatocytes, demonstrated increased oxygen consumption, suggesting that increased EE drove the thin phenotype. Here we provide our data on these and additional assays in Mrs2 KO mice. We generated Mrs2 KO mice by homologous recombination. HFD-fed male and female Mrs2 KO mice had significantly less body fat, measured by quantitative magnetic resonance, than wild-type (WT) littermates. HFD-fed Mrs2 KO mice did not demonstrate increased EE by indirect calorimetry and could not maintain body temperature at 4 °C, consistent with their decreased brown adipose tissue stores but despite increased beige white adipose tissue. Instead, when provided a choice between HFD and low-fat diet (LFD), Mrs2 KO mice showed a significant 15% decrease in total energy intake resulting from significantly lower HFD intake that offset numerically increased LFD intake. Food restriction studies performed using WT mice suggested that this decrease in energy intake could explain the loss of body fat. Oral glucose tolerance test studies revealed significantly improved insulin sensitivity in Mrs2 KO mice. We conclude that HFD-fed Mrs2 KO mice are thin with improved insulin sensitivity, and that this favorable metabolic phenotype is driven by hypophagia. Further evaluation is warranted to determine the suitability of MRS2 as a drug target for antiobesity therapeutics.

Resource allocation in mammalian systems

Cells execute biological functions to support phenotypes such as growth, migration, and secretion. Complementarily, each function of a cell has resource costs that constrain phenotype. Resource allocation by a cell allows it to manage these costs and optimize their phenotypes. In fact, the management of resource constraints (e.g., nutrient availability, bioenergetic capacity, and macromolecular machinery production) shape activity and ultimately impact phenotype. In mammalian systems, quantification of resource allocation provides important insights into higher-order multicellular functions; it shapes intercellular interactions and relays environmental cues for tissues to coordinate individual cells to overcome resource constraints and achieve population-level behavior. Furthermore, these constraints, objectives, and phenotypes are context-dependent, with cells adapting their behavior according to their microenvironment, resulting in distinct steady-states. This review will highlight the biological insights gained from probing resource allocation in mammalian cells and tissues.

Mitochondrial metabolism in blood more reliably predicts whole-animal energy needs compared to other tissues

Understanding energy metabolism in free-ranging animals is crucial for ecological studies. In birds, red blood cells (RBCs) offer a minimally invasive method to estimate metabolic rate (MR). In this study with European starlings Sturnus vulgaris, we examined how RBC oxygen consumption relates to oxygen use in key tissues (brain, liver, heart, and pectoral muscle) and versus the whole organism measured at basal levels. The pectoral muscle accounted for 34%-42% of organismal MR, while the heart and liver, despite their high mass-specific metabolic rate, each contributed 2.5%-3.0% to organismal MR. Despite its low contribution to organismal MR (0.03%-0.04%), RBC MR best predicted organismal MR (r = 0.70). Oxygen consumption of the brain and pectoralis was also associated with whole-organism MR, unlike that of heart and liver. Overall, our findings demonstrate that the metabolism of a systemic tissue like blood is a superior proxy for organismal energy metabolism than that of other tissues.

Exercise metabolism and adaptation in skeletal muscle

Viewing metabolism through the lens of exercise biology has proven an accessible and practical strategy to gain new insights into local and systemic metabolic regulation. Recent methodological developments have advanced understanding of the central role of skeletal muscle in many exercise-associated health benefits and have uncovered the molecular underpinnings driving adaptive responses to training regimens. In this Review, we provide a contemporary view of the metabolic flexibility and functional plasticity of skeletal muscle in response to exercise. First, we provide background on the macrostructure and ultrastructure of skeletal muscle fibres, highlighting the current understanding of sarcomeric networks and mitochondrial subpopulations. Next, we discuss acute exercise skeletal muscle metabolism and the signalling, transcriptional and epigenetic regulation of adaptations to exercise training. We address knowledge gaps throughout and propose future directions for the field. This Review contextualizes recent research of skeletal muscle exercise metabolism, framing further advances and translation into practice.

FAT/CD36 Participation in Human Skeletal Muscle Lipid Metabolism: A Systematic Review

Fatty acid translocase/cluster of differentiation 36 (FAT/CD36) is a multifunctional membrane protein activated by a high-fat diet, physical exercise, fatty acids (FAs), leptin, and insulin. The principal function of FAT/CD36 is to facilitate the transport of long-chain fatty acids through cell membranes such as myocytes, adipocytes, heart, and liver. Under high-energy expenditure, the different isoforms of FAT/CD36 in the plasma membrane and mitochondria bind to the mobilization and oxidation of FAs. Furthermore, FAT/CD36 is released in its soluble form and becomes a marker of metabolic dysfunction. Studies with healthy animals and humans show that physical exercise and a high-lipid diet increase FAT/CD36 expression and caloric expenditure. However, several aspects such as obesity, diabetes, Single Nucleotide polymorphisms (SNPs), and oxidative stress affect the normal FAs metabolism and function of FAT/CD36, inducing metabolic disease. Through a comprehensive systematic review of primary studies, this work aimed to document molecular mechanisms related to FAT/CD36 in FAs oxidation and trafficking in skeletal muscle under basal conditions, physical exercise, and diet in healthy individuals.

Segmental bioelectrical impedance analysis for Korean older population with cold pattern

OBJECTIVE

This study examined the association of whole-body composition and segmental bioimpedance variables with cold pattern (CP) in different sexes.

METHODS

We assigned 667 older individuals to a CP group (n = 488) and a non-CP group (n = 179) by using an eight-item self-administered questionnaire. Seven body composition variables and three pairs of segmental bioimpedance variables for the upper and lower extremities, which were obtained from a segmental multifrequency bioimpedance analyzer, were employed to investigate their association with CP. Participants' characteristics were first described. Then we compared the selected body composition and bioimpedance variables between the CP and non-CP groups. Finally, their association with CP was investigated using univariate and multivariate regression analyses. All analyses were performed separately for women and men.

RESULTS

Both women and men exhibited a comparable mean age in the CP and non-CP groups; however, women with CP had significantly lower blood pressures, whereas men with CP showed a higher proportion of osteoarthritis than those without CP. Compared with the non-CP group, individuals with CP exhibited significantly smaller body sizes indicated by shorter height and smaller weight, lower body mass index, and smaller volume-to-body surface area ratio in both sexes. After controlling for age, height, weight, and other covariates, we found significant reductions in body lean mass such as fat-free mass and body cell mass, basal metabolic rate per unit mass, total body water, and intra-to-extracellular water ratio in the CP group. With regard to segmental bioimpedance analysis, the resistance ratios and phase angles in the upper and lower extremities yield significant associations with CP incidence, as demonstrated by the odds ratio (95% confidence interval) of 1.72 (1.16-2.57), 1.69 (1.18-2.48), 0.60 (0.40-0.89), and 0.57 (0.39-0.82), respectively. However, these results did not emerge in men.

CONCLUSION

Abnormal cellular water distribution and deterioration in body cell mass and/or cell strength are associated with CP prevalence, regardless of age, height, weight. These findings are similar in the upper and lower extremities and are more pronounced in women. The abovementioned patterns may be considered effective indicators for identifying CP in the older adult population.

Barbosa F, Fleury M. Predictive Equations Overestimated the Rest Energy Expenditure by Indirect Calorimetry in Adults with Sickle Cell Disease

Background: Traditionally, hypermetabolism is described in sickle cell disease (SCD). Despite this, few studies have compared rest energy expenditure (REE) with estimated by predictive equations (EEE) in the assessment of adults with SCD. Aims:  To compare REE values determined by indirect calorimetry (IC) with that EEE in adults with SCD. Subjects and Methods: A cross-sectional observational study was performed with 46 individuals over 34 years old in the treatment from two reference centers for SCD located in the city of Rio de Janeiro, Brazil. The dual-energy X-ray absorptiometry (DXA) and IC  were used to assess BC and REE, respectively. Blood levels were measured to assess hemolytic and protein markers. Pearson’s correlation test was used in the univariate correlation. The Intraclass Correlation Coefficient (ICC) and the Bland-Altman analysis were used in the comparison between EEE and IC. P-values ≤ 0.05 were considered statistically significant. Results: Most participants were from the female sex, Hb SS genotype (80.4%) and with black color (52.2%). The mean age was 50 years old. Weight (r= 0.469; p=0,001), LM (r = 0.631; p=0.000), BMC (r = 0.508; p=0.000) and CRP(r=0.319; p = 0.002) correlated positively with the REE. There was no linear correlation between makers of hemolysis with REE. The REE was overestimated in the EEE when compared to IC (p<0.001). Conclusions: The prediction equations developed for healthy populations are not accurate enough to determine the energy requirements and more studies are needed to better understand how REE role in middle-aged and elderly adults with SCD.

Plasma transthyretin is a nutritional biomarker in human morbidities

Transthyretin (TTR) is a small liver-secreted plasma protein that shows close correlations with changes in lean body mass (LBM) during the entire human lifespan and agglomerates the bulk of nitrogen (N)-containing substrates, hence constituting the cornerstone of body building. Amino acids (AAs) dietary restriction causes inhibition of TTR production and impairs the accretion of LBM reserves. Inflammatory disorders result in cytokine-induced abrogation of TTR synthesis and urinary leakage of nitrogenous catabolites. Taken together, the data indicate that malnutrition and inflammation may similarly suppress the production of TTR through distinct and unrelated pathophysiological mechanisms while operating in concert to downsize LBM stores. The hepatic synthesis of TTR integrates both machineries, acting as a marker of reduced LBM resources still available for defense and repair processes. TTR operates as a universal surrogate analyte that allows for the grading of residual LBM capacity to reflect disease burden. Measurement of TTR is a simple, rapid, and inexpensive micro-method that may be reproduced on a daily basis, hence ideally suited for the follow-up of the most intricated clinical situations and as a reliable predictor of any morbidity outcome.

Predicted estimates of resting energy expenditure have limited clinical utility in patients with cirrhosis

BACKGROUND & AIMS

Malnutrition is associated with adverse clinical outcomes in patients with cirrhosis. Accurate assessment of energy requirements is needed to optimize dietary intake. Resting energy expenditure (REE), the major component of total energy expenditure, can be measured using indirect calorimetry (mREE) or estimated using prediction equations (pREE). This study assessed the usefulness of predicted estimates of REE in this patient population.

METHODS

Individual mREE data were available for 900 patients with cirrhosis (mean [±1 SD] age 55.7±11.6 years-old; 70% men; 52% south-east Asian) and 282 healthy controls (mean age 36.0±12.8 years-old; 52% men; 18% south-east Asian). Metabolic status was classified using thresholds based on the mean ± 1 SD of the mREE in the healthy controls. Comparisons were made between mREE and pREE estimates obtained using the Harris-Benedict, Mifflin, Schofield and Henry equations. Stepwise regression was used to build 3 new prediction models which included sex, ethnicity, body composition measures, and model for end-stage liver disease scores.

RESULTS

The mean mREE was significantly higher in patients than controls when referenced to dry body weight (22.4±3.8 cf. 20.8±2.6 kcal/kg/24 hr; p <0.001); there were no significant sex differences. The mean mREE was significantly higher in Caucasian than Asian patients (23.1±4.4 cf. 21.7±2.9 kcal/kg/24 hr; p <0.001). Overall, 37.1% of Caucasian and 25.3% of Asian patients were classified as hypermetabolic. The differences between mREE and pREE were both statistically and clinically relevant; in the total patient population, pREE estimates ranged from 501 kcal/24 hr less to 548 kcal/24 hr more than the mREE. Newly derived prediction equations provided better estimates of mREE but still had limited clinical utility.

CONCLUSIONS

Prediction equations do not provide useful estimates of REE in patients with cirrhosis. REE should be directly measured.

LAY SUMMARY

People with cirrhosis are often malnourished and this has a detrimental effect on outcome. Provision of an adequate diet is very important and is best achieved by measuring daily energy requirements and adjusting dietary intake accordingly. Prediction equations, which use information on age, sex, weight, and height can be used to estimate energy requirements; however, the results they provide are not accurate enough for clinical use, particularly as they vary according to sex and ethnicity.

What Is a 2021 Reference Body?

The historical 1975 Reference Man is a ‘model’ that had been used as a basis for the calculation of radiation doses, metabolism, pharmacokinetics, sizes for organ transplantation and ergonomic optimizations in the industry, e.g., to plan dimensions of seats and other formats. The 1975 Reference Man was not an average individual of a population; it was based on the multiple characteristics of body compositions that at that time were available, i.e., mainly from autopsy data. Faced with recent technological advances, new mathematical models and socio-demographic changes within populations characterized by an increase in elderly and overweight subjects a timely ‘state-of-the-art’ 2021 Reference Body are needed. To perform this, in vivo human body composition data bases in Kiel, Baton Rouge, San Francisco and Honolulu were analyzed and detailed 2021 Reference Bodies, and they were built for both sexes and two age groups (≤40 yrs and >40 yrs) at BMIs of 20, 25, 30 and 40 kg/m2. We have taken an integrative approach to address ‘structure−structure’ and ‘structure−function’ relationships at the whole-body level using in depth body composition analyses as assessed by gold standard methods, i.e., whole body Magnetic Resonance Imaging (MRI) and the 4-compartment (4C-) model (based on deuterium dilution, dual-energy X-ray absorptiometry and body densitometry). In addition, data obtained by a three-dimensional optical scanner were used to assess body shape. The future applications of the 2021 Reference Body relate to mathematical modeling to address complex metabolic processes and pharmacokinetics using a multi-level/multi-scale approach defining health within the contexts of neurohumoral and metabolic control.

Phenotypic differences between people varying in muscularity

BACKGROUND

Body mass is the primary metabolic compartment related to a vast number of clinical indices and predictions. The extent to which skeletal muscle (SM), a major body mass component, varies between people of the same sex, weight, height, and age is largely unknown. The current study aimed to explore the magnitude of muscularity variation present in adults and to examine if variation in muscularity associates with other body composition and metabolic measures.

METHODS

Muscularity was defined as the difference (residual) between a person's actual and model-predicted SM mass after controlling for their weight, height, and age. SM prediction models were developed using data from a convenience sample of 492 healthy non-Hispanic (NH) White adults (ages 18-80 years) who had total body SM and SM surrogate, appendicular lean soft tissue (ALST), measured with magnetic resonance imaging and dual-energy X-ray absorptiometry, respectively; residual SM (SM_R ) and ALST were expressed in kilograms and kilograms per square meter. ALST mass was also evaluated in a population sample of 8623 NH-White adults in the 1999-2006 National Health and Nutrition Examination Survey. Associations between muscularity and variation in the residual mass of other major organs and tissues and resting energy expenditure were evaluated in the convenience sample.

RESULTS

The SM, on average, constituted the largest fraction of body weight in men and women up to respective BMIs of 35 and 25 kg/m² . SM in the convenience sample varied widely with a median of 31.2 kg and an SM_R inter-quartile range/min/max of 3.35 kg/-10.1 kg/9.0 kg in men and 21.1 kg and 2.59 kg/-7.2 kg/7.5 kg in women; per cent of body weight as SM at 25th and 75th percentiles for men were 33.1% and 39.6%; corresponding values in women were 24.2% and 30.8%; results were similar for SM_R indices and for ALST measures in the convenience and population samples. Greater muscularity in the convenience sample was accompanied by a smaller waist circumference (men/women: P < 0.001/=0.085) and visceral adipose tissue (P = 0.014/0.599), larger liver (P = 0.065/<0.001), kidneys (P = 0.051/<0.009), and bone mineral (P < 0.001/<0.001), and larger magnitude resting energy expenditure (P < 0.001/<0.001) than predicted for the same sex, age, weight, and height.

CONCLUSIONS

Muscle mass is the largest body compartment in most adults without obesity and is widely variable in mass across people of similar body size and age; and high muscularity is accompanied by distinct body composition and metabolic characteristics. This previously unrecognized heterogeneity in muscularity in the general population has important clinical and research implications.

Body composition, energy expenditure, and markers of hemolysis in adults with sickle cell disease

Background: Historically, malnutrition is described in individuals with SCD. However, more recent studies have shown a change in the profile of the nutritional status and distribution of body composition of SCD patients, mainly adult individuals. Aims: To assess the body composition (BC), resting energy expenditure (REE), and the biomarkers of hemolysis in adults with sickle cell disease (SCD). Subjects and Methods: A cross-sectional observational study was performed with 64 individuals over 39 years old in the treatment from two reference centers for SCD located in the city of Rio de Janeiro, Brazil. The dual-energy X-ray absorptiometry (DXA) and indirect calorimetry were used to assess BC and REE, respectively. Blood levels of hemoglobin, reticulocytes, lactate dehydrogenase (LDH), leukocytes, platelets, total and direct bilirubin, total protein, and albumin were measured to assess the hemolysis and protein status. The descriptive and inferential analysis was composed of the different methods (one-way ANOVA with the multiple comparison test of Tukey, Student t-test, and Pearson's correlation coefficient). Were considered statistically significant when the p-values were ≤ 0.05. Results: Most participants with SCD were female sex, colored (brown/black), and mean age of 51.2 years old. The obesity prevalence was 70.7% according to the body fat (BF%), with a major mean among women (p < 0.0001). Men had a higher mean of lean mass (LM) (p=0.0005) and fat-free mass (FFM) (p=0.0007). There was no difference for REE in comparing the genotypes (p= 0.53), and genders (p=0.075). The hemolysis markers (LDH, reticulocytes, and TB) correlated inversely with BMI (p=0.013), FM (p=0.022), and FFM (p=0.034). Conclusions: The important change observed in body composition in people with sickle cell disease was characterized by a high percentage of fat body and a decrease in lean mass. The hemolysis markers LDH, reticulocytes, and BT correlated inversely with BMI, FM, and FFM indicating that high levels of hemolysis may affect nutritional status, without influencing the REE. Keywords: sickle cell disease, body composition, fat mass, fat-free mass, energy expenditure, hemolysis.

Clinical meaning of body temperatures in anorexia nervosa and bulimia nervosa

OBJECTIVE

Bradycardia is one of the common cardiac abnormalities in patients with eating disorders. It ensues from hypometabolism, which results from reduced caloric intake and consequential weight loss. Hypothermia is another consequence of hypometabolism. While at-rest metabolism and body mass index (BMI) are typically used to assess hypometabolism and estimate potential bradycardia, we hypothesised that body temperature, which is easy to measure, could also capture the presence of this threatening cardiovascular condition.

METHOD

We monitored heart rate continuously for 72 h, measured resting energy expenditure (REE) and assessed body temperature in 12 body parts for 58 patients with anorexia nervosa (AN) and 29 patients with bulimia nervosa (BN).

RESULTS

Palm temperature reflects bradycardia in both AN and BN, explaining 18% of its variance (p < 0.001), capturing this aspect even more efficiently than BMI. We also observe different correlations between palm temperature, abdominal temperature, BMI, REE and levels of physical activity.

CONCLUSION

Palm temperature could be used as a warning of bradycardia, a serious cardiovascular condition which can be difficult to detect in short visits with outpatients. Further studies are needed to determine how useful bradycardia and palm temperature could be to assess severity and prognosis of the disorder.

Skeletal muscle as a treatment target for older adults with diabetes mellitus: The importance of a multimodal intervention based on functional category

Although the lifespan of people with diabetes has increased in many countries, the age-related increase in comorbidities (sarcopenia, frailty and disabilities) and diabetic complications has become a major issue. Diabetes accelerates the aging of skeletal muscles and blood vessels through mechanisms, such as increased oxidative stress, chronic inflammation, insulin resistance, mitochondrial dysfunction, genetic polymorphism (fat mass and obesity-associated genes) and accumulation of advanced glycation end-products. Diabetes is associated with early onset, and progression of muscle weakness and sarcopenia, thus resulting in diminished daily life function. The type and duration of diabetes, insulin section/resistance, hyperglycemia, diabetic neuropathy, malnutrition and low physical activity might affect muscular loss and weakness. To prevent the decline in daily activities in older adults with diabetes, resistance training or multicomponent exercise should be recommended. To maintain muscle function, optimal energy and sufficient protein intake are necessary. Although no specific drug enhances muscle mass and function, antidiabetic drugs that increase insulin sensitivity or secretion could be candidates for improvement of sarcopenia. The goals of glycemic control for older patients are determined based on three functional categories through an assessment of cognitive function and activities of daily living, and the presence or absence of medications that pose a hypoglycemic risk. As these functional categories are associated with muscle weakness, frailty and mortality risk, providing multimodal interventions (exercise, nutrition, social network or support and optimal medical treatment) is important, starting at the category II stage for maintenance or improvement in daily life functions. Geriatr Gerontol Int 2022; ••: ••-••.

The Mystery of Energy Compensation

AbstractThe received wisdom on how activity affects energy expenditure is that the more activity is undertaken, the more calories will have been burned by the end of the day. Yet traditional hunter-gatherers, who lead physically hard lives, burn no more calories each day than Western populations living in labor-saving environments. Indeed, there is now a wealth of data, both for humans and other animals, demonstrating that long-term lifestyle changes involving increases in exercise or other physical activities do not result in commensurate increases in daily energy expenditure (DEE). This is because humans and other animals exhibit a degree of energy compensation at the organismal level, ameliorating some of the increases in DEE that would occur from the increased activity by decreasing the energy expended on other biological processes. And energy compensation can be sizable, reaching many hundreds of calories in humans. But the processes that are downregulated in the long-term to achieve energy compensation are far from clear, particularly in humans-we do not know how energy compensation is achieved. My review here of the literature on relevant exercise intervention studies, for both humans and other species, indicates conflict regarding the role, if any, of basal metabolic rate (BMR) or low-level activity such as fidgeting play, particularly once changes in body composition are factored out. In situations where BMR and low-level activity are not major components of energy compensation, what then drives it? I discuss how changes in mitochondrial efficiency and changes in circadian fluctuations in BMR may contribute to our understanding of energy management. Currently unexplored, these mechanisms and others may provide important insights into the mystery of how energy compensation is achieved.

Challenges in tackling energy expenditure as obesity therapy: From preclinical models to clinical application

BACKGROUND

A chronic imbalance of energy intake and energy expenditure results in excess fat storage. The obesity often caused by this overweight is detrimental to the health of millions of people. Understanding both sides of the energy balance equation and their counter-regulatory mechanisms is critical to the development of effective therapies to treat this epidemic.

SCOPE OF REVIEW

Behaviors surrounding ingestion have been reviewed extensively. This review focuses more specifically on energy expenditure regarding bodyweight control, with a particular emphasis on the organs and attractive metabolic processes known to reduce bodyweight. Moreover, previous and current attempts at anti-obesity strategies focusing on energy expenditure are highlighted. Precise measurements of energy expenditure, which consist of cellular, animal, and human models, as well as measurements of their translatability, are required to provide the most effective therapies.

MAJOR CONCLUSIONS

A precise understanding of the components surrounding energy expenditure, including tailored approaches based on genetic, biomarker, or physical characteristics, must be integrated into future anti-obesity treatments. Further comprehensive investigations are required to define suitable treatments, especially because the complex nature of the human perspective remains poorly understood.

Resting Energy Expenditure: From Cellular to Whole-Body Level, a Mechanistic Historical Perspective

The basis of heat generated by the human body has been a source of speculation and research for more than 2,000 years. Basal heat production, now usually referred to as resting energy expenditure (REE), is currently recognized as deriving from biochemical reactions at subcellular and cellular levels that are expressed in the energy expended by the body's 78 organs and tissues. These organs and tissues, and the 11 systems to which they belong, influence body size and shape. Connecting these subcellular-/cellular-level reactions to organs and tissues, and then on to body size and shape, provides a comprehensive understanding of individual differences in REE, a contemporary topic of interest in obesity research and clinical practice. This review critically examines these linkages, their association with widely used statistical and physiological REE prediction formulas, and often-unappreciated aspects of measuring basal heat production in humans.

Body Composition Changes after a Weight Loss Intervention: A 3-Year Follow-Up Study

Studies comparing different types of exercise-based interventions have not shown a consistent effect of training on long-term weight maintenance. The aim of this study was to compare the effects of exercise modalities combined with diet intervention on body composition immediately after intervention and at 3 years’ follow-up in overweight and obese adults. Two-hundred thirty-nine people (107 men) participated in a 6-month diet and exercise-based intervention, split into four randomly assigned groups: strength group (S), endurance group (E), combined strength and endurance group (SE), and control group (C). The body composition measurements took place on the first week before the start of training and after 22 weeks of training. In addition, a third measurement took place 3 years after the intervention period. A significant interaction effect (group × time) (p = 0.017) was observed for the fat mass percentage. It significantly decreased by 5.48 ± 0.65%, 5.30 ± 0.65%, 7.04 ± 0.72%, and 4.86 ± 0.65% at post-intervention for S, E, SE, and C, respectively. Three years after the intervention, the fat mass percentage returned to values similar to the baseline, except for the combined strength and endurance group, where it remained lower than the value at pre-intervention (p < 0.05). However, no significant interaction was discovered for the rest of the studied outcomes, neither at post-intervention nor 3 years later. The combined strength and endurance group was the only group that achieved lower levels of fat mass (%) at both post-intervention and 3 years after intervention, in comparison with the other groups.

Estimating resting energy expenditure from dual-energy X-ray absorptiometry: A cross-sectional study in healthy young adults

OBJECTIVE

To qualify a 3C approach model of dual-energy X-ray absorptiometry (DXA) to estimate multicomponent resting energy expenditure (REE) referenced by indirect calorimetry (IC).

METHODS

A sample of 155 college students, of both sexes (18-30 years old) was evaluated. Anthropometric measures, REE by IC, and whole-body DXA-scans were performed. The REE for each body component was determined after transforming the components from the molecular (DXA) to the organ tissue level. Bland-Altman and proportional bias analyses were used to verify agreement between REE measured (REE_IC ) and estimated (REE_DXA ).

RESULTS

Statistically significant differences were found for all sex comparisons (P < .001), except for age (P = .950). Differences from the final sex-specific models' were not found between REE_IC and REE_DXA (P > .05). Men also presented greater expenditure (P < .001) in each component, except for adipose tissue. The plots confirmed the validity of the model for both sexes, with low difference values between the measured and estimated REE. The mean of the differences of REE_IC and REE_DXA showed heteroscedasticity of the data for men (P = .004). The same error tendency was not evident for women (P = .333).

CONCLUSIONS

This 3C model, estimating REE from a multicomponent approach, allows a new application of DXA as tool for understanding intraindividual differences in terms of the mass of metabolically active tissue. Sex and populational differences should be taken in account. Consequently, we present qualified sex-specific DXA models that can be applied in different contexts such as health and sports, besides considering interpersonal differences in terms of energy expenditure.

The effect of exercise interventions on resting metabolic rate: A systematic review and meta-analysis

The systematic review and meta-analysis evaluated the effect of aerobic, resistance and combined exercise on RMR (kCal·day^-1) and performed a methodological assessment of indirect calorimetry protocols within the included studies. Subgroup analyses included energy/diet restriction and body composition changes. Randomized control trials (RCTs), quasi - RCTs and cohort trials featuring a physical activity intervention of any form and duration excluding single exercise bouts were included. Participant exclusions included medical conditions impacting upon RMR, the elderly (≥65 years of age) or pregnant, lactating or post-menopausal women. The review was registered in the International Prospective Register of Systematic Reviews (CRD 42,017,058,503). 1669 articles were identified; 22 were included in the qualitative analysis and 18 were meta-analysed. Exercise interventions (aerobic and resistance exercise combined) did not increase resting metabolic rate (mean difference (MD): 74.6 kCal·day^-1[95% CI: -13.01, 161.33], P = 0.10). While there was no effect of aerobic exercise on RMR (MD: 81.65 kCal·day^-1[95% CI: -57.81, 221.10], P = 0.25), resistance exercise increased RMR compared to controls (MD: 96.17 kCal·day^-1[95% CI: 45.17, 147.16], P = 0.0002). This systematic review effectively synthesises the effect of exercise interventions on RMR in comparison to controls; despite heterogenous methodologies and high risk of bias within included studies.

Clinical determinants of resting metabolic rate in geriatric outpatients

PURPOSE

Accurate estimation of the energy requirements including resting metabolic rate (RMR) is important for optimal nutritional care, yet its clinical determinants are unknown. This study examined the associations between clinical determinants of the Comprehensive Geriatric Assessment (CGA) domains with RMR among geriatric outpatients.

MATERIALS & METHODS

Data were retrieved from cohorts of community-dwelling older adults (n = 84, 54 female) referring to geriatrics outpatient mobility clinics in both Amsterdam, The Netherlands and Melbourne, Australia. Determinants within domains of the CGA included diseases (number, type and severity of diseases, polypharmacy), nutrition (body weight, body mass index, absolute and relative skeletal muscle mass, fat-free mass and fat mass, risk of malnutrition), physical function (handgrip strength, Short Physical Performance Battery, Timed Up & Go), cognition (Mini-Mental State Examination), psychological wellbeing (Geriatric Depression Scale) and blood pressure. RMR was objectively measured using indirect calorimetry with a canopy hood. Association between the clinical determinants with standardized RMR (country and sex-specific z-score) were analysed with linear regression adjusted for age, sex and body weight.

RESULTS

Determinants within the nutritional domain were associated with RMR; body weight showed the strongest association with RMR. Significant associations between determinants within the nutritional domain with RMR disappeared after further adjustment for body weight. None of the other domains were associated with RMR.

CONCLUSIONS

Body weight is the strongest clinical determinant of RMR and should be taken into account when estimating RMR in geriatric care.

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

CONTEXT

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

OBJECTIVE

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

DESIGN

Cross-sectional study.

SETTING

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

PATIENTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Obesity Tissue: Composition, Energy Expenditure, and Energy Content in Adult Humans

OBJECTIVE

Chronic positive energy balance leads to obesity, and the "excess" weight is usually described as consisting solely of adipose tissue (AT) or its two components, fat and fat-free mass (nonfat cell mass, extracellular fluid). This study aimed to clarify the nature of "obesity" tissue.

METHODS

A total of 333 adults had AT, skin, skeletal muscle, bone, heart, liver, kidney, spleen, brain, and residual mass measured or derived using magnetic resonance imaging and dual-energy x-ray absorptiometry. First, associations between these components and AT were examined by developing multiple regression models. Next, obesity-tissue composition was developed by deriving mean component mass differences between participant groups with normal weight (BMI < 25 kg/m² ) and those with obesity (BMI > 29.9 kg/m² ); respective resting energy expenditures and metabolizable energy and protein contents were calculated.

RESULTS

AT significantly predicted organ-tissue mass in 17 of 18 multiple regression models. In addition to AT and skeletal muscle, the following associations were found: skin, liver, and bone were main contributors to obesity-tissue composition; liver, kidneys, and heart to resting energy expenditure; and skin, liver, and bone to metabolizable energy and protein contents. A pronounced sexual dimorphism was present in all three models.

CONCLUSIONS

Obesity is characterized not only by excess AT but by increases in the masses of other "companion" organs and tissues and their related metabolic properties.

Scaling of adult human bone and skeletal muscle mass to height in the US population

OBJECTIVES

The scaling of structural components to body size is well studied in mammals, although comparable human observations in a large and diverse sample are lacking. The current study aimed to fill this gap by examining the scaling relationships between total body (TB) and regional bone and skeletal muscle (SM) mass with body size, as defined by stature, in a nationally representative sample of the US population.

METHODS

Subjects were 17,126 non-Hispanic (NH) white, NH black, and Mexican American men and women, aged ≥18 years, evaluated in the National Health and Nutrition Examination Survey who had TB and regional bone mineral (BMin) and lean soft tissue (LST) mass measured by dual-energy X-ray absorptiometry. BMin and appendicular LST served as surrogate bone and SM mass measures, respectively. The allometric model, BMin or LST = α(height)^β , in a logarithmic form was used to generate scaling exponents.

RESULTS

The findings were similar across all gender and race groups: body mass scaled to height with powers of ~2.0 (mean β ± SE, 1.94 ± 0.08-2.29 ± 0.09) while TB and appendicular BMin and appendicular LST scaled to height with consistently larger powers than those for body mass (eg, all P < .05 in NH white men and women); the largest BMin and LST scaling powers to height were observed in the lower extremities.

CONCLUSIONS

Bone and SM mass, notably those of the lower extremities, increase as proportions of body mass with greater adult height. Metabolic and biomechanical implications emerge from these observations, the first of their kind in a representative adult US population sample.

The anatomy of resting energy expenditure: body composition mechanisms

Body mass in humans and animals is strongly associated with the rate of heat production as defined by resting energy expenditure (REE). Beginning with the ancient Greeks up to the present time, philosophers and scientists have endeavored to understand the nature and sources of bodily heat. Today we recognize that body mass consists of organs and tissues, each of which produces a specified amount of heat at rest. An individual organ's REE can now be estimated in vivo as the product of its assumed mass-specific metabolic rate and its imaging-derived mass; whole-body REE reflects the sum of organ and tissue metabolic rates. The sizes of organs and total body mass in adults are governed by two main factors, a person's stature or height, and their level of adiposity. With greater body size, as represented by adult height independent of adiposity, organs remain stable or increase in mass according to distinct "scaling" patterns. Similarly, with greater relative adiposity organs adaptively accommodate to the increase in imposed mechanical and metabolic loading conditions. Through a detailed analysis of these stature and adiposity effects, we show how classical statistical REE prediction models can be mechanistically understood at the anatomic body composition level.