Effect of cold exposure on fuel utilization in humans: plasma glucose, muscle glycogen, and lipids

Brown adipose tissue metabolism in women is dependent on ovarian status

In rodents, loss of estradiol (E2) reduces brown adipose tissue (BAT) metabolic activity. Whether E2 impacts BAT activity in women is not known. BAT oxidative metabolism was measured in premenopausal (n = 27; 35 ± 9 yr; body mass index = 26.0 ± 5.3 kg/m2) and postmenopausal (n = 25; 51 ± 8 yr; body mass index = 28.0 ± 5.0 kg/m2) women at room temperature and during acute cold exposure using [11C]acetate with positron emission tomography coupled with computed tomograph. BAT glucose uptake was also measured during acute cold exposure using 2-deoxy-2-[18F]fluoro-d-glucose. To isolate the effects of ovarian hormones from biological aging, measurements were repeated in a subset of premenopausal women (n = 8; 40 ± 4 yr; BMI = 28.0 ± 7.2 kg/m2) after 6 mo of gonadotropin-releasing hormone agonist therapy to suppress ovarian hormones. At room temperature, there was no difference in BAT oxidative metabolism between premenopausal (0.56 ± 0.31 min-1) and postmenopausal women (0.63 ± 0.28 min-1). During cold exposure, BAT oxidative metabolism (1.28 ± 0.85 vs. 0.91 ± 0.63 min-1, P = 0.03) and net BAT glucose uptake (84.4 ± 82.5 vs. 29.7 ± 31.4 nmol·g-1·min-1, P < 0.01) were higher in premenopausal than postmenopausal women. In premenopausal women who underwent gonadotropin-releasing hormone agonist, cold-stimulated BAT oxidative metabolism was reduced to a similar level (from 1.36 ± 0.66 min-1 to 0.91 ± 0.41 min-1) to that observed in postmenopausal women (0.91 ± 0.63 min-1). These results provide the first evidence in humans that reproductive hormones are associated with BAT oxidative metabolism and suggest that BAT may be a target to attenuate age-related reduction in energy expenditure and maintain metabolic health in postmenopausal women.NEW & NOTEWORTHY In rodents, loss of estrogen reduces brown adipose tissue (BAT) activity. Whether this is true in humans is not known. We found that BAT oxidative metabolism and glucose uptake were lower in postmenopausal compared to premenopausal women. In premenopausal women who underwent ovarian suppression to reduce circulating estrogen, BAT oxidative metabolism was reduced to postmenopausal levels. Thus the loss of ovarian function in women leads to a reduction in BAT metabolic activity independent of age.

Performance nutrition for cold-weather military operations

.High daily energy expenditure without compensatory increases in energy intake results in severe energy deficits during cold-weather military operations. The severity of energy deficits has been proportionally linked to declines in body mass, negative protein balance, suppression of androgen hormones, increases in systemic inflammation and degraded physical performance. Food availability does not appear to be the predominant factor causing energy deficits; providing additional rations or supplement snack bars does not reduce the severity of the energy deficits. Nutrition interventions that allow greater energy intake could be effective for reducing energy deficits during cold-weather military operations. One potential intervention is to increase energy density (i.e. energy per unit mass of food) by increasing dietary fat. Our laboratory recently reported that self-selected higher energy intakes and reductions in energy deficits were primarily driven by fat intake (r = 0.891, r² = 0.475), which, of the three macronutrients. Further, soldiers who ate more fat lost less body mass, had lower inflammation, and maintained net protein balance compared to those who ate less fat. These data suggest that consuming high-fat energy-dense foods may be a viable nutritional intervention that mitigates the negative physiological effects of energy deficit and sustains physical performance during cold-weather military operations.

Comprehensive quantification of metabolic flux during acute cold stress in mice

Cold-induced thermogenesis (CIT) is widely studied as a potential avenue to treat obesity, but a thorough understanding of the metabolic changes driving CIT is lacking. Here, we present a comprehensive and quantitative analysis of the metabolic response to acute cold exposure, leveraging metabolomic profiling and minimally perturbative isotope tracing studies in unanesthetized mice. During cold exposure, brown adipose tissue (BAT) primarily fueled the tricarboxylic acid (TCA) cycle with fat in fasted mice and glucose in fed mice, underscoring BAT's metabolic flexibility. BAT minimally used branched-chain amino acids or ketones, which were instead avidly consumed by muscle during cold exposure. Surprisingly, isotopic labeling analyses revealed that BAT uses glucose largely for TCA anaplerosis via pyruvate carboxylation. Finally, we find that cold-induced hepatic gluconeogenesis is critical for CIT during fasting, demonstrating a key functional role for glucose metabolism. Together, these findings provide a detailed map of the metabolic rewiring driving acute CIT.

Effect of Neck-Deep Immersion in Cool or Thermoneutral Water on Blood Glucose Levels in Individuals With Type 1 Diabetes

Context

It is unclear whether immersion in cool water, typical of many beaches, increases the concentration of blood glucose in individuals with type 1 diabetes mellitus (T1DM).

Objective

To test the hypothesis in individuals with T1DM that immersion neck-deep in cool water (COOL) causes an increase in blood glucose concentration, but not exposure to thermoneutral water (THERMO) or thermoneutral air.

Methods

Eight overnight-fasted participants with T1DM were exposed for 60 minutes on separate days to 3 experimental conditions: cool water (COOL, 23 °C); thermoneutral water (THERMO, 33.5 °C); or thermoneutral air (24 °C). They then recovered for 60 minutes on land at 24 °C. At time intervals, we measured: blood glucose and plasma insulin concentration, rate of carbohydrate and fat oxidation, skin and core temperature, subcutaneous blood flow, and shivering via electromyography.

Results

There was no change in blood glucose concentration during the 3 experimental conditions (P > .05). During recovery after COOL, blood glucose increased (P < .05) but did not change in the other 2 conditions. The rate of carbohydrate oxidation during and early after COOL was higher than in the other 2 conditions (P < .05), and COOL led to a decrease in subcutaneous blood flow and the concentration of plasma insulin (P < .05).

Conclusion

Cool or thermoneutral neck-deep immersion in water does not cause a change in the concentration of blood glucose in people with T1DM, but on-land recovery from COOL causes an increase in blood glucose that may be due, at least in part, to the accompanying decrease in plasma insulin.

Physiological and molecular mechanisms of cold-induced improvements in glucose homeostasis in humans beyond brown adipose tissue

Exposure to low ambient temperatures has previously been demonstrated to markedly improve glucose homeostasis in both rodents and humans. Although the brown adipose tissue is key in mediating these beneficial effects in rodents, its contribution appears more limited in humans. Hence, the exact tissues and underlying mechanisms that mediate cold-induced improvements in glucose homeostasis in humans remain to be fully established. In this review, we evaluated the response of the main organs involved in glucose metabolism (i.e. pancreas, liver, (white) adipose tissue, and skeletal muscle) to cold exposure and discuss their potential contribution to cold-induced improvements in glucose homeostasis in humans. We here show that cold exposure has widespread effects on metabolic organs involved in glucose regulation. Nevertheless, cold-induced improvements in glucose homeostasis appear primarily mediated via adaptations within the skeletal muscle and (presumably) white adipose tissue. Since the underlying mechanisms remain elusive, future studies should be aimed at pinpointing the exact physiological and molecular mechanisms involved in humans. Nonetheless, cold exposure holds great promise as a novel, additive lifestyle approach to improve glucose homeostasis in insulin resistant individuals. Parts of this graphical abstract were created using (modified) images from Servier Medical Art, licensed under the Creative Commons Attribution 3.0 Unported License. TG = thermogenesis, TAG = triacylglycerol, FFA = free fatty acid, SLN = sarcolipin, UCP3 = uncoupling protein 3, β2-AR = beta-2 adrenergic receptor, SNS = sympathetic nervous system.

Kinetics of lipid indicators in response to short- and long-duration whole-body, cold-water immersion

Cold exposure-induced secretion of stress hormones activates cold-defense responses and mobilizes substrates for increased energy demands to fuel thermogenesis. However, it is unclear whether acute cold exposure-induced stress hormone response kinetics affect circulating lipid parameter kinetics. Therefore, we aimed to investigate the 2-day kinetics of stress hormones (i.e., cortisol, epinephrine, and norepinephrine) and the lipid profile (i.e., total cholesterol [TC], high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides) in response to whole-body long- (intermittent 170 min; 170-CWI) or short-duration (10 min; 10-CWI) cold-water immersion (CWI; 14 °C water) in 17 healthy, young, adult men. Both CWI trials induced a marked release of the stress hormones, epinephrine, and norepinephrine, with higher concentrations detected after 170-CWI (p < 0.05) and a disrupted diurnal peak of cortisol lasting for a few hours. 170-CWI increased triglyceride levels from immediately after until 2 h after CWI, thereafter the concentration decreased at 4 h, 6 h, 1 day and 2 days after CWI (p < 0.05). Furthermore, the HDL-cholesterol level increased immediately after and at 6 h after 170-CWI (p < 0.05), while TC and LDL-cholesterol levels were not altered within 2 days. Lipid parameters were not affected within the 2 days after 10-CWI. Although both CWIs decreased deep body temperature and increased stress hormone levels for a few hours, only long-duration CWI induced changes in the circulating lipid profile within 2 days after CWI. This should be considered when discussing therapeutic protocols to improve circulating lipid profiles and ameliorate diseases associated with such profiles.

Association of apolipoprotein M and sphingosine-1-phosphate with brown adipose tissue after cold exposure in humans

The HDL-associated apolipoprotein M (apoM) and its ligand sphingosine-1-phosphate (S1P) may control energy metabolism. ApoM deficiency in mice is associated with increased vascular permeability, brown adipose tissue (BAT) mass and activity, and protection against obesity. In the current study, we explored the connection between plasma apoM/S1P levels and parameters of BAT as measured via ¹⁸F-FDG PET/CT after cold exposure in humans. Fixed (n = 15) vs personalized (n = 20) short-term cooling protocols decreased and increased apoM (- 8.4%, P = 0.032 vs 15.7%, P < 0.0005) and S1P (- 41.0%, P < 0.0005 vs 19.1%, P < 0.005) plasma levels, respectively. Long-term cooling (n = 44) did not affect plasma apoM or S1P levels. Plasma apoM and S1P did not correlate significantly to BAT volume and activity in the individual studies. However, short-term studies combined, showed that increased changes in plasma apoM correlated with BAT metabolic activity (β: 0.44, 95% CI [0.06-0.81], P = 0.024) after adjusting for study design but not BAT volume (β: 0.39, 95% CI [- 0.01-0.78], P = 0.054). In conclusion, plasma apoM and S1P levels are altered in response to cold exposure and may be linked to changes in BAT metabolic activity but not BAT volume in humans. This contrasts partly with observations in animals and highlights the need for further studies to understand the biological role of apoM/S1P complex in human adipose tissue and lipid metabolism.

High-fructose feeding suppresses cold-stimulated brown adipose tissue glucose uptake independently of changes in thermogenesis and the gut microbiome

Diets rich in added sugars are associated with metabolic diseases, and studies have shown a link between these pathologies and changes in the microbiome. Given the reported associations in animal models between the microbiome and brown adipose tissue (BAT) function, and the alterations in the microbiome induced by high-glucose or high-fructose diets, we investigated the potential causal link between high-glucose or -fructose diets and BAT dysfunction in humans. Primary outcomes are changes in BAT cold-induced thermogenesis and the fecal microbiome (clinicaltrials.gov, NCT03188835). We show that BAT glucose uptake, but not thermogenesis, is impaired by a high-fructose but not high-glucose diet, in the absence of changes in the gastrointestinal microbiome. We conclude that decreased BAT glucose metabolism occurs earlier than other pathophysiological abnormalities during fructose overconsumption in humans. This is a potential confounding factor for studies relying on ¹⁸F-FDG to assess BAT thermogenesis.

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Fructose overfeeding decreases brown adipose tissue glucose metabolism

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These changes occur independently of oxidative metabolism

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No change is observed with glucose overfeeding

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The gut microbiome is not affected by fructose/glucose overfeeding

Exercise training enhances muscle mitochondrial metabolism in diet-resistant obesity

Background

Current paradigms for predicting weight loss in response to energy restriction have general validity but a subset of individuals fail to respond adequately despite documented diet adherence. Patients in the bottom 20% for rate of weight loss following a hypocaloric diet (diet-resistant) have been found to have less type I muscle fibres and lower skeletal muscle mitochondrial function, leading to the hypothesis that physical exercise may be an effective treatment when diet alone is inadequate. In this study, we aimed to assess the efficacy of exercise training on mitochondrial function in women with obesity with a documented history of minimal diet-induced weight loss.

Methods

From over 5000 patient records, 228 files were reviewed to identify baseline characteristics of weight loss response from women with obesity who were previously classified in the top or bottom 20% quintiles based on rate of weight loss in the first 6 weeks during which a 900 kcal/day meal replacement was consumed. A subset of 20 women with obesity were identified based on diet-resistance (n=10) and diet sensitivity (n=10) to undergo a 6-week supervised, progressive, combined aerobic and resistance exercise intervention.

Findings

Diet-sensitive women had lower baseline adiposity, higher fasting insulin and triglycerides, and a greater number of ATP-III criteria for metabolic syndrome. Conversely in diet-resistant women, the exercise intervention improved body composition, skeletal muscle mitochondrial content and metabolism, with minimal effects in diet-sensitive women. In-depth analyses of muscle metabolomes revealed distinct group- and intervention- differences, including lower serine-associated sphingolipid synthesis in diet-resistant women following exercise training.

Interpretation

Exercise preferentially enhances skeletal muscle metabolism and improves body composition in women with a history of minimal diet-induced weight loss. These clinical and metabolic mechanism insights move the field towards better personalised approaches for the treatment of distinct obesity phenotypes.

Funding

Canadian Institutes of Health Research (CIHR-INMD and FDN-143278; CAN-163902; CIHR PJT-148634).

Thermogenic responses to different clamped skin temperatures in cold-exposed men and women

Despite many decades of research examining thermoregulatory responses under varying cold stresses in humans, very little is known about the variability in metabolic heat production and shivering activity. Here, we used a novel closed-loop mean skin temperature clamping technique with a liquid-conditioned suit to isolate the effects of mean skin temperature on the subjective evaluation of thermal sensation, heat production, shivering responses, and oxidative fuel selection in young, lean and healthy men (n = 12) and women (n = 12). Our results showed a skin temperature-dependent increase in metabolic heat production (5.2±1.0 kJ/min, 5.9±1.0 kJ/min and 7.0±1.0 kJ/min with skin temperature maintained at 31°C, 29°C and 27°C, respectively; P< 0.0001) and shivering intensity in both men and women (0.6±0.1 %MVC, 1.1±0.4 %MVC and 2.5±0.7 %MVC, respectively; P<0.0001), including sex-dependent differences in heat production at all three temperatures (P < 0.005). Even when controlling for lean body mass and fat mass, sex differences persisted (P = 0.048 and P = 0.004, respectively), whereas controlling for differences in body surface area eliminated these differences. Interestingly, there were no sex differences in the cold-induced change in thermogenesis. Despite clamping skin temperature, there was tremendous variability in the rate of heat production and shivering intensity. Collectively this data suggests that many of the inter-individual differences in thermogenesis and shivering may be explained by differences in morphology and body composition.

PET/MRI-evaluated brown adipose tissue activity may be related to dietary MUFA and omega-6 fatty acids intake

An investigation of new ways to activate brown adipose tissue (BAT) is highly valuable, as it is a possible tool for obesity prevention and treatment. The aim of our study was to evaluate the relationships between dietary intake and BAT activity. The study group comprised 28 healthy non-smoking males aged 21–42 years. All volunteers underwent a physical examination and 75-g OGTT and completed 3-day food intake diaries to evaluate macronutrients and fatty acid intake. Body composition measurements were assessed using DXA scanning. An FDG-18 PET/MR was performed to visualize BAT activity. Brown adipose tissue was detected in 18 subjects (67% normal-weight individuals and 33% overweight/obese). The presence of BAT corresponded with a lower visceral adipose tissue (VAT) content (p = 0.04, after adjustment for age, daily kcal intake, and DXA Lean mass). We noted significantly lower omega-6 fatty acids (p = 0.03) and MUFA (p = 0.02) intake in subjects with detected BAT activity after adjustment for age, daily average kcal intake, and DXA Lean mass, whereas omega-3 fatty acids intake was comparable between the two groups. BAT presence was positively associated with the concentration of serum IL-6 (p = 0.01) during cold exposure. Our results show that BAT activity may be related to daily omega-6 fatty acids intake.

Gene Profile of Adipose Tissue of Patients with Pheochromocytoma/Paraganglioma

Background: Brown adipose tissue (BAT) is a therapeutic target to combat obesity and related disorders. Pheochromocytoma and functional paraganglioma (PPGL) are associated with activated BAT due to catecholamine excess. Our aim was to evaluate BAT activity by gene profile and assess its relation to clinical characteristics and overproduced catecholamine. Methods: mRNA expression of 15 genes in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) was measured via RT-PCR in 25 patients with PPGL and 14 controls undergoing cholecystectomy. Results: We found in VAT of PPGL higher expression of UCP1 (p < 0.001), CEBPB, PPARGC1A (both p < 0.001), PRDM16 (p = 0.069) and DIO2 (p = 0.005). UCP1 expression correlated only with norepinephrine levels and its metabolite. UCP1 expression, among others, correlated negatively with BMI, age and positively with HDLc levels. Dominance of BAT or BeAT markers was not assessed in PPGL. In SAT of PPGL, we found higher expression of ADRB3, CIDEA (both p < 0.05), and PPARGC1A (p = 0.001), but not UCP1. Conclusion: We demonstrate signs of UCP1-dependent norepinephrine-induced thermogenesis connected with higher expression of DIO2, PPARGC1A, CEBPB and PRDM16 in retroperitoneal VAT of PPGL and its relations to circulating HDLc and triglycerides levels. However, no direct relationship with increased basal energy metabolism measured by calorimetry was found.

The oral 13C-bicarbonate technique for determination of energy expenditure in dogs: dietary and environmental factors affecting the respiratory quotient and 13C recovery factor

The oral ¹³C-bicarbonate technique (o¹³CBT) can be used for short-term measurements of CO₂ production (RCO₂) and energy expenditure (EEx). The method relies on appropriate estimates for the respiratory quotient (RQ) and recovery factor (RF) of ¹³C. Four Retriever dogs were included in four experiments to validate the o¹³CBT against indirect calorimetry (IC), and determine RQ and RF; Expt. 1: feeding different protein:fat:carbohydrate ratios [in % of metabolisable energy]: 25:33:42 in a maintenance (Mnt.) diet; 38:26:36 in a high-protein high-fibre (H_Fibre) diet and 27:56:17 in a high-fat (H_Fat) diet, simultaneously with start of measurements (T₀); Expt. 2: the Mnt. diet at T₀ or 4 h postprandial (T₄); Expt. 3: T₄ at different ambient temperatures, 22°C and 15°C; Expt. 4: T₄ after 1 h physical activity. The RCO₂ and EEx were determined from the respiration chamber measurements made simultaneously with IC and the o¹³CBT (o¹³CBT_online), and in Expts. 1 and 2, also on two consecutive days using o¹³CBT with collection of breath into breath bags (o¹³CBT_breathbags). The RQ values obtained at T₀ reflected dietary compositions, with the highest least square mean (LSM) of 0.954  for the Mnt. diet, 0.905 for the H_Fibre and 0.877 for the H_Fat diet (p < 0.05). An increased interval between meal and measurement period decreased RQ significantly (p < 0.05) in Expt. 2, LSM being 0.954 at T₀ and 0.909 at T₄. Ambient temperature (Expt. 3) and physical activity (Expt. 4) did not influence postprandial RQ. The RF values were not significantly affected by diet (Expt. 1). Measurements starting at T₀ (Expt. 2) resulted in higher (p < 0.05) RF values than at T₄ (LSM = 0.971 and 0.836, respectively). The ambient temperatures (Expt. 3) did not influence postprandial RF. However, when dogs were physically active prior to measurements (Expt. 4), RF values (LSM = 1.019) were higher (p < 0.05) than when resting only (LSM = 0.836). Calculations based on RQ and RF determined in each experiment resulted in RCO₂ and EEx values which were not different regardless of method used, except for Expt. 1 where EEx-values [kJ · kg BW^-0.75 · d^-1] were higher (p < 0.05) when measured with o¹³CBT_breathbags (460) than by IC (421) and o¹³CBT_online (420). Provided accurate RQ and RF values, the o¹³CBT_breathbags can be used as an independent and minimally invasive research tool to determine EEx in dogs under carefully standardised conditions.

Setting Ambient Temperature Conditions to Optimize Translation of Molecular Work from the Mouse to Human: The "Goldilocks Solution"

Temperature has a profound effect on many aspects of murine physiology. This raises the question of the best temperature at which mice should be housed to maximize the translational potential to humans. The temperatures at which mice have been routinely kept for studies of molecular physiology (20-21 °C) maximize the comfort of animal handling staff. There is a widespread movement suggesting we should perform experiments instead on mice housed at 30 °C. This often produces very different outcomes. Here we analyze the basis of this suggestion and show that while 20-21 °C is too cold, 30 °C is probably too hot. Rather we suggest an intermediate temperature "the Goldilocks solution" of 25-26 °C is probably optimal. This should be combined with providing animals with nesting material so that they can construct nests to generate microclimates that are within their own control. Providing copious nesting material has additional spin-off advantages in terms of increasing environmental enrichment. Ultimately, however, advocating a single temperature to mimic human physiology is plagued by the problem that humans vary widely in the temperature environments they experience, with consequences for human disease. Hence studying responses at a range of temperatures may provide the greatest insights and translational potential.

Overheating or overcooling: heat transfer in the spot to fight against the pandemic obesity

The prevalence of obesity has nearly doubled worldwide over the past three and a half decades, reaching pandemic status. Obesity is associated with decreased life expectancy and with an increased risk of metabolic, cardiovascular, nervous system diseases. Hence, understanding the mechanisms involved in the onset and development of obesity is mandatory to promote planned health actions to revert this scenario. In this review, common aspects of cold exposure, a process of heat generation, and exercise, a process of heat dissipation, will be discussed as two opposite mechanisms of obesity, which can be oversimplified as caloric conservation. A common road between heat generation and dissipation is the mobilization of Free Faty Acids (FFA) and Carbohydrates (CHO). An increase in energy expenditure (immediate effect) and molecular/metabolic adaptations (chronic effect) are responses that depend on SNS activity in both conditions of heat transfer. This cycle of using and removing FFA and CHO from blood either for heat or force generation disrupt the key concept of obesity: energy accumulation. Despite efforts in making the anti-obesity pill, maybe it is time to consider that the world's population is living at thermoneutrality since temperature-controlled places and the lack of exercise are favoring caloric accumulation.

Meta-analysis to predict the effects of temperature stress on meat quality of poultry

Temperature stress (TS) is a significant issue in poultry production, which has implications for animal health and welfare, productivity, and industry profitability. Temperature stress, including both hot (heat stress) and cold conditions (cold stress), is associated with increased incidence of meat quality defects such as pale, soft, and exudative (PSE) and dark, firm, and dry (DFD) meat costing poultry industries millions of dollars annually. A meta-analysis was conducted to determine the effect of ambient TS on meat quality parameters of poultry. Forty-eight publications which met specific criteria for inclusion were identified through a systematic literature review. Temperature stress was defined by extracting 2 descriptors for each treatment mean from the chosen studies: (1) temperature imposed for the experimental treatments (°C) and duration of temperature exposure. Treatment duration was categorized for analysis into acute (≤24 h) or chronic (>24 h) treatments. Meat quality parameters considered were color (L*-a*-b* scheme), pH (initial and ultimate), drip loss, cooking loss, and shear force. Linear mixed model analysis, including study as a random effect, was used to determine the effect of treatment temperature and duration on meat quality. Model evaluation was conducted by performing a k-fold cross-validation to estimate test error, and via assessment of the root mean square prediction error (RMSPE), and concordance correlation coefficient (CCC). Across both acute and chronic durations, treatment temperature was found to have a significant effect on all studied meat quality parameters. As treatment temperature increased, meat demonstrated characteristics of PSE meat and, as temperature decreased, meat demonstrated characteristics of DFD meat. The interaction between treatment temperature and duration was significant for most traits, however, the relative impact of treatment duration on the studied traits was inconsistent. Acute TS had a larger effect than chronic TS on ultimate pH, and chronic stress had a more considerable impact on color traits (L* and a*). This meta-analysis quantifies the effect of ambient TS on poultry meat quality. However, quantitative effects were generally small, and therefore may or may not be of practical significance from a processing perspective.

Physiological Demands of Basic Fire Management Tasks in Members of the Canadian Armed Forces: A Pilot Study

INTRODUCTION

Members of the Canadian Armed Forces (CAF) are required to meet the minimum standards of the Fitness for Operational Requirements of CAF Employment (FORCE) job-based simulation test (JBST) and must possess the capacity to perform other common essential tasks. One of those tasks is to perform basic fire management tasks during fire emergencies to mitigate damage and reduce the risk of injuries and/or death until professional firefighters arrive at the scene. To date however, the physiological demands of common firefighting tasks have mostly been performed on professional firefighters, thus rendering the transferability of the demands to the general military population unclear. This pilot study aimed to quantify, for the first time, the physiological demands of basic fire management tasks in the military, to determine if they are reflected in the FORCE JBST minimum standard. We hypothesized that the physiological demands of basic fire management tasks within the CAF are below the physiological demands of the FORCE JBST minimum standard, and as such, be lower than the demands of professional firefighting.

MATERIALS AND METHODS

To achieve this, 21 CAF members (8 females; 13 males; mean [SD] age: 33 [10] years; height: 174.5 [10.5] cm; weight: 85.4 [22.1] kg, estimated maximal oxygen uptake [$\dot V$O2peak]: 44.4 (7.4) mL kg-1 min-1) participated in a realistic, but physically demanding, JBST developed by CAF professional firefighting subject matter experts. The actions included lifting, carrying, and manipulating a 13-kg powder fire extinguisher and connecting, coupling, and dragging a 38-mm fire hose over 30 m. The rate of oxygen uptake ($\dot V$O2), heart rate, and percentage of heart rate reserve were measured continuously during two task simulation trials, which were interspersed by a recovery period. Rating of perceived exertion (6-no exertion; 20-maximal exertion) was measured upon completion of both task simulations. Peak $\dot V$O2 ($\dot V$O2peak) was estimated based on the results of the FORCE JBST.

RESULTS

The mean (SD) duration of both task simulation trials was 3:39 (0:19) min:s, whereas the rest period in between both trials was 62 (19) minutes. The mean O2 was 21.1 (4.7) mL kg-1 min-1 across trials, which represented 52.1 (12.2) %$\dot V$O2peak and ∼81% of the FORCE JBST. This was paralleled by a mean heart rate of 136 (18) beats min-1, mean percentage of heart rate reserve of 61.2 (10.8), and mean rating of perceived exertion of 11 ± 2. Other physical components of the JBST consisted of lifting, carrying, and manipulating a 13-kg load for ∼59 seconds, which represents 65% of the load of the FORCE JBST. The external resistance of the fire hose drag portion increased up to 316 N, translating to a total of 6205 N over 30 m, which represents 96% of the drag force measured during the FORCE JBST.

CONCLUSIONS

Our findings demonstrate that the physiological demands of basic fire management tasks in the CAF are of moderate intensity, which are reflected in the CAF physical fitness standard. As such, CAF members who achieve the minimum standard on the FORCE JBST are deemed capable of physically performing basic fire management tasks during fire emergencies.

Histopathological, histochemical and biochemical postmortem changes in induced fatal hypothermia in rats

Reaching a postmortem diagnosis of hypothermia is challenging in forensic practice. Therefore, this study was conducted to detect the histopathological, histochemical and biochemical changes that occur in adult albino rats following exposure to induced fatal hypothermia. Twenty-four adult albino rats were divided into the negative control, moderate hypothermia, severe hypothermia and hypoxia groups. Rats in the control group were euthanized when those in the moderate hypothermic group died. Blood samples were collected via heart puncture, and the cerebrum, heart, suprarenal gland, kidney, liver and skeletal muscle were removed to investigate the biochemical, histochemical and histopathological changes. Postmortem assessment depicted significant changes in lipid peroxidation, represented by increased malondialdehyde levels in the studied organs of the rats in hypothermic and hypoxia groups. Histopathological examination of the rats’ organs revealed degeneration and necrosis in the hypothermia and hypoxia groups. Sections taken from the severe hypothermic rats revealed a loss of normal cardiac tissue architecture, necrotic changes in the pyramidal cells in the cerebral cortex, and massive necrosis, mainly in the tubules of the renal cortex and medulla. These findings suggest that histological changes might be used as biochemical markers for postmortem diagnosing of fatal hypothermia, particularly in severe hypothermic conditions.

Key points

Death by hypothermia is a serious public health problem worldwide.

Confirming a diagnosis and determining the cause of death in cases of hypothermia are among the most difficult practices in forensic medicine.

Death by hypothermia might be associated with structural abnormalities in various organs.

Studies using different tissue staining techniques will enable an overall illustration of the role of histopathological changes in body organs as indicators of hypothermia.

Examining the benefits of cold exposure as a therapeutic strategy for obesity and type 2 diabetes

The pathogenesis of metabolic diseases such as obesity and type 2 diabetes are characterized by a progressive dysregulation in energy partitioning, often leading to end-organ complications. One emerging approach proposed to target this metabolic dysregulation is the application of mild cold exposure. In healthy individuals, cold exposure can increase energy expenditure and whole body glucose and fatty acid utilization. Repeated exposures can lower fasting glucose and insulin levels and improve dietary fatty acid handling, even in healthy individuals. Despite its apparent therapeutic potential, little is known regarding the effects of cold exposure in populations for which this stimulation could benefit the most. The few studies available have shown that both acute and repeated exposures to the cold can improve insulin sensitivity and reduce fasting glycemia in individuals with type 2 diabetes. However, critical gaps remain in understanding the prolonged effects of repeated cold exposures on glucose regulation and whole body insulin sensitivity in individuals with metabolic syndrome. Much of the metabolic benefits appear to be attributable to the recruitment of shivering skeletal muscles. However, further work is required to determine whether the broader recruitment of skeletal muscles observed during cold exposure can confer metabolic benefits that surpass what has been historically observed from endurance exercise. In addition, although cold exposure offers unique cardiovascular responses for a physiological stimulus that increases energy expenditure, further work is required to determine how acute and repeated cold exposure can impact cardiovascular responses and myocardial function across a broader scope of individuals.

Changes in electrocardiogram parameters during acute nonshivering cold exposure and associations with brown adipose tissue activity, plasma catecholamine levels, and brachial blood pressure in healthy adults

BACKGROUND

Sympathetic activity causes changes in electrocardiogram (ECG) during cold exposure and the changes have been studied mostly during hypothermia and less during mild acute nonshivering cold exposure. Cold-induced sympathetic activity also activates brown adipose tissue (BAT) and increases arterial blood pressure (BP) and plasma catecholamine levels. We examined changes in ECG parameters during acute nonshivering cold exposure and their associations with markers of sympathetic activity during cold exposure: brachial blood pressure (BP), plasma catecholamine levels, and BAT activity measured by positron emission tomography (PET).

METHODS AND RESULTS

Healthy subjects (M/F = 13/24, aged 20-55 years) were imaged with [¹⁵ O]H₂ O (perfusion, N = 37) and [¹⁸ F]FTHA to measure plasma nonesterified fatty acid uptake (NEFA uptake, N = 37) during 2-h nonshivering cold exposure. 12-lead ECG (N = 37), plasma catecholamine levels (N = 17), and brachial BP (N = 31) were measured at rest in room temperature (RT) and re-measured after a 2-h nonshivering cold exposure. There were significant differences between RT and cold exposure in P axis (35.6 ± 26.4 vs. 50.8 ± 22.7 degrees, p = 0.005), PR interval (177.7 ± 24.6 ms vs.163.0 ± 28.7 ms, p = 0.001), QRS axis (42.1 ± 31.3 vs. 56.9 ± 24.1, p = 0.003), and QT (411.7 ± 25.5 ms vs. 434.5 ± 39.3 ms, p = 0.001). There was no significant change in HR, QRS duration, QTc, JTc, and T axis during cold exposure. Systolic BP (127.2 ± 15.7 vs. 131.8 ± 17.9 mmHg, p = 0.008), diastolic BP (81.7 ± 12.0 vs. 85.4 ± 13.0 mmHg, p = 0.02), and plasma noradrenaline level increased during cold exposure (1.97 ± 0.61 vs. 5.07 ± 1.32 µmol/L, p = 0.001). Cold-induced changes in ECG parameters did not correlate with changes in BAT activity, brachial BP, plasma catecholamines, or skin temperature.

CONCLUSIONS

During short-term nonshivering cold exposure, there were increases in P axis, PR interval, QRS axis, and QT compared to RT in healthy adults. Cold-induced changes in ECG parameters did not correlate with BAT activity, brachial BP, or plasma catecholamine levels which were used as markers of cold-induced sympathetic activity.

Melanotan II, a melanocortin agonist, partially rescues the impaired thermogenic capacity of pituitary adenylate cyclase-activating polypeptide deficient mice

NEW FINDINGS

What is the central question of this study? Can chronic treatment of pituitary adenylate cyclase-activating polypeptide (PACAP) deficient mice with the melanocortin agonist melanotan II during cold acclimation rescue the impaired thermogenic capacity previously observed in PACAP deficient mice? What is the main finding and its importance? Using a genetic model of PACAP deficiency, this study provides evidence that PACAP acts upstream of the melanocortin system in regulating sympathetic nerve activity to brown adipose tissue in mice.

ABSTRACT

Impaired adipose tissue function in obesity, including reduced thermogenic potential, has detrimental consequences for metabolic health. Hormonal regulation of adaptive thermogenesis is being explored as a potential therapeutic target for human obesity. Pituitary adenylate cyclase-activating polypeptide (PACAP) is a neuropeptide expressed in nuclei of the hypothalamus known to regulate energy expenditure, and functional studies reveal a role for PACAP in the central regulation of thermogenesis, although mechanisms are not well understood. We hypothesized that PACAP acts upstream of the melanocortin system to regulate sympathetic nerve activity to stimulate thermogenesis. To assess this, female PACAP^-/- and PACAP^+/+ mice were given daily peripheral injections of a melanocortin receptor agonist, melanotan II (MTII), for 3 weeks during cold acclimation, and the effect of MTII on thermogenic capacity and adipose tissue remodelling was examined by physiological and histological analyses. MTII partially rescued the impaired thermogenic capacity in PACAP^-/- mice as compared to PACAP^+/+ mice as determined by measuring noradrenaline-induced metabolic rate. In addition, MTII treatment during cold acclimation corrected the previously identified deficit in lipid utilization in response to adrenergic stimulation in PACAP^-/- null mice, suggesting impaired lipid mobilization may contribute to the impaired thermogenic capacity of PACAP^-/- mice. Results presented here provide physiological evidence to suggest that PACAP acts upstream of melanocortin receptors to facilitate sympathetically induced mechanisms of adaptive thermogenesis in response to cold acclimation.

Seven days of cold acclimation substantially reduces shivering intensity and increases nonshivering thermogenesis in adult humans

Daily compensable cold exposure in humans reduces shivering by ~20% without changing total heat production, partly by increasing brown adipose tissue thermogenic capacity and activity. Although acclimation and acclimatization studies have long suggested that daily reductions in core temperature are essential to elicit significant metabolic changes in response to repeated cold exposure, this has never directly been demonstrated. The aim of the present study is to determine whether daily cold-water immersion, resulting in a significant fall in core temperature, can further reduce shivering intensity during mild acute cold exposure. Seven men underwent 1 h of daily cold-water immersion (14°C) for seven consecutive days. Immediately before and following the acclimation protocol, participants underwent a mild cold exposure using a novel skin temperature clamping cold exposure protocol to elicit the same thermogenic rate between trials. Metabolic heat production, shivering intensity, muscle recruitment pattern, and thermal sensation were measured throughout these experimental sessions. Uncompensable cold acclimation reduced total shivering intensity by 36% (P = 0.003), without affecting whole body heat production, double what was previously shown from a 4-wk mild acclimation. This implies that nonshivering thermogenesis increased to supplement the reduction in the thermogenic contribution of shivering. As fuel selection did not change following the 7-day cold acclimation, we suggest that the nonshivering mechanism recruited must rely on a similar fuel mixture to produce this heat. The more significant reductions in shivering intensity compared with a longer mild cold acclimation suggest important differential metabolic responses, resulting from an uncompensable compared with compensable cold acclimation. NEW & NOTEWORTHY Several decades of research have been dedicated to reducing the presence of shivering during cold exposure. The present study aims to determine whether as little as seven consecutive days of cold-water immersion is sufficient to reduce shivering and increase nonshivering thermogenesis. We provide evidence that whole body nonshivering thermogenesis can be increased to offset a reduction in shivering activity to maintain endogenous heat production. This demonstrates that short, but intense cold stimulation can elicit rapid metabolic changes in humans, thereby improving our comfort and ability to perform various motor tasks in the cold. Further research is required to determine the nonshivering processes that are upregulated within this short time period.

The Effect of Repeated Whole-Body Cryostimulation on the HSP-70 and Lipid Metabolisms in Healthy Subjects

The aim of this study was to evaluate the effects of exposure to 30 daily whole body cryostimulation (WBC) on lipid metabolic parameters and serum HSP-70 concentration. The study involved 45 volunteers, homogeneous in terms of diet and daily physical activity. Blood samples were collected before and after the 10th, the 20th, and the 30th session and one month after the intervention. Total cholesterol, HDL, TG concentrations and Apolipoprotein A-I, ApoB and HSP-70 protein levels were determined in serum. Additionally, the LI (Lipid Index) and the LDL level were calculated. During exposure, positive changes in the lipid profile that included a decrease in the TCh, initiated after the 20th WBC session with a simultaneous decrease in TG and LDL levels, and an increase in the HDL concentration were observed. These changes were accompanied by a downward trend in the ApoB concentration and a decrease in the ApoB:ApoA-I ratio after 30 sessions. The nature of these changes persisted for a month after the exposure. The obtained results indicate metabolic benefits that result from prolonged exposure to cryogenic temperatures, confirming the postulate of using WBC in the regulation of lipid metabolism and the prevention of cardiovascular diseases.

Exposure to Cold Unmasks Potential Biomarkers of Fibromyalgia Syndrome Reflecting Insufficient Sympathetic Responses to Stress

OBJECTIVES

Fibromyalgia syndrome (FMS) is a chronically painful condition whose symptoms are widely reported to be exacerbated by stress. We hypothesized that female patients with FMS differ from pain-free female controls in their sympathetic responses, a fact that may unmask important biomarkers and factors that contribute to the etiology of FMS.

MATERIALS AND METHODS

In a pilot study, blood pressure (BP), skin temperature, thermogenic activity, circulating glucose, and pain sensitivity of 13 individuals with FMS and 11 controls at room temperature (24°C) were compared with that after exposure to cold (19°C).

RESULTS

When measured at 24°C, BP, skin temperature, blood glucose, and brown adipose tissue (BAT) activity, measured using F-fluorodeoxyglucose positron-emission tomography/computed tomography, did not differ between controls and individuals with FMS. However, after cold exposure (19°C), BP and BAT activity increased in controls but not in individuals with FMS; skin temperature on the calf and arm decreased in controls more than in individiuals with FMS; and circulating glucose was lower in individiuals with FMS than in controls. Pain sensitivity did not change during the testing interval in response to cold.

DISCUSSION

The convergence of the effect of cold on 4 relatively simple measures of thermogenic, cardiovascular, and metabolic activity, each regulated by sympathetic activity, strongly indicate that individuals with FMS have impaired sympathetic responses to stress that are observable and highly significant even when measured in extraordinarily small sample populations. If insufficient sympathetic responses to stress are linked to FMS, stress may unmask and maximize these potential clinical biomarkers of FMS and be related to its etiology.

Use of the "Cool Fat Burner" in conjunction with drinking of cold water is associated with acute and minor increases in energy expenditure and fat metabolism in overweight men and women

BACKGROUND

Exposure to cold is associated with increased energy expenditure to maintain thermal equilibrium. The Cool Fat Burner vest and Gut Buster are chilling devices used to induce shivering and increase calorie use. Drinking chilled water has a similar effect.

METHODS

Indirect calorimetry was performed on volunteers at rest with induced shivering. Eight men and 6 women with a mean age of 32.14+7.26 years were evaluated while wearing the Cool Fat Burner Vest and Gut Buster and drinking chilled water.

RESULTS

Use of the chilling devices was associated with a significant increase in VO2, VT, VE, R, and EE. An over 20% increase in fat use as a fuel source was observed along with a 67% increase in EE. The energy expenditure during the final 30 minutes of shiver chilling was 74.6% above that of the RMR. Chilling induced significant increases in energy expenditure associated with a shift in energy source towards more fat tissue use.

CONCLUSIONS

Indirect calorimetry evaluation of overweight subjects wearing a Cool Fat Burner vest and Gut Buster and drinking chilled water demonstrated significant increases in oxygen uptake and energy expenditure, and a shift in fuel utilization towards fat as the substrate of choice.

Effects of ambient temperature and rumen-protected fat supplementation on growth performance, rumen fermentation and blood parameters during cold season in Korean cattle steers

Objective

This study was performed to evaluate whether cold ambient temperature and dietary rumen-protected fat (RPF) supplementation affect growth performance, rumen fermentation, and blood parameters in Korean cattle steers.

Methods

Twenty Korean cattle steers (body weight [BW], 550.6±9.14 kg; age, 19.7±0.13 months) were divided into a conventional control diet group (n = 10) and a 0.5% RPF supplementation group (n = 10). Steers were fed a concentrate diet (1.6% BW) and a rice straw diet (1 kg/d) for 16 weeks (January 9 to February 5 [P1], February 6 to March 5 [P2], March 6 to April 3 [P3], and April 4 to May 2 [P4]).

Results

The mean and minimum indoor ambient temperatures in P1 (−3.44°C, −9.40°C) were lower (p<0.001) than those in P3 (5.87°C, −1.86°C) and P4 (11.18°C, 4.28°C). The minimum temperature in P1 fell within the moderate cold-stress (CS) category, as previously reported for dairy cattle, and the minimum temperatures of P2 and P3 were within the mild CS category. Neither month nor RPF supplementation affected the average daily gain or gain-to-feed ratio (p>0.05). Ruminal ammonia nitrogen concentrations were higher (p<0.05) in cold winter than spring. Plasma cortisol concentrations were lower (p<0.05) in the coldest month than in the other months. Serum glucose concentrations were generally higher in colder months than in the other months but were unaffected by RPF supplementation. RPF supplementation increased both total cholesterol (p = 0.004) and high-density lipoprotein (HDL) concentrations (p = 0.03).

Conclusion

Korean cattle may not be significantly affected by moderate CS, considering that the growth performance of cattle remained unchanged, although variations in blood parameters were observed among the studied months. RPF supplementation altered cholesterol and HDL concentrations but did not affect growth performance.

Alcantara JM, Acosta-Manzano P, Morales-Artacho AJ, R. Ruiz J. Physiological responses to acute cold exposure in young lean men

The aim of this study was to comprehensively describe the physiological responses to an acute bout of mild cold in young lean men (n = 11, age: 23 ± 2 years, body mass index: 23.1 ± 1.2 kg/m2) to better understand the underlying mechanisms of non-shivering thermogenesis and how it is regulated. Resting energy expenditure, substrate metabolism, skin temperature, thermal comfort perception, superficial muscle activity, hemodynamics of the forearm and abdominal regions, and heart rate variability were measured under warm conditions (22.7 ± 0.2°C) and during an individualized cooling protocol (air-conditioning and water cooling vest) in a cold room (19.4 ± 0.1°C). The temperature of the cooling vest started at 16.6°C and decreased ~ 1.4°C every 10 minutes until participants shivered (93.5 ± 26.3 min). All measurements were analysed across 4 periods: warm period, at 31% and at 64% of individual´s cold exposure time until shivering occurred, and at the shivering threshold. Energy expenditure increased from warm period to 31% of cold exposure by 16.7% (P = 0.078) and to the shivering threshold by 31.7% (P = 0.023). Fat oxidation increased by 72.6% from warm period to 31% of cold exposure (P = 0.004), whereas no changes occurred in carbohydrates oxidation. As shivering came closer, the skin temperature and thermal comfort perception decreased (all P<0.05), except in the supraclavicular skin temperature, which did not change (P>0.05). Furthermore, the superficial muscle activation increased at the shivering threshold. It is noteworthy that the largest physiological changes occurred during the first 30 minutes of cold exposure, when the participants felt less discomfort.

Shivering and nonshivering thermogenesis in skeletal muscles

Humans have inherited complex neural circuits which drive behavioral, somatic, and autonomic thermoregulatory responses to defend their body temperature. While they are well adapted to dissipate heat in warm climates, they have a reduced capacity to preserve it in cold environments. Consequently, heat production is critical to defending their core temperature. As in other large mammals, skeletal muscles are the primary source of heat production recruited in cold-exposed humans. This is achieved voluntarily in the form of contractions from exercising muscles or involuntarily in the form of contractions from shivering muscles and the recruitment of nonshivering mechanisms. This review describes our current understanding of shivering and nonshivering thermogenesis in skeletal muscles, from the neural circuitry driving their recruitment to the metabolic substrates that fuel them. The presence of these heat-producing mechanisms can be measured in vivo by combining indirect respiratory calorimetry with electromyography or biomedical imaging modalities. Indeed, much of what is known regarding shivering in humans and other animal models stems from studies performed using these methods combined with in situ and in vivo neurologic techniques. More recent investigations have focused on understanding the metabolic processes that produce the heat from both contracting and noncontracting mechanisms. With the growing interest in the potential therapeutic benefits of shivering and nonshivering skeletal muscle to counter the effects of neuromuscular, cardiovascular, and metabolic diseases, we expect this field to continue its growth in the coming years.

The ineluctable constraints of thermodynamics in the aetiology of obesity

We exploit the detail-independence feature of thermodynamics to examine issues related to the development of obesity. We adopt a 'global' approach consistent with focus on the first law of thermodynamics - namely that the metabolic energy provided by dietary foodstuffs has only three possible fates: the performance of work (be it microscopic or macroscopic), the generation of heat, or storage - primarily in the form of adipose tissue. Quantification of the energy expended, in the form of fat metabolised, during selected endurance events, reveals the inherent limitation of over-reliance on exercise as a primary agent of weight loss. This result prompts examination of various (non-exercise based) possibilities of increasing the rate of heat loss. Since these, too, give little cause for optimism, we are obliged to conclude that obesity can be prevented, or weight loss achieved, only if exercise is supplemented by reduction of food intake.

Beta2-adrenergic stimulation increases energy expenditure at rest, but not during submaximal exercise in active overweight men

PURPOSE

β₂-Agonists have been proposed as weight-loss treatment, because they elevate energy expenditure. However, it is unknown what effect β₂-agonists have on energy expenditure in overweight individuals. Furthermore, the influence of β₂-agonist R- and S-enantiomer ratio for the increased energy expenditure is insufficiently explored.

METHODS

Nineteen males were included in the study of which 14 completed. Subjects were 31.6 (±3.5) years [mean (±95% CI)] and had a fat percentage of 22.7 (±2.1)%. On separate days, subjects received either placebo or inhaled racemic (rac-) formoterol (2 × 27 µg). After an overnight fast, energy expenditure and substrate oxidation were estimated by indirect calorimetry at rest and during submaximal exercise. Plasma (R,R)- and (S,S)-formoterol enantiomer levels were measured by ultra-performance liquid chromatograph-mass spectrometry.

RESULTS

At rest, energy expenditure and fat oxidation were 12% (P ≤ 0.001) and 38% (P = 0.006) higher for rac-formoterol than placebo. Systemic (R,R):(S,S) formoterol ratio was correlated with change in energy expenditure at rest in response to rac-formoterol (r = 0.63, P = 0.028), whereas no association was observed between fat percentage and rac-formoterol-induced change in energy expenditure. During exercise, energy expenditure was not different between treatments, although carbohydrate oxidation was 15% higher (P = 0.021) for rac-formoterol than placebo. Rac-formoterol-induced shift in substrate choice from rest to exercise was related to plasma ln-rac-formoterol concentrations (r = 0.75, P = 0.005).

CONCLUSION

Selective β₂-adrenoceptor agonism effectively increases metabolic rate and fat oxidation in overweight individuals. The potential for weight loss induced by β₂-agonists may be greater for R-enantiopure formulations.

Shivering thermogenesis in humans: Origin, contribution and metabolic requirement

As endotherms, humans exposed to a compensable cold environment rely on an increase in thermogenic rate to counteract heat lost to the environment, thereby maintaining a stable core temperature. This review focuses primarily on the most important contributor of heat production in cold-exposed adult humans, shivering skeletal muscles. Specifically, it presents current understanding on (1) the origins of shivering, (2) the contribution of shivering to total heat production and (3) the metabolic requirements of shivering. Although shivering had commonly been measured as a metabolic outcome measure, considerable research is still needed to clearly identify the neuroanatomical structures and circuits that initiate and modulate shivering and drives the shivering patterns (continuous and burst shivering). One thing is clear, the thermogenic rate in humans can be maintained despite significant inter-individual differences in the thermogenic contribution of shivering, the muscles recruited in shivering, the burst shivering rate and the metabolic substrates used to support shivering. It has also become evident that the variability in burst shivering rate between individuals, despite not influencing heat production, does play a key role in orchestrating metabolic fuel selection in the cold. In addition, advances in our understanding of the thermogenic role of brown adipose tissue have been able to explain, at least in part, the large inter-individual differences in the contribution of shivering to total heat production. Whether these differences in the thermogenic role of shivering have any bearing on cold endurance and survival remains to be established. Despite the available research describing the relative thermogenic importance of shivering skeletal muscles in humans, the advancement in our understanding of how shivering is initiated and modulated is needed. Such research is critical to consider strategies to either reduce its role to improve occupational performance or exploit its metabolic potential for clinical purposes.

Inhibition of Intracellular Triglyceride Lipolysis Suppresses Cold-Induced Brown Adipose Tissue Metabolism and Increases Shivering in Humans

Indirect evidence from human studies suggests that brown adipose tissue (BAT) thermogenesis is fueled predominantly by fatty acids hydrolyzed from intracellular triglycerides (TGs). However, no direct experimental evidence to support this assumption currently exists in humans. The aim of this study was to determine the role of intracellular TG in BAT thermogenesis, in cold-exposed men. Using positron emission tomography with ¹¹C-acetate and ¹⁸F-fluorodeoxyglucose, we showed that oral nicotinic acid (NiAc) administration, an inhibitor of intracellular TG lipolysis, suppressed the cold-induced increase in BAT oxidative metabolism and glucose uptake, despite no difference in BAT blood flow. There was a commensurate increase in shivering intensity and shift toward a greater reliance on glycolytic muscle fibers without modifying total heat production. Together, these findings show that intracellular TG lipolysis is critical for BAT thermogenesis and provides experimental evidence for a reciprocal role of BAT thermogenesis and shivering in cold-induced thermogenesis in humans.

Four-week cold acclimation in adult humans shifts uncoupling thermogenesis from skeletal muscles to brown adipose tissue

KEY POINTS

Muscle-derived thermogenesis during acute cold exposure in humans consists of a combination of cold-induced increases in skeletal muscle proton leak and shivering. Daily cold exposure results in an increase in brown adipose tissue oxidative capacity coupled with a decrease in the cold-induced skeletal muscle proton leak and shivering intensity. Improved coupling between electromyography-determined muscle activity and whole-body heat production following cold acclimation suggests a maintenance of ATPase-dependent thermogenesis and decrease in skeletal muscle ATPase independent thermogenesis. Although daily cold exposure did not change the fibre composition of the vastus lateralis, the fibre composition was a strong predictor of the shivering pattern evoked during acute cold exposure.

ABSTRACT

We previously showed that 4 weeks of daily cold exposure in humans can increase brown adipose tissue (BAT) volume by 45% and oxidative metabolism by 182%. Surprisingly, we did not find a reciprocal reduction in shivering intensity when exposed to a mild cold (18°C). The present study aimed to determine whether changes in skeletal muscle oxidative metabolism or shivering activity could account for these unexpected findings. Nine men participated in a 4 week cold acclimation intervention (10°C water circulating in liquid-conditioned suit, 2 h day^-1 , 5 days week^-1 ). Shivering intensity and pattern were measured continuously during controlled cold exposure (150 min at 4 °C) before and after the acclimation. Muscle biopsies from the m. vastus lateralis were obtained to measure oxygen consumption rate and proton leak of permeabilized muscle fibres. Cold acclimation elicited a modest 21% (P < 0.05) decrease in whole-body and m. vastus lateralis shivering intensity. Furthermore, cold acclimation abolished the acute cold-induced increase in proton leak. Although daily cold exposure did not change the fibre composition of the m. vastus lateralis, fibre composition was a strong predictor of the shivering pattern evoked during acute cold. We conclude that muscle-derived thermogenesis during acute cold exposure in humans is not only limited to shivering, but also includes cold-induced increases in proton leak. The efficiency of muscle oxidative phosphorylation improves with cold acclimation, suggesting that reduced muscle thermogenesis occurs through decreased proton leak, in addition to decreased shivering intensity as BAT capacity and activity increase. These changes occur with no net difference in whole-body thermogenesis.

Dietary fatty acid metabolism of brown adipose tissue in cold-acclimated men

In rodents, brown adipose tissue (BAT) plays an important role in producing heat to defend against the cold and can metabolize large amounts of dietary fatty acids (DFA). The role of BAT in DFA metabolism in humans is unknown. Here we show that mild cold stimulation (18 °C) results in a significantly greater fractional DFA extraction by BAT relative to skeletal muscle and white adipose tissue in non-cold-acclimated men given a standard liquid meal containing the long-chain fatty acid PET tracer, 14(R,S)-[¹⁸F]-fluoro-6-thia-heptadecanoic acid (¹⁸FTHA). However, the net contribution of BAT to systemic DFA clearance is comparatively small. Despite a 4-week cold acclimation increasing BAT oxidative metabolism 2.6-fold, BAT DFA uptake does not increase further. These findings show that cold-stimulated BAT can contribute to the clearance of DFA from circulation but its contribution is not as significant as the heart, liver, skeletal muscles or white adipose tissues.

Brown adipose tissue (BAT) takes up and burns fatty acids for thermogenesis in mice. Here the authors use PET to show that, in humans, cold stimulation increases BAT dietary fatty acid uptake from plasma and oxidative metabolism, although, unlike mice, human BAT takes up less fatty acids than other metabolic tissues.

Browning of white adipose tissue: lessons from experimental models

Beige or brite (brown-in-white) adipocytes are present in white adipose tissue (WAT) and have a white fat-like phenotype that when stimulated acquires a brown fat-like phenotype, leading to increased thermogenesis. This phenomenon is known as browning and is more likely to occur in subcutaneous fat depots. Browning involves the expression of many transcription factors, such as PR domain containing 16 (PRDM16) and peroxisome proliferator-activated receptor (PPAR)-γ, and of uncoupling protein (UCP)-1, which is the hallmark of thermogenesis. Recent papers pointed that browning can occur in the WAT of humans, with beneficial metabolic effects. This fact indicates that these cells can be targeted to treat a range of diseases, with both pharmacological and nutritional activators. Pharmacological approaches to induce browning include the use of PPAR-α agonist, adrenergic receptor stimulation, thyroid hormone administration, irisin and FGF21 induction. Most of them act through the induction of PPAR-γ coactivator (PGC) 1-α and the consequent mitochondrial biogenesis and UCP1 induction. About the nutritional inducers, several compounds have been described with multiple mechanisms of action. Some of these activators include specific amino acids restriction, capsaicin, bile acids, Resveratrol, and retinoic acid. Besides that, some classes of lipids, as well as many plant extracts, have also been implicated in the browning of WAT. In conclusion, the discovery of browning in human WAT opens the possibility to target the adipose tissue to fight a range of diseases. Studies have arisen showing promising results and bringing new opportunities in thermogenesis and obesity control.

Relevance of lipid metabolism for brown fat visualization and quantification

PURPOSE OF REVIEW

Brown adipose tissue (BAT) is an emerging target to combat cardiometabolic disorders as it can take up substantial amounts of glucose and lipids from the circulation for heat production. This review focuses on new concepts in BAT physiology and discusses the need for new techniques to determine BAT activity in humans.

RECENT FINDINGS

Mouse studies showed that BAT activation selectively increases oxidation of lipids over glucose, by recruiting fatty acids from intracellular triglycerides. To replenish these intracellular lipid stores, brown adipocytes take up both glucose and triglyceride-derived fatty acids, resulting in attenuation of dyslipidaemia, insulin resistance and atherosclerosis. Clinical studies identified the involvement of the β3-adrenergic receptor in BAT activation and demonstrated that human BAT activation also selectively increases lipid oxidation. Notably, insulin resistance during ageing or weight gain reduces the capacity of BAT to internalize glucose, without reducing fatty acid uptake or oxidative metabolism.

SUMMARY

Preclinical studies established BAT as an important target to combat cardiometabolic disorders and elucidated underlying mechanisms whereas clinical studies identified therapeutic handles. Development of novel lipid-based PET-CT tracers and identification of translational biomarkers of BAT activity are required as alternatives to [F]fluorodeoxyglucose PET-CT to accelerate clinical development of BAT-activating therapeutic strategies.

Effects of dietary phosphate on glucose and lipid metabolism

Recent epidemiological and animal studies have suggested that excess intake of phosphate (Pi) is a risk factor for the progression of chronic kidney disease and its cardiovascular complications. However, little is known about the impact of dietary high Pi intake on the development of metabolic disorders such as obesity and type 2 diabetes. In this study, we investigated the effects of dietary Pi on glucose and lipid metabolism in healthy rats. Male 8-wk-old Sprague-Dawley rats were divided into three groups and given experimental diets containing varying amounts of Pi, i.e., 0.2 [low Pi(LP)], 0.6 [control Pi(CP)], and 1.2% [high Pi(HP)]. After 4 wk, the HP group showed lower visceral fat accumulation compared with other groups, accompanied by a low respiratory exchange ratio (V̇CO2/V̇O2) without alteration of locomotive activity. The HP group had lower levels of plasma insulin and nonesterified fatty acids. In addition, the HP group also showed suppressed expression of hepatic lipogenic genes, including sterol regulatory element-binding protein-1c, fatty acid synthase, and acetyl-CoA carboxylase, whereas there was no difference in hepatic fat oxidation among the groups. On the other hand, uncoupling protein (UCP) 1 and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) expression were significantly increased in the brown adipose tissue (BAT) of the HP group. Our data demonstrated that a high-Pi diet can negatively regulate lipid synthesis in the liver and increase mRNA expression related to lipid oxidation and UCP1 in BAT, thereby preventing visceral fat accumulation. Thus, dietary Pi is a novel metabolic regulator.

The relation of saturated fatty acids with low-grade inflammation and cardiovascular disease

The mantra that dietary (saturated) fat must be minimized to reduce cardiovascular disease (CVD) risk has dominated nutritional guidelines for decades. Parallel to decreasing intakes of fat and saturated fatty acids (SFA), there have been increases in carbohydrate and sugar intakes, overweight, obesity and type 2 diabetes mellitus. The "lipid hypothesis" coined the concept that fat, especially SFA, raises blood low-density lipoprotein-cholesterol and thereby CVD risk. In view of current controversies regarding their adequate intakes and effects, this review aims to summarize research regarding this heterogenic group of fatty acids and the mechanisms relating them to (chronic) systemic low-grade inflammation, insulin resistance, metabolic syndrome and notably CVD. The intimate relationship between inflammation and metabolism, including glucose, fat and cholesterol metabolism, revealed that the dyslipidemia in Western societies, notably increased triglycerides, "small dense" low-density lipoprotein and "dysfunctional" high-density lipoprotein, is influenced by many unfavorable lifestyle factors. Dietary SFA is only one of these, not necessarily the most important, in healthy, insulin-sensitive people. The environment provides us not only with many other proinflammatory stimuli than SFA but also with many antiinflammatory counterparts. Resolution of the conflict between our self-designed environment and ancient genome may rather rely on returning to the proinflammatory/antiinflammatory balance of the Paleolithic era in consonance with the 21st century culture. Accordingly, dietary guidelines might reconsider recommendations for SFA replacement and investigate diet in a broader context, together with nondietary lifestyle factors. This should be a clear priority, opposed to the reductionist approach of studying the effects of single nutrients, such as SFA.

Oxidative fuel selection and shivering thermogenesis during a 12- and 24-h cold-survival simulation

Because the majority of cold exposure studies are constrained to short-term durations of several hours, the long-term metabolic demands of cold exposure, such as during survival situations, remain largely unknown. The present study provides the first estimates of thermogenic rate, oxidative fuel selection, and muscle recruitment during a 24-h cold-survival simulation. Using combined indirect calorimetry and electrophysiological and isotopic methods, changes in muscle glycogen, total carbohydrate, lipid, protein oxidation, muscle recruitment, and whole body thermogenic rate were determined in underfed and noncold-acclimatized men during a simulated accidental exposure to 7.5 °C for 12 to 24 h. In noncold-acclimatized healthy men, cold exposure induced a decrease of ∼0.8 °C in core temperature and a decrease of ∼6.1 °C in mean skin temperature (range, 5.4-6.9 °C). Results showed that total heat production increased by approximately 1.3- to 1.5-fold in the cold and remained constant throughout cold exposure. Interestingly, this constant rise in Ḣprod and shivering intensity was accompanied by a large modification in fuel selection that occurred between 6 and 12 h; total carbohydrate oxidation decreased by 2.4-fold, and lipid oxidation doubled progressively from baseline to 24 h. Clearly, such changes in fuel selection dramatically reduces the utilization of limited muscle glycogen reserves, thus extending the predicted time to muscle glycogen depletion to as much as 15 days rather than the previous estimates of approximately 30-40 h. Further research is needed to determine whether this would also be the case under different nutritional and/or colder conditions.

Cold Stress Effects on Exposure Tolerance and Exercise Performance

Cold weather can have deleterious effects on health, tolerance, and performance. This paper will review the physiological responses and external factors that impact cold tolerance and physical performance. Tolerance is defined as the ability to withstand cold stress with minimal changes in physiological strain. Physiological and pathophysiological responses to short-term (cold shock) and long-term cold water and air exposure are presented. Factors (habituation, anthropometry, sex, race, and fitness) that influence cold tolerance are also reviewed. The impact of cold exposure on physical performance, especially aerobic performance, has not been thoroughly studied. The few studies that have been done suggest that aerobic performance is degraded in cold environments. Potential physiological mechanisms (decreases in deep body and muscle temperature, cardiovascular, and metabolism) are discussed. Likewise, strength and power are also degraded during cold exposure, primarily through a decline in muscle temperature. The review also discusses the concept of thermoregulatory fatigue, a reduction in the thermal effector responses of shivering and vasoconstriction, as a result of multistressor factors, including exhaustive exercise.

Maintaining thermogenesis in cold exposed humans: relying on multiple metabolic pathways

In cold exposed humans, increasing thermogenic rate is essential to prevent decreases in core temperature. This review describes the metabolic requirements of thermogenic pathways, mainly shivering thermogenesis, the largest contributor of heat. Research has shown that thermogenesis is sustained from a combination of carbohydrates, lipids, and proteins. The mixture of fuels is influenced by shivering intensity and pattern as well as by modifications in energy reserves and nutritional status. To date, there are no indications that differences in the types of fuel being used can alter shivering and overall heat production. We also bring forth the potential contribution of nonshivering thermogenesis in adult humans via the activation of brown adipose tissue (BAT) and explore some means to stimulate the activity of this highly thermogenic tissue. Clearly, the potential role of BAT, especially in young lean adults, can no longer be ignored. However, much work remains to clearly identify the quantitative nature of this tissue's contribution to total thermogenic rate and influence on shivering thermogenesis. Identifying ways to potentiate the effects of BAT via cold acclimation and/or the ingestion of compounds that stimulate the thermogenic process may have important implications in cold endurance and survival.

Selective Impairment of Glucose but Not Fatty Acid or Oxidative Metabolism in Brown Adipose Tissue of Subjects With Type 2 Diabetes

Spontaneous glucose uptake by brown adipose tissue (BAT) is lower in overweight or obese individuals and in diabetes. However, BAT metabolism has not been previously investigated in patients with type 2 diabetes during controlled cold exposure. Using positron emission tomography with (11)C-acetate, (18)F-fluoro-deoxyglucose ((18)FDG), and (18)F-fluoro-thiaheptadecanoic acid ((18)FTHA), a fatty acid tracer, BAT oxidative metabolism and perfusion and glucose and nonesterified fatty acid (NEFA) turnover were determined in men with well-controlled type 2 diabetes and age-matched control subjects under experimental cold exposure designed to minimize shivering. Despite smaller volumes of (18)FDG-positive BAT and lower glucose uptake per volume of BAT compared with young healthy control subjects, cold-induced oxidative metabolism and NEFA uptake per BAT volume and an increase in total body energy expenditure did not differ in patients with type 2 diabetes or their age-matched control subjects. The reduction in (18)FDG-positive BAT volume and BAT glucose clearance were associated with a reduction in BAT radiodensity and perfusion. (18)FDG-positive BAT volume and the cold-induced increase in BAT radiodensity were associated with an increase in systemic NEFA turnover. These results show that cold-induced NEFA uptake and oxidative metabolism are not defective in type 2 diabetes despite reduced glucose uptake per BAT volume and BAT "whitening."

Contributions of white and brown adipose tissues and skeletal muscles to acute cold-induced metabolic responses in healthy men

KEY POINTS

Both brown adipose tissue (BAT) and skeletal muscle activation contribute to the metabolic response of acute cold exposure in healthy men even under minimal shivering. Activation of adipose tissue intracellular lipolysis is associated with BAT metabolic response upon acute cold exposure in healthy men. Although BAT glucose uptake per volume of tissue is important, the bulk of glucose turnover during cold exposure is mediated by skeletal muscle metabolic activation even when shivering is minimized.

ABSTRACT

Cold exposure stimulates the sympathetic nervous system (SNS), triggering the activation of cold-defence responses and mobilizing substrates to fuel the thermogenic processes. Although these processes have been investigated independently, the physiological interaction and coordinated contribution of the tissues involved in producing heat or mobilizing substrates has never been investigated in humans. Using [U-(13)C]-palmitate and [3-(3)H]-glucose tracer methodologies coupled with positron emission tomography using (11)C-acetate and (18)F-fluorodeoxyglucose, we examined the relationship between whole body sympathetically induced white adipose tissue (WAT) lipolysis and brown adipose tissue (BAT) metabolism and mapped the skeletal muscle shivering and metabolic activation pattern during a mild, acute cold exposure designed to minimize shivering response in 12 lean healthy men. Cold-induced increase in whole-body oxygen consumption was not independently associated with BAT volume of activity, BAT oxidative metabolism, or muscle metabolism or shivering intensity, but depended on the sum of responses of these two metabolic tissues. Cold-induced increase in non-esterified fatty acid (NEFA) appearance rate was strongly associated with the volume of metabolically active BAT (r = 0.80, P = 0.005), total BAT oxidative metabolism (r = 0.70, P = 0.004) and BAT glucose uptake (r = 0.80, P = 0.005), but not muscle glucose metabolism. The total glucose uptake was more than one order of magnitude greater in skeletal muscles compared to BAT during cold exposure (674 ± 124 vs. 12 ± 8 μmol min(-1), respectively, P < 0.001). Glucose uptake demonstrated that deeper, centrally located muscles of the neck, back and inner thigh were the greatest contributors of muscle glucose uptake during cold exposure due to their more important shivering response. In summary, these results demonstrate for the first time that the increase in plasma NEFA appearance from WAT lipolysis is closely associated with BAT metabolic activation upon acute cold exposure in healthy men. In humans, muscle glucose utilization during shivering contributes to a much greater extent than BAT to systemic glucose utilization during acute cold exposure.

Brown adipose tissue improves whole-body glucose homeostasis and insulin sensitivity in humans

Brown adipose tissue (BAT) has attracted scientific interest as an antidiabetic tissue owing to its ability to dissipate energy as heat. Despite a plethora of data concerning the role of BAT in glucose metabolism in rodents, the role of BAT (if any) in glucose metabolism in humans remains unclear. To investigate whether BAT activation alters whole-body glucose homeostasis and insulin sensitivity in humans, we studied seven BAT-positive (BAT(+)) men and five BAT-negative (BAT(-)) men under thermoneutral conditions and after prolonged (5-8 h) cold exposure (CE). The two groups were similar in age, BMI, and adiposity. CE significantly increased resting energy expenditure, whole-body glucose disposal, plasma glucose oxidation, and insulin sensitivity in the BAT(+) group only. These results demonstrate a physiologically significant role of BAT in whole-body energy expenditure, glucose homeostasis, and insulin sensitivity in humans, and support the notion that BAT may function as an antidiabetic tissue in humans.

Plasma lactate concentration as a prognostic biomarker in dogs with gastric dilation and volvulus

Initial and serial plasma lactate concentrations can be used to guide decision making in individual dogs with GDV but care is necessary in phrasing conversations with owners. Published data suggests that survival is more likely and the chance of complications less in dogs with an initial plasma lactate of <4 mmol/L. An initial lactate >6 mmol/L makes gastric necrosis and greater expense more likely. However, because of the overlap between groups and the good overall survival rates, exploratory laparotomy should always be recommended irrespective of the plasma lactate concentration. Falls in plasma lactate of greater than ~40% after fluid resuscitation are likely to indicate better survival. If the initial plasma lactate concentration is moderately to severely increased (5->10 mmol/L) and a sustained increase in plasma lactate occurs after fluid resuscitation, the cause should be aggressively pursued. Many dogs with persistent hyperlactatemia over 24-48 hours do not survive.

Increased brown adipose tissue oxidative capacity in cold-acclimated humans

CONTEXT

Recent studies examining brown adipose tissue (BAT) metabolism in adult humans have provided convincing evidence of its thermogenic potential and role in clearing circulating glucose and fatty acids under acute mild cold exposure. In contrast, early indications suggest that BAT metabolism is defective in obesity and type 2 diabetes, which may have important pathological and therapeutic implications. Although many mammalian models have demonstrated the phenotypic flexibility of this tissue through chronic cold exposure, little is known about the metabolic plasticity of BAT in humans.

OBJECTIVE

Our objective was to determine whether 4 weeks of daily cold exposure could increase both the volume of metabolically active BAT and its oxidative capacity.

DESIGN

Six nonacclimated men were exposed to 10°C for 2 hours daily for 4 weeks (5 d/wk), using a liquid-conditioned suit. Using electromyography combined with positron emission tomography with [(11)C]acetate and [(18)F]fluorodeoxyglucose, shivering intensity and BAT oxidative metabolism, glucose uptake, and volume before and after 4 weeks of cold acclimation were examined under controlled acute cold-exposure conditions.

RESULTS

The 4-week acclimation protocol elicited a 45% increase in BAT volume of activity (from 66 ± 30 to 95 ± 28 mL, P < .05) and a 2.2-fold increase in cold-induced total BAT oxidative metabolism (from 0.725 ± 0.300 to 1.591 ± 0.326 mL·s(-1), P < .05). Shivering intensity was not significantly different before compared with after acclimation (2.1% ± 0.7% vs 2.0% ± 0.5% maximal voluntary contraction, respectively). Fractional glucose uptake in BAT increased after acclimation (from 0.035 ± 0.014 to 0.048 ± 0.012 min(-1)), and net glucose uptake also trended toward an increase (from 163 ± 60 to 209 ± 50 nmol·g(-1)·min(-1)).

CONCLUSIONS

These findings demonstrate that daily cold exposure not only increases the volume of metabolically active BAT but also increases its oxidative capacity and thus its contribution to cold-induced thermogenesis.

Seasonal variation in basal metabolic rates among the Yakut (Sakha) of Northeastern Siberia

OBJECTIVES

Previous research has shown that indigenous circumpolar populations have elevated basal metabolic rates (BMRs), yet few studies have explored whether metabolic rates increase during the winter. This study addresses this gap by examining seasonal variation in BMR and its associations with thyroid function and lifestyle factors among the Yakut (Sakha) of Siberia.

METHODS

Anthropometric dimensions, BMR, and thyroid hormone levels (free triiodothyronine [fT3], free thyroxine [fT4], thyroid-stimulating hormone [TSH]) were measured on two occasions (July/August, 2009 and January 2011) on a sample of 94 Yakut (Sakha) adults (35 men, 59 women) from the rural village of Berdygestiakh, Sakha Republic, Russia.

RESULTS

Seasonal changes in BMR varied by age. Younger Yakut adults (19-49 years) showed significant elevations in winter-time BMR of 6% (P < 0.05), whereas older individuals (≥50 years) showed modest declines (2%; n.s.). Both younger and older Yakut men and women showed increased respiratory quotients during the winter. FT3 and fT4 levels significantly declined during the winter in both younger and older Yakut men and women (P < 0.05). Lifestyle factors were significant predictors of BMR variation, particularly among older men and women.

CONCLUSIONS

Among the Yakut, increased wintertime BMR was observed among younger but not older adults, whereas all adults showed sharp reductions in free thyroid hormone levels during the winter. Among men, greater participation in subsistence activities was associated with increased BMRs and greater fat oxidation. Among women, variation in food use had the strongest impact on metabolic function.

Cold exposure enhances fat utilization but not non-esterified fatty acids, glycerol or catecholamines availability during submaximal walking and running

Cold exposure modulates the use of carbohydrates (CHOs) and fat during exercise. This phenomenon has mostly been observed in controlled cycling studies, but not during walking and running when core temperature and oxygen consumption are controlled, as both may alter energy metabolism. This study aimed at examining energy substrate availability and utilization during walking and running in the cold when core temperature and oxygen consumption are maintained. Ten lightly clothed male subjects walked or ran for 60-min, at 50% and 70% of maximal oxygen consumption, respectively, in a climatic chamber set at 0°C or 22°C. Thermal, cardiovascular, and oxidative responses were measured every 15-min during exercise. Blood samples for serum non-esterified fatty acids (NEFAs), glycerol, glucose, beta-hydroxybutyrate (BHB), plasma catecholamines, and serum lipids were collected immediately prior, and at 30- and 60-min of exercise. Skin temperature strongly decreased while core temperature did not change during cold trials. Heart rate (HR) was also lower in cold trials. A rise in fat utilization in the cold was seen through lower respiratory quotient (RQ) (-0.03 ± 0.02), greater fat oxidation (+0.14 ± 0.13 g · min(-1)) and contribution of fat to total energy expenditure (+1.62 ± 1.99 kcal · min(-1)). No differences from cold exposure were observed in blood parameters. During submaximal walking and running, a greater reliance on derived fat sources occurs in the cold, despite the absence of concurrent alterations in NEFAs, glycerol, or catecholamine concentrations. This disparity may suggest a greater reliance on intra-muscular energy sources such as triglycerides during both walking and running.