Basal metabolic rate in morbidly obese patients with non-alcoholic fatty liver disease

Article (PDF Available)inClinical and investigative medicine. Medecine clinique et experimentale 31(1):E24-9 · January 2008with84 Reads
Source: PubMed
Non-Alcoholic Fatty Liver Disease occurs mainly in severly obese patients and its relationship to Metabolic Syndrome is increasingly recognized. The aim of this study was to determine energy production-utilization by measuring the Basal Metabolic Rate in severely obese patients, characterized by NAFLD, with or without Metabolic Syndrome. Then, the role of systemic inflammation was assessed. Twenty severly obese men with Metabolic Syndrome were compared with a well-matched cohort of patients without Metabolic Syndrome. All showed hepatic steatosis at UltraSonography. Basal Metabolic Rate was measured by indirect calorimetry using a canopy system and single-frequency bio-impedance analysis. Serum Interleukin-6 and fibrinogen levels were measured as markers of inflammation Basal Metabolic Rate was higher in severely obese patients with Metabolic Syndrome than in those without it: 2,496+/-358 kcal/d vs 2,126+/-253 kcal/d, P = 0 .001. Laboratory findings of concurrent chronic inflammation were also higher in these patients, i.e., Il6 4.35+/-1.34 pg/ml vs 6.23+/-2.1 pg/ml, P = 0.034; fibrinogenemia 285+/-40 mg/dL vs 376+/-91 mg/dL, P = 0.020; these of of cytonecrosis, i.e., AlaninaminoTransferase, equally behaved 32.3+/-7.9 UI vs 65.7+/-28.2 UI, P < 0.001. Visceral adiposity and arterial hypertension were more frequently detected in patients with Metabolic Syndrome. Increased energy expenditure, observed in morbidly obese patients as a consequence of a systemic, low-grade, inflammatory process, may explain progression from obesity to Metabolic Syndrome, independent of the presence of NAFLD. In this context, increased Basal Metabolic Rate may be a clue of Metabolic Syndrome.
    • "Regarding basal metabolic status, PKU patients showed similar BMR values in comparison to controls. Some studies have found increased basal metabolism in different diseases32333435 , although the mechanisms are not yet elucidated. Despite that, our results agree with the study by Allen et al. [36], where no differences in BMR were found between early diagnosed PKU children and matched controls. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: In phenylketonuria, dietary treatment prevents most of the severe brain disease. However, patients have to follow a diet restricted in several natural components, what may cause decreased bone density and obesity. Exercise is known to improve both mental functioning and bone density also avoiding obesity, and could optimize aspects of central and peripheral outcome, regardless changes in phenylalanine (Phe) levels. However, the acute effects of exercise on metabolic parameters in phenylketonuria patients are unknown and thereby long-term adaptations are unclear. Therefore, this study aimed to evaluate patients' basal metabolic rate (BMR), and their acute response to an aerobic exercise session on plasma concentrations of Phe, tyrosine (Tyr), and branched-chain amino acids (BCAA), as well as metabolic and hormonal responses. Methods: Five early- and four late diagnosed phenylketonuria patients aged 21 ± 4 years and 17 sex-, age-, and BMI-matched controls were evaluated for BMR, peak oxygen consumption (VO2peak) and plasma amino acid, glucose, lipid profile and hormonal levels. At least one week later, participants performed a 30-min aerobic exercise session (intensities individually calculated using the VO2peak results). Blood samples were collected in fasted state (moment 1, M1) and immediately after a small breakfast, which included the metabolic formula for patients but not for controls, and the exercise session (moment 2, M2). Results: Phenylketonuria patients and controls showed similar BMR and physical capacities. At M1, patients presented higher Phe concentration and Phe/Tyr ratio; and lower levels of BCAA and total cholesterol than controls. Besides that, poorly controlled patients tended to stay slightly below the prescribed VO2 during exercise. Both patients and controls showed increased levels of total cholesterol and LDL at M2 compared with M1. Only controls showed increased levels of Tyr, lactate, and HDL; and decreased Phe/Tyr ratio and glucose levels at M2 compared to values at M1. Conclusions: Acute aerobic exercise followed by a Phe-restricted breakfast did not change Phe concentrations in treated phenylketonuria patients, but it was associated with decreased Phe/Tyr only in controls. Further studies are necessary to confirm our results in a higher number of patients.
    Full-text · Article · Dec 2015
    • "Metabolic activity, which is maximal during intense physical activity and lowest during resting conditions, increases with both psychological and physiological activity as well as with stress and many pathological conditions [7,10]. Higher oxygen consumption (OC) is seen with mental arithmetic or video gaming111213 and OC is reported to be higher in people with pathological conditions such as chronic obstructive pulmonary diseases [14], congestive heart failure [15], insomnia [16], anxiety [17], HIV-AIDS [18,19] as well as the individual features of metabolic syndrome such as hypertension [20,21], obesity [22,23], diabetes [24,25] and dyslipidaemia [26] . Peak oxygen consumption has also been found to be lower in people with metabolic syndrome [19,27]. "
    [Show abstract] [Hide abstract] ABSTRACT: Stress places a metabolic burden on homeostasis and is linked to heightened sympathetic activity, increased energy expenditure and pathology. The yogic state is a hypometabolic state that corresponds with mind-body coherence and reduced stress. This study aimed to investigate metabolic responses to stress and different yoga practices in regular yoga practitioners (YP), non-yoga practitioners (NY) and metabolic syndrome patients (MS). YP (n = 16), NY (n = 15) and MS (n = 15) subjects underwent an experimental protocol that comprised of different 5-minute interventions including mental arithmetic stress test (MAST), alternate nostril breathing (ANB), Kapabhati breathing (KB) and meditation (Med) interspersed with 5 minutes of quiet resting (neutral condition (NC)). During the intervention periods continuous body weight adjusted oxygen consumption (VO2ml/min/kg) was measured using open circuit indirect calorimetry with a canopy hood. This is the first study to report oxygen consumption (OC) in yoga practitioners during and after MAST and the first to report both within and between different populations. The results were analysed with SPSS 16 using 3X9 mixed factorial ANOVAs. The single between-subject factor was group (YP, NY and MS), the single within-subject factor was made up of the nine intervention phases (NC1, MAST, NC2, ANB, NC3, KB, NC4, Med, NC5). The results demonstrated that the regular YP group had significantly less OC and greater variability in their OC across all phases compared to the MS group (p = .003) and NY group (p = .01). All groups significantly raised their OC during the mental arithmetic stress, however the MS group had a significantly blunted post-stress recovery whereas the YP group rapidly recovered back to baseline levels with post stress recovery being greater than either the NY group or MS group. Yoga practitioners have greater metabolic variability compared to non-yoga practitioners and metabolic syndrome patients with reduced oxygen requirements during resting conditions and more rapid post-stress recovery. OC in metabolic syndrome patients displays significantly blunted post-stress recovery demonstrating reduced metabolic resilience. Our results support the findings of previous randomised trials that suggest regular yoga practice may mitigate against the effects of metabolic syndrome. Clinical trial number ACTRN12614001075673; Date of Registration: 07/10/2014.
    Full-text · Article · Nov 2014
    • "After a 15– 20 min adaptation to the instrument, oxygen consumption and carbon dioxide production were determined for 45 min. Energy expenditure was derived from CO2 production and O2 consumption with the appropriate Weir formula neglecting protein oxidation [23]. BMR, expressed as kcal/24 h, was adjusted for changes in fat-free mass (FFM)], which was evaluated by single-frequency bioimpedance analysis obtaining an RMR/FFM ratio, expressed as kcal/24 h*kg of body [24]. "
    [Show abstract] [Hide abstract] ABSTRACT: Atherosclerosis is a chronic inflammatory process of the vessel walls, and CD4+ T-cells are peculiar to both human and murine atherosclerotic lesions. There is a recent line of research favoring hypothetic allergic mechanisms in the genesis of atherosclerosis and, consequently, coronary artery disease (CAD), among which Interleukin (IL)-17 appears to be a key cytokine regulating local tissue inflammation. The objective was to add a piece of information on the role of IL-17 in the genesis of atherosclerosis. Eighty obese patients with normal liver enzyme levels but presenting with ultrasonographic evidence of NAFLD formed the population of this cross-sectional study. Anthropometric measures, data on excess adiposity, metabolic profile, serum concentrations of IL-17, eotaxin-3, IL-8, and CCL4/MIP1β, C-reactive protein, fibrinogen, ferritin, TNF-α, as well carotid intima-media thickness (IMT), a marker of atherosclerosis, and the main risk factors for CAD, such as blood pressure and smoking status, but also less determinant ones such as degree of NAFLD severity, Intramuscular Triglyceride storage and Resting Metabolic Rate were evaluated. Serum concentrations of Il-17 were detected as related to those of inflammatory cytokines, IL-6, IFN-γ and TNF-α. Furthermore, circulating levels of IL-17 were linked to those mirroring allergic process, IL-8, CCL4/MIP1β and eotaxin. Early atherosclerosis, evidenced as increased IMT, was not associated with circulating IL-17 levels. At multiple regression, IMT was predicted, other than by age, by the amount of the visceral adiposity, expressed as visceral adipose tissue at ultrasonography, and by serum eotaxin. In conclusion, a strong relationship was found between the IL-17-related chemokine eotaxin and IMT. The association found between the amount of visceral fat and circulating levels of eotaxin on the one hand, and IMT on the other, could reinforce the hypothesis that IL-17, released by the visceral adipose tissue, induces eotaxin secretion via the smooth muscle cells present in the atheromatosus vessels.
    Full-text · Article · Aug 2014
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