Tounian P, Frelut M L, Parlier G, Abounaufal C, Aymard N, Veinberg F, Fontaine J L, Girardet J P
Pediatric Gastroenterology and Nutrition Department, Armand-Trousseau Hospital (AP-HP), Paris.
Int J Obes Relat Metab Disord. 1999 Aug;23(8):830-7. doi: 10.1038/sj.ijo.0800959.
To investigate the energy metabolism modifications induced by energy restriction and weight loss in massively obese adolescents.
Ten massively obese girls (179 +/- 31% of ideal body weight; age, 13.3-16.4 y) after 2-5 weeks on a low-energy diet and 4.5-11.5 months later, that is, after a substantial weight loss, and eight controls.
Resting energy expenditure (REE) and carbohydrate-induced thermogenesis (CIT) after a sucrose load (by indirect calorimetry), plasma glucose and insulin before and after the sucrose load.
After 2-5 weeks on a low-energy diet, REE (7415 +/- 904 kJ/d) was lower than the expected value calculated from the regression equation of REE on fat free mass in controls (P = 0.005). After a 37 +/- 17% reduction in excess weight, REE decreased (6405 +/- 613 kJ/d) and remained lower than the expected value (P = 0.005). At the early stages of weight loss, the area under the plasma glucose response curve was negatively correlated with CIT (r = -0.80, P = 0.01) and was higher in the six obese adolescents with low CIT than in the four with normal CIT (396 +/- 52 vs 283 +/- 26 mmol.l-1.min-1, P = 0.01). After substantial weight loss, the area under the plasma insulin response curve decreased by 32% (P = 0.02), and both CIT and the area under the plasma glucose response curve became similar in obese patients with low and normal CIT prior to weight loss.
These results indicate that in massively obese adolescents, REE for fat-free mass is decreased at the very beginning of the process of losing weight and remains decreased as long as energy restriction and weight reduction carry on. They also indicate that the impaired CIT sometimes observed returns to normal after weight reduction suggesting that it is secondary to a decrease in glucose uptake induced by obesity-associated insulin resistance.
研究能量限制和体重减轻对极度肥胖青少年能量代谢的影响。
10名极度肥胖女孩（理想体重的179±31%；年龄13.3 - 16.4岁），她们在进行了2 - 5周的低能量饮食后，4.5 - 11.5个月后即体重大幅减轻后，以及8名对照者。
静息能量消耗（REE）和蔗糖负荷后碳水化合物诱导的产热（CIT）（通过间接测热法）、蔗糖负荷前后的血浆葡萄糖和胰岛素。
在进行2 - 5周低能量饮食后，REE（7415±904 kJ/天）低于根据对照组无脂肪体重的REE回归方程计算出的预期值（P = 0.005）。超重体重减少37±17%后，REE降低（6405±613 kJ/天）且仍低于预期值（P = 0.005）。在体重减轻的早期阶段，血浆葡萄糖反应曲线下面积与CIT呈负相关（r = -0.80，P = 0.01），在6名CIT低的肥胖青少年中高于4名CIT正常的青少年（396±52 vs 283±26 mmol·l-1·min-1，P = 0.01）。体重大幅减轻后，血浆胰岛素反应曲线下面积下降32%（P = 0.02），体重减轻前CIT低和正常的肥胖患者的CIT及血浆葡萄糖反应曲线下面积变得相似。
这些结果表明，在极度肥胖青少年中，无脂肪体重的REE在体重减轻过程开始时就降低，并且只要能量限制和体重减轻持续，就会一直降低。它们还表明，有时观察到的CIT受损在体重减轻后恢复正常，提示其继发于肥胖相关胰岛素抵抗引起的葡萄糖摄取减少。
