肥胖患者的静息能量消耗、心血管危险因素及胰岛素抵抗

Resting energy expenditure, cardiovascular risk factors and insulin resistance in obese patients.

作者信息

de Luis D A, Aller R, Izaola O, Gonzalez Sagrado M, Conde R

机构信息

Institute of Endocrinology and Nutrition, Medical School and Unit of Investigation, Hospital Rio Hortega, University of Valladolid, Spain.

出版信息

Ann Nutr Metab. 2005 Nov-Dec;49(6):381-5. doi: 10.1159/000088890. Epub 2005 Oct 11.

DOI:10.1159/000088890

PMID:16219989

Abstract

OBJECTIVE

The aim of our study was to determine whether energy expenditure modified by increasing body mass over the wide range of body mass index (BMI) was related to insulin resistance, cardiovascular risk factors and dietary intakes.

SUBJECTS AND METHODS

A population of 87 obese non-diabetic outpatients was analyzed prospectively. Indirect calorimetry, tetrapolar electrical bioimpedance, serial assessment of nutritional intake using written 3-day food records and biochemical analyses were performed.

RESULTS

The mean age was 45.1 +/- 16.7 years and the mean BMI was 35.2 +/- 5.2. Indirect calorimetry showed a resting metabolic rate (RMR) of 1,732.2 +/- 406.6 kcal/day and oxygen consumption of 266.2 +/- 63.3 ml/min. RMR corrected by fat-free mass was 36.8 +/- 14.1 kcal/day/kg. Serial assessment of nutritional intake using written 3-day food records showed a calorie intake of 1,660 +/- 551.7 cal/day, a carbohydrate intake of 168.63 +/- 76.6 g/day, a fat intake of 72.1 +/- 26.42 g/day and a protein intake of 81.1 +/- 23.3 g/day. Insulin, HOMA, systolic blood pressure, diastolic blood pressure, waist circumference, fat mass, waist-to-hip ratio were higher in the third BMI tertile than in the first and second tertiles. No differences were detected in calorie intake, carbohydrate intake, fat intake, protein intake, drinking and alcoholic habit among BMI tertiles. RMR was similar in the different tertiles and the corrected RMR by fat-free mass was higher in first tertile than in the second and third tertiles (44.2 +/- 20.7 vs. 34.5 +/- 9.1 vs. 33.1 +/- 8.5 kcal/kg/day; p < 0.05). In multivariate analysis with a dependent variable (RMR), the fat-free mass remained in the model (F = 7.8; p < 0.05), with an increase of 10.1 (95% CI 3.6-17.5) kcal/day with each 1 kg of fat-free mass adjusted by age and sex.

CONCLUSION

Resting energy expenditure in obese patients is not related to the BMI, insulin resistance and dietary intake. RMR is related to fat-free mass in a multivariant model.

摘要

目的

我们研究的目的是确定在广泛的体重指数（BMI）范围内，因体重增加而改变的能量消耗是否与胰岛素抵抗、心血管危险因素和饮食摄入量有关。

对象与方法

对87名肥胖非糖尿病门诊患者进行前瞻性分析。进行了间接测热法、四极生物电阻抗分析、使用3天饮食记录的营养摄入量连续评估以及生化分析。

结果

平均年龄为45.1±16.7岁，平均BMI为35.2±5.2。间接测热法显示静息代谢率（RMR）为1732.2±406.6千卡/天，耗氧量为266.2±63.3毫升/分钟。经去脂体重校正后的RMR为36.8±14.1千卡/天/千克。使用3天饮食记录对营养摄入量进行的连续评估显示，卡路里摄入量为1660±551.7千卡/天，碳水化合物摄入量为168.63±76.6克/天，脂肪摄入量为72.1±26.42克/天，蛋白质摄入量为81.1±23.3克/天。BMI第三三分位数组的胰岛素、稳态模型评估胰岛素抵抗（HOMA）、收缩压、舒张压、腰围、脂肪量、腰臀比高于第一和第二三分位数组。在BMI三分位数组之间，卡路里摄入量、碳水化合物摄入量、脂肪摄入量、蛋白质摄入量、饮酒和酒精摄入习惯未检测到差异。不同三分位数组的RMR相似，经去脂体重校正后的RMR在第一三分位数组高于第二和第三三分位数组（44.2±20.7 vs. 34.5±9.1 vs. 33.1±8.5千卡/千克/天；p<0.05）。在以RMR为因变量的多变量分析中，去脂体重仍在模型中（F=7.8；p<0.05），每1千克经年龄和性别调整的去脂体重，RMR增加10.1（95%可信区间3.6-17.5）千卡/天。