Foppiani Andrea, Sileo Federica, Menichetti Francesca, Pozzi Giorgia, Gallosti Silvia, De Amicis Ramona, Leone Alessandro, Bertoli Simona, Battezzati Alberto
Department of Food, Environmental and Nutritional Sciences (DeFENS), International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), University of Milan, Milan 20133, Italy.
Department of Endocrine and Metabolic Diseases, IRCCS Auxologico, Clinical Nutrition Unit, Milan 20145, Italy.
J Endocr Soc. 2025 Mar 15;9(5):bvaf047. doi: 10.1210/jendso/bvaf047. eCollection 2025 May.
Impaired metabolic flexibility is associated with prediabetes. However, its assessment with reference methods is impractical in routine clinical practice.
This study investigates the relationship between fasting respiratory exchange ratio (RER), measured through indirect calorimetry, and glucose metabolism in individuals with prediabetes.
The study involved 2 cohorts: (1) a cross-sectional cohort of 10 176 individuals to assess the association between fasting RER and glucose metabolism parameters, and (2) a matched longitudinal cohort of 86 patients with impaired fasting glucose, categorized into fat oxidation (RER < 0.775) and glucose oxidation (RER > 0.925) groups, to evaluate the impact of fasting RER on impaired fasting glucose resolution and fasting glucose after a 1-year lifestyle intervention.
In the cross-sectional cohort, a higher fasting RER was associated with higher fasting glucose, insulin, and Homeostatic Model Assessment for Insulin Resistance. In the longitudinal cohort, the fat oxidation group showed a greater reduction in fasting glucose (+5.9; 95% CI 1.4, 10; = .011) and a higher probability of achieving normal fasting glycemia (log(odds ratio) -0.89; 95% CI -1.8, -0.03; = .046) after the intervention, despite similar weight loss between groups.
Our findings suggest that fasting RER, a readily accessible clinical measure, can provide valuable insights into glucose metabolism and impaired fasting glucose resolution. A lower fasting RER, indicative of a greater capacity for fat oxidation, is associated with improved glycemic control after a lifestyle intervention.
代谢灵活性受损与糖尿病前期相关。然而，在常规临床实践中，使用参考方法对其进行评估并不实际。
本研究调查了通过间接量热法测量的空腹呼吸交换率（RER）与糖尿病前期个体葡萄糖代谢之间的关系。
该研究涉及两个队列：（1）一个包含10176名个体的横断面队列，以评估空腹RER与葡萄糖代谢参数之间的关联；（2）一个由86名空腹血糖受损患者组成的匹配纵向队列，分为脂肪氧化（RER < 0.775）和葡萄糖氧化（RER > 0.925）组，以评估空腹RER对1年生活方式干预后空腹血糖受损缓解和空腹血糖的影响。
在横断面队列中，较高的空腹RER与较高的空腹血糖、胰岛素以及胰岛素抵抗稳态模型评估值相关。在纵向队列中，尽管两组体重减轻相似，但脂肪氧化组在干预后空腹血糖下降幅度更大（+5.9；95%可信区间1.4，10；P = 0.011），且实现正常空腹血糖的概率更高（对数（比值比）-0.89；95%可信区间-1.8，-0.03；P = 0.046）。
我们的研究结果表明，空腹RER是一种易于获得的临床测量指标，可为葡萄糖代谢和空腹血糖受损缓解提供有价值的见解。较低的空腹RER表明脂肪氧化能力更强，与生活方式干预后血糖控制改善相关。
