Objective Assessment of total energy expenditure (TEE) is essential for appropriate recommendations regarding dietary intake and physical activity in patients with and without diabetes mellitus (DM). However, few reports have focused on TEE in patients with DM, particularly in Asian countries. Therefore, we evaluated TEE in Japanese patients with DM using the doubly labeled water (DLW) method and physical activity level (PAL).
Research design and methods In this cross-sectional observational study, we evaluated 52 patients with type 2 DM and 15 patients without DM. Free-living TEE was measured over 12–16 days by the DLW method, and PAL was calculated as TEE divided by the basal metabolic rate (BMR) as assessed by indirect calorimetry. The equivalence margin was defined as 5 kcal/kg/day.
Results The numbers of patients with DM treated with insulin, oral antidiabetic drugs, and diet were 18 (34.6%), 20 (38.5%), and 14 (26.9%), respectively. The mean±SD level of glycated hemoglobin was 6.9%±0.8% and 5.5%±0.3% in the DM and non-DM group, respectively (p<0.001). The mean body mass index was 23.3±3.0 and 22.7±2.1 kg/m2 in the DM and non-DM group, respectively. The mean TEE per kilogram body weight adjusted for sex and age was 36.5 kcal/kg/day and 37.5 kcal/kg/day in the DM and non-DM group, respectively, with no significant difference (mean difference, −1.0 kcal/kg/day; 95% CI -4.2 to 2.3 kcal/kg/day). The BMR tended to be higher in the DM than in the non-DM group (mean difference, 33 kcal/day; 95% CI, −15 to 80 kcal/day). The mean PAL adjusted for sex and age was 1.71 and 1.81 in the DM and non-DM group, respectively, without a significant difference (mean difference, −0.10; 95% CI −0.21 to 0.01).
Conclusion TEE was comparable between Japanese patients with and without DM.
Trial registration number UMIN000023051.
- energy expenditure
- physical activity
- type 2 diabetes
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Presented at Parts of this study were presented in abstract form at the 78th Scientific Sessions of the American Diabetes Association, Orlando, Florida, June 22–26, 2018.
Collaborators A complete list of the members of the CLEVER-DM Study is provided in online supplementary information 2. The authors also thank Keiko Kosaka, Eriko Naiki, Chikako Ikeuchi, Takako Fujii, Noriko Yamamoto, Kaori Nagano, Mayumi Yotsushika, Mai Nakaizumi, Akiko Sakata, and Hiroko Kogure for their expert technical assistance. Finally, the authors thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac), for editing the English text of a draft of this manuscript.
Contributors KM and KK contributed to the planning and conduct of the study, and drafted and revised the manuscript. ST contributed to the planning of the study and revised the manuscript. AO, KN, MK, KF, and IM contributed to the conduct of the study. YN, SN, YY, SU, MS, FK, HM, and NE contributed to the planning of the study and revised the manuscript. NE and SS contributed to the planning of the study. All authors read and approved the final manuscript.
Funding This study was funded by AMED under Grant Numbers JP17ek0210045 and JP18ek0210112. This study was also supported in part by the Japan Foundation for Applied Enzymology (to KK).
Competing interests ST received consigned research funds from Omron Healthcare. The remaining authors declare no competing interests.
Patient consent for publication Not required.
Ethics approval The study was performed in accordance with the principles contained within the Declaration of Helsinki. The protocol was approved by the ethics committee of Keio University (Protocol No 2015–03), National Institutes of Biomedical Innovation, Health and Nutrition (Protocol No 29), and Shiga University of Medical Science (Protocol No 28–062).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available upon reasonable request.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.