Increased 24-h energy expenditure in type-2 diabetes

OBJECTIVE - The aim of this study was to determine whether overweight and obese individuals with type 2 diabetes have higher basal and 24-h energy expenditure compared with healthy control subjects before and after adjustment for body composition, spontaneous physical activity (SPA), sex, and age. RESEARCH DESIGN AND METHODS - Data from 31 subjects with type 2 diabetes and 61 nondiabetic control subjects were analyzed. The 24-h energy expenditure, based metabolic rate (BMR), and sleeping energy expenditure (EEsleep) between 1:00 A.M and 6:00 A.M. were measured in whole-body respiratory chambers. Body composition was assessed by dual-energy X-ray absorptiometry (DXA). RESULTS - No significant differences in unadjusted EEsleep, BMR, and 24-h energy expenditure were observed between the type 2 diabetic group and the control group. After adjustment for fat-free mass (FFM), fat mass, SPA, sex, and age, EEsleep and BMR were respectively, 7.7 and 6.9% higher in the type 2 diabetic group compared with the control group. This was equivalent to 144+/-40 kcal/day (P = 0.0001) and 139+/-61 kcal/day (P = 0.0026), respectively. Adjusted 24-h energy expenditure was 6.5% higher in the type 2 diabetic group compared with the nondiabetic control subjects (2.679+/-37 vs 2,515+/-23 kcal/day, P = 0.0002). In multiple regression analyses, FFM, fat mass, SPA, and diabetes status were all significant determinants of EEsleep and 24-h energy expenditure explaining 83 and 81% of the variation, respectively. CONCLUSIONS - This study confirms reports in Pima Indians that basal and 24-h energy expenditure adjusted for body composition, SPA, sex, and age are higher in individuals with type 2 diabetes compared with nondiabetic control subjects and may be even more pronounced in Caucasians.