variation (Table 1).Those who did not currently have set targets for CGM were asked what targets they would like patients to aim for, again producing varied suggestions (Table 2)

Foods with high contents of slowly digestible starch (SDS) elicit lower glycemic responses than foods with low contents of SDS but there has been debate on the underlying changes in plasma glucose kinetics, that is, respective contributions of the increase in the rates of appearance and disappearance of plasma glucose (RaT and RdT), and of the increase in the rate of appearance of exogenous glucose (RaE) and decrease in endogenous glucose production (EGP). Sixteen young healthy females ingested in random order four types of breakfasts: an extruded cereal (0.3% SDS: Lo-SDS breakfast) or one of three biscuits (39–45% SDS: Hi-SDS breakfasts). The flour in the cereal products was labeled with 13C, and plasma glucose kinetics were measured using [6,6-2H2]glucose infusion, along with the response of plasma glucose, insulin and glucose-dependent insulinotropic peptide (GIP) concentrations. When compared with the Lo-SDS breakfast, after the three Hi-SDS breakfasts, excursions in plasma glucose, the response of RaE, RaT and RdT, and the reduction in EGP were significantly lower (P<0.05). The amount of exogenous glucose absorbed over the 4.5-h postprandial period was also significantly lower by ~31% (P<0.001). These differences were associated with lower responses of GIP and insulin concentrations. Substituting extruded cereals with biscuits slows down the availability of glucose from the breakfast and its appearance in peripheral circulation, blunts the changes in plasma glucose kinetics and homeostasis, reduces excursions in plasma glucose, and possibly distributes the glucose ingested over a longer period following the meal.

The present study aims to show the accuracy of a portable motion sensor, the SenseWear Armband, for the estimation of energy expenditure vs. energy expenditure measured by indirect calorimetry during ergocycling. 31 healthy adults (52% women; age: 26.7±6.3 years; Body Mass Index: 23.9±3.3 kg/m2) completed a 45-min ergocycling session at 50% of their VO2(peak). Despite a significant underestimation of 18.7±13.2 kcal during the first 10 min of the activity (T=5.06; p<0.001), we observed an overall good agreement between energy expenditure estimated by the SenseWear Armband during ergocycling and indirect calorimetry (260.3±80.1 vs. 287.8±97.1 kcal, respectively) (T=-2.148; p=0.04) and a significant intra-class correlation (r=0.81; p<0.001). The results of the present study indicate that the SenseWear Armband underestimated energy expenditure during a 45-min ergocycling session at a 50% VO2(peak) intensity, mainly during the first 10 min. Underestimation at the onset of the activity warrants further research.

Chronic subclinical inflammation and regular physical activity have opposing relationships to obesity-related metabolic diseases. Yet, the association between chronic inflammation and physical activity has rarely been examined in obese subjects. We examined the association between physical activity energy expenditure (PAEE), total (TEE) and resting energy expenditure (REE) and cardiorespiratory fitness (VO2peak) with inflammatory markers in overweight/obese women. Cross-sectional study. The study included 152 overweight/obese postmenopausal women who were sedentary and free of chronic/inflammatory diseases (mean age: 57.5 (95% confidence interval (CI) 56.7–58.3) years, body mass index (BMI): 32.5 (95% CI 31.8–33.2) kg m−2). The following parameters were measured: TEE (doubly labeled water), REE (indirect calorimetry), PAEE (as (TEE × 0.90)−REE), VO2peak (ergocycle) and serum high-sensitive C-reactive protein (hsCRP), haptoglobin, soluble tumor necrosis factor-α receptor 1 (sTNFR1), interleukin-6, orosomucoid and white blood cells. Sedentary women with the highest tertile of PAEE (1276 (1233–1319) kcal day−1) had lower concentrations of hsCRP and haptoglobin than those in the lowest tertile (587 (553–621) kcal day−1) after adjustment for fat mass (P<0.05). Soluble TNFR1 was positively correlated with VO2peak, TEE and REE (P<0.05), and hsCRP and orosomucoid were positively associated with REE (P<0.01), whereas haptoglobin was negatively associated with PAEE (P<0.05). In stepwise regression analyses that examined the concomitant associations of components of energy expenditure with inflammatory markers, PAEE remained the only predictor of hsCRP and haptoglobin (P<0.05), explaining 14 and 5%, respectively, of their variation,whereas REE was the only predictor of orosomucoid (r2=0.05, P=0.02) after adjustment for fat mass. Adding leptin to the regression models results in similar relationships between inflammatory markers and components of energy expenditure. PAEE is an independent predictor of hsCRP and haptoglobin in sedentary overweight/obese postmenopausal women free of chronic disease. Our data support the role of physical activity in reducing subclinical inflammation and risk of metabolic and cardiovascular diseases.

Lifestyle modifications involving diet and exercise are effective in reducing the incidence of type 2 diabetes (1–3). In particular, lifestyle changes targeted toward increasing daily energy expenditure are a cornerstone treatment of type 2 diabetes (2). In the Diabetes Prevention Research Group study (4), a goal of 150 min/week of physical activity was recommended, and 74% of the patients in this study group achieved this level by 24 weeks. This type of success in exercise modification is made possible in research protocols by intensive individual counseling (5), which may not be easily reproduced in primary care settings. Because of the critical importance of increasing daily energy expenditure and its central role in preventing and/or treating diabetes, one can surmise that instrumentation providing accurate and simple feedback to type 2 patients may have clinical utility. Therefore, we provide preliminary data on the accuracy of the HealthWear Armband (Roche Diagnostics, Indianapolis, IN), an instrument designed …

Ghrelin is a novel peptide that has been isolated from human and rat stomach tissues. Despite its known stimulatory effects on appetite and eating behavior, little information is available regarding its relationship with energy expenditure in normal-weight humans. To address this issue, we examined the relationship between serum ghrelin and resting metabolic rate (RMR), the thermic effect of food (TEF), fasting and postprandial respiratory quotient, physical activity level, peak aerobic capacity (VO2 peak), energy intake, and psychological measures of feeding behavior. We recruited 65 young healthy women and determined RMR and TEF by indirect calorimetry after a 12-h fast. Physical activity was determined by a leisure time physical activity questionnaire; VO2 (peak) was determined by bicycle ergometer test to exhaustion; energy intake was determined by a 24-h dietary recall; and food behavior was determined by a three-factor eating questionnaire. Our cohort showed a broad range of body mass index ( range, 16.8 - 28.3 kg/m(2)), RMR (range, 820- 1550 kcal/d), TEF (range, 74.4 - 136.5 kcal/d), and percent body fat ( range, 14.0 - 37.7%). We noted significant inverse correlations between ghrelin and RMR ( r = - 0.350, P = 0.004) and TEF ( r = - 0.396, P = 0.001). These inverse correlations persisted after statistical control for both fat-free mass and fat mass ( ghrelin vs. RMR partial, r = - 0.284, P = 0.024; and ghrelin vs. TEF partial, r = - 0.329, P = 0.01) and insulin levels ( ghrelin vs. RMR partial, r = - 0.255, P = 0.046; and ghrelin vs. TEF partial, r = - 0.287, P = 0.024) using partial correlation analysis. We also observed a significant inverse correlation between ghrelin and daily caloric intake ( r = - 0.266, P = 0.032), but ghrelin levels were not significantly correlated with fasting ( r = - 0.002), postprandial respiratory quotient (r = - 0.016), leisure time physical activity (r = 0.104), VO2 peak ( r = 0.138), dietary disinhibition ( r = - 0.071), dietary restraint ( r = 0.051), or feeling of general hunger ( r = - 0.028). These results suggest that higher levels of ghrelin are associated with low levels of resting and postprandial thermogenesis, which is independent of individual differences in fat-free mass and fat mass. Although speculative, serum ghrelin may play a role in the regulation of energy homeostasis by acting as a hormonal marker of increased energy efficiency.