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PubMed1998

Evaluation of drug usage and expenditure in a hospital diabetes clinic.

BACKGROUND: Diabetes mellitus is a major public health problem and often coexists with hypertension and dyslipidaemia. A prescription-based survey was conducted to examine the use of antidiabetic, antihypertensive and lipid lowering drugs in a hospital diabetes clinic. The expenditure incurred was also evaluated. METHOD: Prescriptions issued from the diabetes clinic were collected for 4 consecutive weeks. Drugs were categorized into three main classes--antidiabetic, antihypertensive and lipid-lowering drugs. The unit cost of each drug and the total amount prescribed were used to estimate the total drug costs. RESULTS: During the 4-week study period, 534 prescriptions were collected, of which 520 contained antidiabetic drugs. Oral hypoglycaemic agents were prescribed in 379 patients (72.9%). Sulphonylurea was used as a single agent in 119 (22.9%) patients, in combination with metformin in 219 (42%) patients and with insulin in 17 patients (3.3%). Among patients treated with sulphonylureas (n=342), glibenclamide (47.7%) and gliclazide (30.7%) were the main drugs prescribed. Metformin monotherapy was prescribed in only 31 patients (6%). Insulin treatment was prescribed in 141 (27%) patients and in combination with oral drugs in 23 patients (4.5%). Of the 534 prescriptions, 225 (42%) contained antihypertensive drugs. Calcium channel blocking agents and angiotensin converting enzyme inhibitors were the most commonly prescribed drugs in both monotherapy (n=155) and combination therapy (n=70). The antidiabetic and antihypertensive drugs accounted for 45% and 39% of the total drug expenditure, respectively. Lipid-lowering drugs were prescribed in 8% of the diabetic patients. Simvastatin and gemfibrozil were the most common drugs prescribed and accounted for 12% of the total drug expenditure. CONCLUSION: The use of antidiabetic drugs represents a major burden on the health care system. The high proportions of patients requiring antihypertensive drugs and lipid lowering drugs further increase drug expenditure. Most of these treatments have been shown to improve clinical outcomes and quality of life, if used appropriately. The impacts of these long-term medications on health care financing require careful evaluation to assess their cost-effectiveness.

Adult↗
PubMed2000

Hematocrit levels and associated Medicare expenditures.

Clinical studies and the National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines suggest that a target hematocrit of 33% to less than 36% is appropriate for patient benefit. Previous studies have shown an association of lower risks for death and hospitalization when hematocrits were 33% to less than 36%. In this study, we assessed the relationship between hematocrit value and associated Medicare expenditures, analyzing incident Medicare hemodialysis patients from January 1, 1991, through June 30, 1995. All patients survived at least 90 days to normalize eligibility and an additional 6-month entry period to assess comorbidity and hematocrit values. All patients were followed up from July 1, 1991, through December 31, 1996. We assessed the association between hematocrit values in the 6-month entry period and the Medicare-allowable Part A and Part B per-member-per-month (PMPM) expenditures in the follow-up period, controlling for other variables, including patient demographic characteristics, comorbid conditions, and severity of disease. We found that hematocrits of 33% to less than 36% and 36% and higher were associated with lower Medicare-allowable payments in the follow-up period. Compared with reference patients with hematocrits of 30% to less than 33%, the Medicare-allowable PMPM expenditures were significantly greater for patients with hematocrits less than 27% and 27% to less than 30% (12. 7% and 5.3%, respectively), and the Medicare-allowable PMPMs were significantly less for patients with hematocrits of 33% to less than 36% and 36% and higher (6.0% and 8.2%, respectively). Although these findings suggest that the treatment of anemia may be associated with significant savings in total patient Medicare expenditures, caution should be considered because these findings are associations and should not be deemed as showing causality.

Adult↗
PubMed2000

Elevated bound leptin correlates with energy expenditure in cirrhotics.

BACKGROUND & AIMS: Leptin, found to be elevated in patients with liver cirrhosis, may contribute to the inadequate energy expenditure and malnutrition associated with a negative prognosis for these patients. Our aim was to characterize leptin components and their relationships to body composition, resting energy expenditure (REE), and substrate use in patients with posthepatic liver cirrhosis. METHODS: Using specific radioimmunoassays, we measured free leptin and bound leptin in 27 cirrhotics and 27 matched control subjects. In the cirrhotic group, body composition and REE were determined. RESULTS: Free leptin was not different in cirrhotics and control subjects and was related to body mass index (controls: r = 0.34, P < 0.05; cirrhotics: r = 0.55, P < 0.005) and to fat mass (cirrhotics: r = 0.76, P < 0.0001). Bound leptin was significantly higher in cirrhotic subjects than in controls (P < 0.001) and was related to REE x fat-free mass(-1) (r = 0.57, P < 0.005) or to the difference between measured and estimated REE (r = 0.55, P < 0.005). CONCLUSIONS: Free leptin reflects fat mass in controls and cirrhotics. Increased serum leptin in cirrhotics is a result of increased bound leptin serum concentrations, which are positively related to energy expenditure. Moreover, bound leptin may be a useful marker for inadequate energy expenditure in patients with liver cirrhosis.

Adipose Tissue↗
PubMed2005

Comparison of methods to estimate physical activity and energy expenditure in African American children.

Low levels of physical activity and high levels of obesity among children in the US is a public health concern. Accurate methods to estimate physical activity are needed to determine the efficacy of intervention programs and to explore relationships between daily physical activity and health status in children. The purpose of this study was to compare the simultaneous use of the Tritrac-R3D accelerometer (Tritrac), Yamax SW-200 Digiwalker step-counter (Digiwalker) and the Self Administered Physical Activity Checklist (SAPAC) to assess physical activity (PA) and energy expenditure (EE) in African-American children aged 7 to 10 years, using the doubly-labeled water (DLW) as the criterion method. Physical activity and energy expenditure were measured over seven consecutive days under free-living conditions. Resting metabolic rate and peak VO(2) were measured before the experimental period. There was no difference in physical activity energy expenditure (PAEE) measured by Tritrac or DLW (p > 0.05). Tritrac activity counts were highly correlated with DLW-PAEE (r = 0.81). High correlations between Digiwalker and DLW were observed when body weight was considered. A low correlation (r = 0.49) was observed between the physical activity energy expenditure by SAPAC and DLW. In conclusion, with some limitations the Tritrac and Digiwalker can provide useful and accurate information about PA and EE in 7- to 10-year-old children.

Black or African American↗
PubMed1986

Increased 24-hour energy expenditure in cigarette smokers.

We studied the effect of smoking on energy expenditure in eight healthy cigarette smokers who spent 24 hours in a metabolic chamber on two occasions, once without smoking and once while smoking 24 cigarettes per day. Diet and physical exercise (30 minutes of treadmill walking) were standardized on both occasions. Physical activity in the chamber was measured by use of a radar system. Smoking caused an increase in total 24-hour energy expenditure (from a mean value [+/- SEM] of 2230 +/- 115 to 2445 +/- 120 kcal per 24 hours; P less than 0.001), although no changes were observed in physical activity or mean basal metabolic rate (1545 +/- 80 vs. 1570 +/- 70 kcal per 24 hours). During the smoking period, the mean diurnal urinary excretion of norepinephrine (+/- SEM) increased from 1.25 +/- 0.14 to 1.82 +/- 0.28 micrograms per hour (P less than 0.025), and mean nocturnal excretion increased from 0.73 +/- 0.07 to 0.91 +/- 0.08 micrograms per hour (P less than 0.001). These short-term observations demonstrate that cigarette smoking increases 24-hour energy expenditure by approximately 10 percent, and that this effect may be mediated in part by the sympathetic nervous system. The findings also indicate that energy expenditure can be expected to decrease when people stop smoking, thereby favoring the gain in body weight that often accompanies the cessation of smoking.

Adult↗
PubMed1988

Energy expenditure and intake in infants born to lean and overweight mothers.

We investigated the contributions of low energy expenditure and high energy intake to excessive weight gain in infants born to overweight mothers. The subjects were infants of 6 lean and 12 overweight mothers, recruited soon after birth. Total energy expenditure and metabolizable energy intake were measured with a new doubly labeled water method over a period of seven days when the infants were 3 months of age, and the postprandial metabolic rate was measured by indirect calorimetry when the infants were 0.1 and 3 months of age. The results were related to weight gain in the first year of life. No significant difference was observed between infants who became overweight by the age of one year (50 percent of infants born to overweight mothers) and those who did not, with respect to weight, length, skinfold thicknesses, metabolic rate at 0.1 and 3 months of age, and metabolizable energy intake at 3 months. However, total energy expenditure at three months of age was 20.7 percent lower in the infants who became overweight than in the other infants (means +/- SE, 256 +/- 27 and 323 +/- 12 kJ per kilogram of body weight per day; P less than 0.05). This difference could account for the mean difference in weight gain. These data suggest that reduced energy expenditure, particularly on physical activity, was an important factor in the rapid weight gain during the first year of life in infants born to overweight mothers.

Body Weight↗
PubMed1987

Food intake and energy expenditure of Nigerian female students.

Twenty apparently healthy and normal Nigerian female students, resident at the University of Ibadan campus, were studied for seven consecutive days to assess their food energy intake and energy expenditure during sedentary and physical activities. The mean age (years) of the group was 20.05 (SD 3.44, range 16-29), mean height (m) 1.62 (SD 0.07, range 1.47-1.74) and body-weight (kg) 51.28 (SD 3.21, range 46-58). The food intake of each subject was obtained by direct weighing, and the energy value determined using a ballistic bomb calorimeter. Daily activities were recorded and the energy cost of representative activities was determined by indirect calorimetry. Activities mainly involved sitting, mean (min/d) 354 (SD 84, range 253-475). Personal domestic activities took a mean of 162 (SD 73) min/d. Sleeping took a mean of 451 (SD 62) min/d. The mean energy intake of the group was 8480 (SD 1316) kJ/d or 167 (SD 30.6) kJ/kg body-weight per d. This value is lower than that recommended by the Food and Agriculture Organization/World Health Organization (FAO/WHO) (1973) as the energy requirement for adult women engaged in light activities (9205 kJ/d), but it is higher than the FAO/WHO/United Nations University (UNU) (1985) recommended value of 8326 kJ (1990 kcal)/d for a housewife in an affluent society. It is lower than the recommended intake of 9350 kJ/d for rural women in developing countries (FAO/WHO/UNU, 1985). The mean energy expenditure (kJ/d) of the female subjects was 6865 (SD 214, range 6519-7222). Mean energy expenditure was lower than mean energy intake. The energy intake and expenditure values indicated that the subjects participating in the present study were not physically very active. It is suggested, for health reasons, that they might undertake more physical activity.

Adolescent↗
PubMed1990

Discrepancies between energy intake and expenditure in physically active women.

Energy intake and expenditure in women runners and non-runners were assessed by weighed food records, evaluation of minute-by-minute activity diaries, and indirect calorimetry. All participants were adapted to their stated activity levels for at least 6 months and maintained a constant body-weight throughout their participation. Calculated daily energy intake equalled calculated expenditure in non-runners (7300 (SD 1536) v. 7476 (SD 872) kJ/d), but calculated energy expenditure in women running about 54 km/week was found to exceed intake by more than 2700 kJ/d (8259 (SD 1466) v. 10963 (SD 1367), P less than 0.01). The runners showed no evidence of compensating for the increased energy expenditure associated with running by engaging in lower-intensity activities during non-running time. Further, runners did not decrease energy expended at various activities. The findings suggest that women adapted to high levels of activity may possess mechanisms to maintain body-weight without significantly increasing energy intake.

Activities of Daily Living↗
PubMed1992

The effect of environmental temperature and humidity on 24 h energy expenditure in men.

The effects of environmental temperature and humidity and their interaction on 24 h energy expenditure were measured using whole-body indirect calorimetry in eight normal-weight young men who wore standardized light clothing and followed a controlled activity regimen. A randomized-block experimental design was used, with temperature effects assessed by measurements at 20, 23, 26 and 30 degrees, while humidity was altered from ambient (50-65% relative humidity) to high (80-93% relative humidity) at 20 and 30 degrees only. There was no significant effect of humidity on 24 h energy expenditure at the two extreme temperatures in this range, though when periods of sleep and exercise were excluded the energy expenditure at high humidity was significantly higher than that ambient humidity (P < 0.02). The effect of temperature at ambient humidity levels showed lower values at 23 and 26 degrees than at 20 and 30 degrees (P < 0.02). The effect of temperature was not equally apparent in all components of the 24 h energy expenditure, as sleeping metabolic rate and the energy cost of walking and cycling showed no significant effect of temperature over this range. This raises the possibility that the effects of temperature are attributable to behavioural changes during the waking portion of the day rather than any non-shivering thermogenic mechanisms at tissue level.

Adult↗
PubMed1994

Total energy expenditure and energy intake in the pre-school child: a comparison.

In a cohort (n 81) of healthy children aged 1.5-4.5 years, measurements of energy intake and energy expenditure were compared. Energy intake was calculated following a 4 d weighed record completed by the mother or guardian of the child. Total energy expenditure was measured using the doubly-labelled water technique. Mean energy intake and expenditure in the cohort were 4773 kJ/d and 4928 kJ/d respectively. The mean relative bias between the techniques was 154 kJ/d. In the older children (3.5-4.5 years) the mean relative bias was only 37 kJ/d. At the population level the measurements of energy intake and energy expenditure were extremely close, and the study has provided sufficient confidence in weighed intake methodology for it to be used in a major nationwide study of dietary intake and nutritional status of children aged 1.5-4.5 years.

Age Factors↗
PubMed2004

The use of uniaxial accelerometry for the assessment of physical-activity-related energy expenditure: a validation study against whole-body indirect calorimetry.

Assessing the total energy expenditure (TEE) and the levels of physical activity in free-living conditions with non-invasive techniques remains a challenge. The purpose of the present study was to investigate the accuracy of a new uniaxial accelerometer for assessing TEE and physical-activity-related energy expenditure (PAEE) over a 24 h period in a respiratory chamber, and to establish activity levels based on the accelerometry ranges corresponding to the operationally defined metabolic equivalent (MET) categories. In study 1, measurement of the 24 h energy expenditure of seventy-nine Japanese subjects (40 (SD 12) years old) was performed in a large respiratory chamber. During the measurements, the subjects wore a uniaxial accelerometer (Lifecorder; Suzuken Co. Ltd, Nagoya, Japan) on their belt. Two moderate walking exercises of 30 min each were performed on a horizontal treadmill. In study 2, ten male subjects walked at six different speeds and ran at three different speeds on a treadmill for 4 min, with the same accelerometer. O2 consumption was measured during the last minute of each stage and was expressed in MET. The measured TEE was 8447 (SD 1337) kJ/d. The accelerometer significantly underestimated TEE and PAEE (91.9 (SD 5.4) and 92.7 (SD 17.8) % chamber value respectively); however, there was a significant correlation between the two values (r 0.928 and 0.564 respectively; P<0.001). There was a strong correlation between the activity levels and the measured MET while walking (r(2) 0.93; P<0.001). Although TEE and PAEE were systematically underestimated during the 24 h period, the accelerometer assessed energy expenditure well during both the exercise period and the non-structured activities. Individual calibration factors may help to improve the accuracy of TEE estimation, but the average calibration factor for the group is probably sufficient for epidemiological research. This method is also important for assessing the diurnal profile of physical activity.

Acceleration↗
PubMed2003

The effects of enterostatin intake on food intake and energy expenditure.

Enterostatin (ENT) has been found to inhibit food intake and selectively inhibit fat intake in rats. Both peripheral and central mechanisms have been proposed. It also has been suggested that ENT may increase thermogenesis. The present study investigated the effects of oral ENT administration on food intake, energy expenditure and body weight in subjects with a preference for a high-fat diet. In a double-blind, placebo-controlled, randomized and crossover design, nine female and three male healthy subjects (age 34 (sd 11) years, BMI 24.5 (sd 2.5) kg/m(2)) with a preference for a high-fat diet ingested ENT (3 x 15 mg/d) or placebo (PLA) while consuming a high-fat diet ad libitum for 4 d. Eight subjects ended each intervention with a 36 h stay in the respiration chamber, continuing the diet and treatment. Body-weight loss was significant (ENT 0.8 (se 0.3) kg, P<0.05; PLA 1.3 (se 0.3) kg, P<0.001), but not different between treatments. There was no difference between treatments in total energy intake (ENT 37.1 (se 2.6), PLA 35.9 (se 3.2) MJ), macronutrient composition, hunger, satiety and hedonic scores during the 4 d high-fat diet. Energy expenditure (24 h) (ENT 9.6 (se 0.4), PLA 9.5 (se 0.4) MJ), sleeping and resting metabolic rate, diet-induced thermogenesis, activity-induced energy expenditure and 24 h RQ (ENT 0.77 (se 0.01), PLA 0.77 (se 0.01)) were similar for both treatments. We conclude that oral ENT administration did not affect food intake, energy expenditure or body weight in subjects with a preference for a high-fat diet experiencing a negative energy and fat balance.

Adult↗
PubMed2005

Effects of encapsulated green tea and Guarana extracts containing a mixture of epigallocatechin-3-gallate and caffeine on 24 h energy expenditure and fat oxidation in men.

It has been reported that green tea has a thermogenic effect, due to its caffeine content and probably also to the catechin, epigallocatechin-3-gallate (EGCG). The main aim of the present study was to compare the effect of a mixture of green tea and Guarana extracts containing a fixed dose of caffeine and variable doses of EGCG on 24 h energy expenditure and fat oxidation. Fourteen subjects took part to this randomized, placebo-controlled, double-blind, cross-over study. Each subject was tested five times in a metabolic chamber to measure 24 h energy expenditure, substrate oxidation and blood pressure. During each stay, the subjects ingested a capsule of placebo or capsules containing 200 mg caffeine and a variable dose of EGCG (90, 200, 300 or 400 mg) three times daily, 30 min before standardized meals. Twenty-four hour energy expenditure increased significantly by about 750 kJ with all EGCG-caffeine mixtures compared with placebo. No effect of the EGCG-caffeine mixture was observed for lipid oxidation. Systolic and diastolic blood pressure increased by about 7 and 5 mmHg, respectively, with the EGCG-caffeine mixtures compared with placebo. This increase was significant only for 24 h diastolic blood pressure. The main finding of the study was the increase in 24 h energy expenditure with the EGCG-caffeine mixtures. However, this increase was similar with all doses of EGCG in the mixtures.

Adult↗
PubMed2005

Resting energy expenditure measured longitudinally following hip fracture compared to predictive equations: is an injury adjustment required?

The present study measuring resting energy expenditure (REE; kJ/d) longitudinally using indirect calorimetry in six elderly women aged > or =70 years following surgery for hip fracture, describes changes over time (days 10, 42 and 84 post-injury) and compares measured values to those calculated from routinely applied predictive equations. REE was compared to REE predicted using the Harris Benedict and Schofield equations, with and without accounting for the theoretical increase in energy expenditure of 35 % secondary to physiological stress of injury and surgery. Mean (95 % CI) measured REE (kJ/d) was 4704 (4354, 5054), 4090 (3719, 4461) and 4145 (3908, 4382) for days 10, 42 and 84, respectively. A time effect was observed for measured REE, P=0.003. Without adjusting for stress the mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Harris Benedict equation were 1 (-9, 12), 10 (2, 18) and 9 (1, 17) for days 10, 42 and 84, respectively. The mean difference and 95 % limits of agreement for measured and predicted REE (kJ/kg per d) for the Schofield equation without adjusting for stress were 8 (-3, 19), 16 (6, 26) and 16 (10, 22) for days 10, 42 and 84, respectively. After adjusting for stress, REE predicted from the Harris Benedict or Schofield equations overestimated measured REE by between 38 and 69 %. Energy expenditure following fracture is poorly understood. Our data suggest REE was relatively elevated early in recovery but declined during the first 6 weeks. Using the Harris Benedict or Schofield equations adjusted for stress may lead to overestimation of REE in the clinical setting. Further work is required to evaluate total energy expenditure before recommendations can be made to alter current practice for calculating theoretical total energy requirements of hip fracture patients.

Aged↗
PubMed1997

Energy expenditure, body composition, and disease risk in children and adolescents.

Recent methodological advances have led to a tremendous improvement in our ability to measure energy expenditure, body composition and fat distribution in children. The availability of new and improved measurement techniques has greatly enhanced the scope of research studies in children. The key findings from the present review are as follows: total energy expenditure in young children is approximately 25% lower than current recommendations for energy intake and revised recommendations are necessary; reduced energy expenditure, however, does not necessarily explain the greater prevalence of obesity in the population as a whole or in sub-groups at greater risk of obesity; qualitative aspects of physical activity (e.g. time, intensity) may be more important than the energy expenditure of physical activity in the regulation of body composition; for body composition assessment, DXA is emerging as a technique which can substantially improve the accuracy and standardization in children; body fat begins to accumulate in the obese; waist:hip ratio or waist circumference are inadequate markers of intra-abdominal adipose tissue in children and adolescents; finally, the early accumulation of fat in the intra-abdominal region is significantly related to the development of adverse health effects, including dyslipidaemia and glucose intolerance.

Adipose Tissue↗
PubMed1987

Physical activity and energy expenditure of laying hens as affected by light intensity.

The influence of light intensity using incandescent bulbs in a 16L:8D day:night schedule on the number and strength of movements and on total, resting and activity-related energy expenditure was investigated. Movements were classified into 10 activity levels of progressively increasing vigour. The number of movements at all activity levels was significantly positively correlated with the logarithm of the light intensity. Movements of low activity strength were less affected by increasing light intensities than vigorous movements. Activity-related energy expenditure was highly significant and positively affected by light intensity. A decrease of the light intensity from 120 to 1 lux may reduce total energy expenditure by 18%. A decrease in energy expenditure by 9% may be achieved by reducing the light intensity to about 15 lux, measured perpendicular to the main axis of radiation.

Animals↗
PubMed1993

Artificial light sources and their influence on physical activity and energy expenditure of laying hens.

1. The influence of fluorescent and incandescent artificial lighting in a 16L:8D day/night schedule on number and intensity of movements, and on total, resting and activity-related energy expenditure was investigated. 2. Fluorescent light showed the same positive correlation between light intensity and physical activity at all activity levels as was found previously for incandescent light. 3. Light-dependent physical activity under fluorescent light was higher than under incandescent light at illuminances of 5 lux and above, indicating the fowl's ability to perceive qualitative light differences. 4. Total and activity-related energy expenditure were positively associated with illuminance; resting energy expenditure was not influenced. 5. Total, resting and activity-related energy expenditure were not statistically significantly different between light sources. 6. The results are discussed in relationship to Teichmüller's concept of adequate lighting and the characteristics of the fowl's visual system.

Animals↗
PubMed2006

Bicycle messengers: energy expenditure and exposure to air pollution.

The purpose of the study was to determine the level of energy expenditure and exposure to air pollution for bicycle messengers. Relationships between heart rate (HR) and oxygen uptake, and between HR and pulmonary ventilation (VE) for each participant were established in laboratory tests. Air pollution and HR were measured during one working day. The total oxygen uptake was then described as the total energy expenditure in Joule (J) and in multiples of the energy expenditure at rest (MET). The mean energy expenditure during a working day (8 h) was 12 MJ, (4.8 MET). The level of air pollution exposure when cycling seemed to be comparable with the levels of exposure when sitting inside a vehicle. The VE during cycling was four times higher than resting value. Increased VE led to increased exposure to air pollution.

Adult↗