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PubMed2001

Medical care expenditures for hypertension, its complications, and its comorbidities.

OBJECTIVES: Medical expenditures attributed to hypertension were estimated, including expenditures for cardiovascular complications, other conditions for which hypertensives are at higher risk, and comorbidities (secondary diagnoses) that raise the cost of medical care. This article presents total, per capita, and per condition US expenditures in 1998 according to sex, age, and type of health service. METHODS: A variety of national data sources were used to disaggregate national health expenditures in 1998 by diagnosis. Expenditures for cardiovascular complications and other conditions for which hypertensives had higher rates of utilization were determined by analysis of attributable risks. Additional expenditures generated by extra hospital inpatient days and higher charges for nursing home and home health care for comorbidities were estimated by regression analyses. RESULTS: In 1998, $108.8 billion in health care spending was attributed to hypertension, 12.6% of total national spending that could be allocated to diagnoses, including $22.8 billion for hypertension, $29.7 billion for cardiovascular complications, and $56.4 billion for other diagnoses. Per capita expenditures increased with age from $249 for those younger than 65 years to $3,007 for those 85 years and older. The average amount spent per hypertensive condition was $3,787. Expenditures were generally higher for females. CONCLUSIONS: The economic burden of hypertension is large, but health services directly related to hypertension account for only a fraction of attributed expenditures. Comprehensive accounting of expenditures more accurately assesses the cost of hypertension and potential savings from prevention and treatment. Alteration of lifestyles and medical intervention provide opportunities to reduce national health expenditures.

Adult↗
PubMed2003

Regression-based sampling for persons with high health expenditures: evaluating accuracy and yield with the 1997 MEPS.

BACKGROUND: Given the high concentration of health care expenditures among a relatively small percentage of the population, the 1997 Medical Expenditure Panel Survey was designed to learn more about these high expenditure individuals by oversampling them. OBJECTIVE: Oversampling high expenditure individuals enables more precise estimation of what the nation's health care dollar buys and who pays it. It also enhances the ability to discern the causes of high health care expenses and the characteristics of the individuals who incur them. METHOD: Using the 1987 National Medical Expenditure Survey, a probabilistic model was developed to select households from the 1996 National Health Interview Survey likely to contain individuals incurring high levels of medical expenditures in the 1997 MEPS. The accuracy of the selection model, and the degree to which the high expenditure population was oversampled, are assessed with the 1997 MEPS data. RESULTS: Over half of the persons selected by the regression model were expected to have high health expenditures. Of the 456 persons selected by the model for oversampling, 257 individuals or 56.4% did, in fact, have high expenditures. Regression-based sampling increased the proportion of MEPS individuals with high expenditures from 14.3% without oversampling to 17.2% of the total cohort with oversampling (or from 938-1,126 persons). CONCLUSION: This paper demonstrates that a model-based approach to oversampling a high expenditure population, or any population with dynamic characteristics, can be highly successful in terms of sampling yield and accuracy.

Adult↗
PubMed2006

Malaria prevention in The Gambia: patterns of expenditure and determinants of demand at the household level.

OBJECTIVE: To provide a better understanding of (1) the amounts households in The Gambia spend on a wide variety of malaria prevention measures, (2) how expenditure fluctuates throughout the year and (3) the main determinants of expenditure. METHODS: A random sample of 1700 households from the Farafenni region were interviewed about their expenditure on malaria prevention over the past 2 weeks. Interviews were staggered over 12 months. Expenditure was measured for bed nets, treating and repairing bed nets, aerosols, coils, indoor spraying, smoke and other prevention strategies such as drinking herbs and cleaning the outside environment. Results Expenditure on bed nets, including treatment and repair, constituted only 10% of total expenditure on malaria prevention. Every fortnight, households spent an average of 8.40 Dalasis (D) on coils, 4.20 D on indoor sprays, 3.09 D on smoke and 3.06 D on aerosols, together making up 81% of total fortnightly expenditure. Of the 442 households that did not own a bed net, 68% said it was because they could not afford one. Every 2 months, the same households spent an average of US 5 dollars, the equivalent to the cost of an insecticide treated bed net, on other forms of prevention. Total expenditure was 42% higher during the wet season than for the rest of the year. For every month of the year, coils were the dominant form of prevention expenditure. Wealth, age, occupation of household head, location of residence and month of the year were significant determinants of prevention expenditure. CONCLUSIONS: Households in The Gambia spend considerable amounts on a range of malaria prevention products and activities throughout the year. Bed nets represent a relatively small proportion of this expenditure even though they are perceived to be the most efficient and effective method of malaria control. A more concerted effort is needed to develop appropriate targeting strategies to encourage bed net use especially for children <5 years of age. Equal emphasis should be given to addressing barriers to purchasing nets such as their relative high upfront cost.

Adult↗
PubMed1999

Dental expenditures and source of payment by race/ethnicity and other sociodemographic characteristics.

OBJECTIVE: This study presents race/ethnic-specific distributions of dental expenditures and their sources of payment by socioeconomic characteristics among US working-age adults. METHODS: Data for persons aged 19-64 years from the 1987 National Medical Expenditure Survey (NMES) (n = 18,696) were used to calculate mean dental expenditures and their 95 percent confidence intervals. RESULTS: Dental expenditures were reported by 44.5 percent of participants. Non-Hispanic whites and persons with higher income were more likely to report dental expenditures than their counterparts. Among persons reporting expenditures, those with lower income had lower expenditures than higher-income persons. No differences in the amount of expenditures by race/ethnicity, sex, or employment status were observed. In all race/ethnic groups almost half the expenditures were paid out-of-pocket and one-third by dental insurance. CONCLUSION: While sociodemographic characteristics determined who had dental expenditures, they did not determine the amount or source of those expenditures.

Adult↗
PubMed1994

Health care expenditures for people with diabetes mellitus, 1992.

The purpose of this report is to estimate diabetes prevalence and annual health care costs for people with diabetes in 1992, compare average annual costs for diabetics and nondiabetics, and estimate the portion of total U.S. health care expenditures incurred by people with the disease. Data from the 1987 National Medical Expenditure Survey were used to estimate diabetes prevalence and health care expenditures for diabetics in 1992. Diabetics were identified based on self-reports of a physician diagnosis of diabetes, a history of taking diabetic medications, or an encounter with the health care system specifically related to diabetes. Identified diabetics were classified as confirmed if they had a history of taking diabetic medications, had a diabetes-specific encounter with the health care system, or purchased diabetic equipment. Estimates of diabetes prevalence and health care expenditures were calculated separately for identified and confirmed diabetics using the National Medical Expenditure Survey database. Total health care expenditures included costs associated with inpatient hospital care, outpatient hospital care, office visits to a physician or other provider, emergency room visits, home health care, prescription drugs, dental care, and durable medical equipment purchases. We estimate that percapita annual health care expenditures in 1992 were more than three times greater for diabetics ($9,493) than for nondiabetics ($2,604). Percapita expenditures for confirmed diabetics ($11,157) were more than four times greater than for nondiabetics. In 1992, diabetics constituted 4.5% of the U.S. population but accounted for 14.6% of total U.S. health care expenditures ($105 billion). Confirmed diabetics constituted 3.1% of the U.S. population but accounted for 11.9% of total U.S. health care expenditures ($85 billion). This study found that health care expenditures for people with diabetes constituted about one in seven health care dollars spent in 1992. Health care reform and insurers should take note of these findings and structure benefit packages to promote care likely to reduce the costs of caring for diabetics.

Adolescent↗
PubMed1997

Expenditures for care of children with chronic illnesses enrolled in the Washington State Medicaid program, fiscal year 1993.

OBJECTIVE: We calculated expenditures for children with one of eight selected chronic health conditions who were enrolled in the Washington State Medicaid program and compared them with payments for all Medicaid-enrolled children. We examined variation in mean, median, and total expenditures and identified expenditure sources. METHODS: This study analyzed Medicaid claims data for 310 977 children aged 0 to 18 who were enrolled at any time in fiscal year 1993. Tracer conditions were used to examine expenditure variation within and between diagnostic groupings. A total of 18 233 children (5.9%) had at least one of the conditions. Expenditures were calculated based on payments made by the Medicaid program. RESULTS: Children with one of the eight selected conditions incurred mean expenditures of $3800, compared with $955 for all Medicaid-enrolled children. Mean payments associated with the selected conditions ranged from 2.5 times to 20 times more than payments to all children. Approximately 10% of children accounted for approximately 70% of the payments in general and in each diagnostic grouping. Variation in mean, median, and total expenditures was extensive among the conditions. For most conditions, inpatient stays accounted for the greatest proportion of expenditures; for some conditions, durable equipment, home nursing, and medication-related services accounted for substantial proportions of total expenditures. CONCLUSIONS: Medical care for children with selected chronic health conditions is 2.5 to 20 times more expensive than children in general, depending on the condition. A relatively few children account for the majority of expenditures. Extensive variation in mean, median, and total expenditures suggests that different conditions will need to be kept distinct for purposes of establishing payment rates. Children with certain conditions are vulnerable to restrictions in specific services, depending on what restrictions are imposed by a financing program. Further analyses are needed to identify risk-adjustment strategies to support delivery of high-quality services to this population of children as they migrate into managed-care environments.

Asthma↗
PubMed2005

Health care expenditures of immigrants in the United States: a nationally representative analysis.

OBJECTIVES: We compared the health care expenditures of immigrants residing in the United States with health care expenditures of US-born persons. METHODS: We used the 1998 Medical Expenditure Panel Survey linked to the 1996-1997 National Health Interview Survey to analyze data on 18398 US-born persons and 2843 immigrants. Using a 2-part regression model, we estimated total health care expenditures, as well as expenditures for emergency department (ED) visits, office-based visits, hospital-based outpatient visits, inpatient visits, and prescription drugs. RESULTS: Immigrants accounted for $39.5 billion (SE=$4 billion) in health care expenditures. After multivariate adjustment, per capita total health care expenditures of immigrants were 55% lower than those of US-born persons ($1139 vs $2546). Similarly, expenditures for uninsured and publicly insured immigrants were approximately half those of their US-born counterparts. Immigrant children had 74% lower per capita health care expenditures than US-born children. However, ED expenditures were more than 3 times higher for immigrant children than for US-born children. CONCLUSIONS: Health care expenditures are substantially lower for immigrants than for US-born persons. Our study refutes the assumption that immigrants represent a disproportionate financial burden on the US health care system.

Adolescent↗
PubMed1998

Patterns of expenditures and use of services among older adults with diabetes. Implications for the transition to capitated managed care.

OBJECTIVE: To examine health care use and expenditures among older adults with diabetes, investigate factors that are associated with higher expenditures, and describe the policy implications of caring for this population under managed care. RESEARCH DESIGN AND METHODS: A cross-sectional analysis of expenditures for individuals with diabetes over age 65 years from a nationwide 5% random sample of Medicare beneficiaries was conducted during 1992. All components of medical care covered under Medicare were examined. Multivariate analysis was used to assess the contribution of age, race, sex, number of diabetic complications, and comorbidity (Charlson Index) on total expenditures. RESULTS: On average, individuals with diabetes (n = 188,470) were 1.5 times (P < 0.0001) as expensive as all Medicare beneficiaries (n = 1,371,960). However, there were wide variations, with the most expensive 10% of beneficiaries with diabetes accounting for 56% of expenditures for individuals with diabetes and the least expensive 50% accounting for 4%. Acute care hospitalizations accounted for the majority (60%) of total expenditures, whereas outpatient and physician services accounted for 7 and 33%, respectively. There were no differences in the number of complications for all older adults with diabetes compared with those with the highest expenditures. However, the average number of hospitalizations was 1.6 times (0.53 vs. 0.34; P < 0.0001) higher, and the average length of stay was 2 days longer, among older adults with diabetes (P < 0.0001). In the regression model, age and male sex (factors currently used to set payment rates for Medicare managed care enrollees), and number of diabetic complications, but not race, were positively related to expenditures, yet had minimal predictive power (R2 = 0.0006). The addition of the Charlson Index, also positively related to expenditures, was able to explain up to 20% of the variation in total expenditures (R2 = 0.196). CONCLUSIONS: There are large variations in expenditures among older adults with diabetes. Because elderly beneficiaries with diabetes are more expensive than the average older adult, current Medicare capitation rates may be inadequate. To avoid selection bias and under-treatment of this vulnerable population under managed care, methods to construct fair payment rates and safeguard quality of care are desirable.

Age Factors↗
PubMed2003

Health care expenditures and ageing: an international comparison.

This study examines national health expenditure trends for Japan, Canada, Australia, and England and Wales (combined) to assess the impact of changing demographics and changing age-specific per capita expenditure on national health expenditure. Age-specific expenditure data were obtained from each country's department of health. We calculated changes in age-specific per capita expenditure, population demographics and the share of expenditures used by the different age groups over time. We then determined the extent to which isolated changes in population growth, demographic shifts and changes in age-specific per capita expenditure could predict observed increases in health expenditure. For Japan, Canada and Australia per capita health expenditure increased fastest among those aged 65 and over, at up to twice the increase of those aged 45-64. In England and Wales, on the other hand, those aged 65 and over experienced one-third of the cost increase of those aged 45-64. Hence, the proportion of national health expenditures used by the population aged 65 and over decreased from 40% to 35% in England and Wales, while increasing in the other countries by up to 10 percentage points. Demographic shifts and population growth predicted only 18% of the observed increases in health care expenditures in England and Wales, compared to 68%, 44% and 34% for Japan, Canada and Australia respectively. These differential changes in costs for older age groups over time invite future research into the driving forces behind these costs.

Adolescent↗
PubMedDate not supplied

Measuring state expenditures for core public health functions.

In 1993, the U.S. Public Health Service, with the assistance of the Public Health Foundation (PHF), launched a pilot study to develop state and national expenditure estimates for the core functions of public health. The core public health functions selected for the data collection effort were (1) health-related data, surveillance, and outcomes monitoring; (2) investigation and control of diseases, injuries, and response to natural disasters; (3) immunizations, family planning, and STD and TB clinical services; (4) protection of environment, housing, food, water, and the workplace; (5) laboratory services; (6) public information and education and community mobilization; (7) targeted outreach and linkage to personal services; (8) accountability/quality assurance; (9) training and education; and (10) leadership, planning, policy development, and administration. State health officials from Connecticut, Iowa, Missouri, Oregon, and Rhode Island helped develop a methodology and a set of guidelines for estimating expenditures on core functions and used this methodology to report expenditure data. Three additional states--Illinois, New York, and Texas--joined in a second phase of the pilot study, one that included collecting data on personal health services and total agency expenditure data. The eight states' combined per capita core function expenditures were $44 in fiscal year (FY) 1993. This included expenditures by state and local public health agencies and state substance abuse, mental health, and environmental health agencies. Expenditures for core public health functions accounted for 27% of these agencies' total expenditures. The largest core function expenditure accounting for approximately 30% of the total was for the protection of environment, housing, food, water, and the workplace. Extrapolating the eight states' expenditure estimates to the national level, spending for core public health functions in FY 1993 totaled $11.4 billion, or 1.3% of total U.S. health spending. The pilot project demonstrates that with appropriate guidance, including an estimating methodology and uniform definitions, categorical program data can be reported by function. The results of the data collection effort also demonstrate the potential utility of examining expenditures by core functions for state planning and policy making. The methodology allows states to distinguish core functions from other responsibilities, providing states with quantified information useful for reform efforts.

Data Collection↗
PubMed1984

Clinical implications of continuous measurement of energy expenditure in mechanically ventilated patients.

Energy expenditure was monitored in 20 critically-ill mechanically ventilated patients using the Siemens-Elema Oxygen Consumption Calculator (OCC 980). Energy expenditure was measured continuously over the 24-h period in all patients (altogether, over 2500 patient hours; range 48-288 h). A predicted energy expenditure was calculated for each patient from standard tables for basal metabolic rates modified according to previously published reports on the influence of trauma, infection and elevated body temperature. For all patients combined, the agreement between the predicted and the measured energy expenditure was good. However, in individual patients the measured energy expenditure varied between 48 and 148% of the predicted value. The measured energy expenditure in surviving traumatized and/or septic patients correlated well (95-100%) with the predicted value at the time when weaning off the ventilator could be initiated. On the first day of measurements, the energy expenditure (in % of the predicted value) in the six patients who later died was significantly lower than in surviving patients (84 +/- 6 vs 107 +/- 2%; p < 0.01). Over a 24-h period, energy expenditure, defined as the value noted during a stable 30-40-min period of measurement, varied between 12 and 50% in the individual patients. This study shows that energy expenditure cannot be accurately predicted in the individual patient, that an energy expenditure below predicted values appears to be indicative of a poor prognosis and that short periods of energy expenditure monitoring may fail to reflect 24-h conditions.

Journal Article↗
PubMed2002

Relation of body composition, parental overweight, pubertal stage, and race-ethnicity to energy expenditure among premenarcheal girls.

BACKGROUND: Previous studies assessed the influence of parental weight status, sexual maturation, race-ethnicity, and energy expenditure among children, but few examined these issues comprehensively. OBJECTIVE: The objective was to determine whether differences in energy expenditure among premenarcheal girls are related to the pubertal stage and the race-ethnicity of the girls or to the weight status of their parents. DESIGN: We measured the body composition and the energy expenditure of 196 nonobese girls enrolled in a longitudinal study. Total body water was measured by the isotopic dilution of (18)O water. We measured resting metabolic rate with the use of indirect calorimetry and daily energy expenditure by the doubly labeled water method. We used established criteria to determine sexual maturation. Parental weight status was based on body mass index. RESULTS: Resting metabolic rate was higher among girls with >or=1 overweight parent than among girls with 2 normal-weight parents. Total energy expenditure was also higher among girls with >or=1 overweight parent, but these results were of borderline significance. We found no effect of pubertal stage on resting metabolic rate. Nonresting energy expenditure was significantly lower among pubertal girls than among prepubertal girls. After adjustments for age and body composition, we noted that resting metabolic rate, nonresting energy expenditure, and total energy expenditure were all significantly lower among black girls than among white girls. CONCLUSIONS: Differences in resting metabolic rate and total energy expenditure among premenarcheal girls were associated with parental weight status and the girls' race-ethnicity, whereas differences in nonresting energy expenditure were associated with pubertal stage and race-ethnicity. Whether the observed differences in energy expenditure persist after puberty and predict weight gain during puberty awaits the results of longitudinal analyses.

Black People↗
PubMed2003

Effect of fluoroquinolone expenditures on susceptibility of Pseudomonas aeruginosa to ciprofloxacin in U.S. hospitals.

The effect of fluoroquinolone use on the susceptibility of Pseudomonas aeruginosa to fluoroquinolones in U.S. hospitals was studied. Benchmarking surveys were sent annually to pharmacists practicing in U.S. hospitals from 1993 to 1999. Data collected included hospital characteristics, antimicrobial expenditures and use, antimicrobial stewardship activities, and bacterial susceptibilities. Antimicrobial expenditures were normalized for the number of occupied beds (OBs) per year. General linear modeling and repeated-measures mixed-effects modeling were used to determine factors predictive of P. aeruginosa susceptibility to fluoroquinolones. A total of 174 hospitals provided data for fluoroquinolone expenditures and susceptibility of P. aeruginosa; the median number of years of data was 3 (range, 1-6), representing 416 hospital years. Community hospitals contributed a majority of the data. Median fluoroquinolone expenditures increased gradually from $230 per OB in 1993 to $400 per OB in 1998. A 55% increase to $620 per OB occurred in 1999, largely because of increased spending on levofloxacin. Susceptibility to ciprofloxacin was commonly used to assess fluoroquinolone susceptibility. The median susceptibility of P. aeruginosa to ciprofloxacin decreased from 84% to 71%. Increasing expenditures for ofloxacin and levofloxacin, but not ciprofloxacin, were associated with decreasing P. aeruginosa susceptibility to ciprofloxacin. In the final multivariable model, each study year after 1993 and every increase in ofloxacin expenditure of $100 per OB were associated with decreases in P. aeruginosa susceptibility. Data from a benchmarking survey of U.S. hospitals for 1993-1999 revealed increases in levofloxacin expenditures, total fluoroquinolone expenditures, expenditures for nonfluoroquinolone antipseudomonal antimicrobials, and total antimicrobial expenditures in 1999. Increases in expenditures for levofloxacin and ofloxacin were associated with a significant decrease in P. aeruginosa susceptibility to ciprofloxacin.

Anti-Bacterial Agents↗
PubMed1999

Effects of red blood cell transfusion on resting energy expenditure in adolescents with sickle cell anemia.

BACKGROUND: Previous studies indicate that resting energy expenditure is elevated in children with sickle cell anemia, possibly caused in part by hemolysis and increased erythropoietic activity. The purpose of the present investigation was to determine whether erythrocyte transfusion normalizes resting energy expenditure in sickle cell anemia. METHODS: Five adolescents with sickle cell anemia (12-16 years old; 4 boys, 1 girl) were studied before and 1 week after erythrocyte transfusion before elective surgery or at the initial transfusion for growth failure. Resting energy expenditure was measured by indirect calorimetry, and laboratory measures were determined by routine, validated methods. Data comparisons were by nonparametric analysis. RESULTS: After erythrocyte transfusion, total hemoglobin levels increased (difference (D) = 15 g/l; p < 0.05), whereas hemoglobin S (D = -0.36; p < 0.05) and reticulocyte count (D = -0.12; p < 0.05) decreased. Mean pretransfusion resting energy expenditure was elevated to 124% above predicted levels (p < 0.05) and increased further to 134% above prediction (p < 0.05 vs. pretransfusion levels). Plasma triiodothyronine (T3) levels increased (D = 0.17 nmol/l; p < 0.05), reverse T3 (rT3) levels tended to decline (D = -0.04 nmol/l; p = 0.14), and rT3/T3 decreased (D = -0.03; p < 0.05). Plasma insulin-like growth factor-I (IGF-I) levels were low-normal before transfusion and did not change, despite the change in resting energy expenditure. CONCLUSIONS: The results confirm that resting energy expenditure is elevated in patients with sickle cell anemia. However, resting energy expenditure further increased after transfusion, despite decreased erythropoietic activity. A posttransfusion decrease in rT3/T3 may contribute to the increased resting energy expenditure. That there was no change in IGF-I implies that the growth hormone-IGF system is not involved in posttransfusion regulation of resting energy expenditure. Therefore, our data are not consistent with the hypothesis that increased resting energy expenditure in sickle cell anemia is directly related to erythropoietic activity. The mechanisms by which resting energy expenditure increases after transfusion in sickle cell anemia require additional investigation.

Adolescent↗
PubMed1993

The use of indirect calorimetry in critically ill patients--the relationship of measured energy expenditure to Injury Severity Score, Septic Severity Score, and APACHE II Score.

The nutritional needs of critically ill septic patients or patients with multiple injuries are often difficult to estimate. Indirect calorimetry can simply and accurately determine individual caloric and nutritional needs, especially in cases of critically ill patients with complicated injuries. This prospective study compared the measured energy expenditures of 30 patients using indirect calorimetry with their predicted basal energy expenditure according to the Harris-Benedict equation, or their calculated energy expenditure derived from basal energy expenditure times, an activity factor, and a stress factor. These numbers were then used to evaluate the relationship between measured energy expenditure, measured energy expenditure per kilogram, and four specific scoring systems--the Septic Severity Score (SSS), the Injury Severity Score (ISS), the Trauma Score (TS), and APACHE II. The results showed the severity of sepsis or trauma correlated with the measured energy expenditure per kilogram of body weight. Among the 15 septic patients, in whom the measured energy expenditure per kilogram was 42.2 +/- 2.6 kcal/kg, the SSS provided a better predictor of energy needs and closer correlation with measured energy expenditure per kilogram (r = 0.69, Y = 1.41 + 0.72 X). Their stress factors could be modified as "0.97 + 0.0125 x SSS" to get a more accurate Harris-Benedict calculation. For the 15 patients with multiple injuries in whom the measured energy expenditure per kilogram was 34.9 +/- 1.6 kcal/kg, the ISS offered the best correlation with measured energy expenditure per kilogram (r = 0.84, Y = -31.47 +/- 1.73 X). Their stress factors could be modified as "1.04 + 0.0077 x ISS" to get a more accurate Harris-Benedict calculation.

Adult↗
PubMed1997

Is energy expenditure in the hamster primarily under homeostatic or circadian control?

1. In order to discriminate between homeostatic and circadian control of energy expenditure, this paper considers whether a shorter circadian cycle will produce a proportional reduction in energy expenditure (so that expenditure per unit time is conserved) or alternatively whether energy expenditure will be compressed into the shorter cycle (so that energy expenditure per cycle is conserved). To answer this question, we measured energy expenditure in tau mutant hamsters (whose free-running circadian period has been reduced to about 20 h by a single gene mutation) and wild-type hamsters (whose free-running circadian period is about 24 h). 2. In one experiment, the circadian rhythm of running-wheel activity of tau mutant hamsters was compared with that of wild-type hamsters. The rate of running was not affected by the mutation and, consequently, the total amount of activity per cycle was significantly less in mutants than in wild-type hamsters, whereas the total amount of activity per unit time was nearly the same. 3. In a second experiment, we measured energy expenditure by indirect calorimetry. Metabolic rate was not affected by the mutation and, consequently, the total amount of energy expended per cycle was significantly less in mutants than in wild-type hamsters but equivalent per unit time. 4. Because the amount of energy expenditure and locomotor activity was found to be proportional to the circadian cycle, we conclude that expenditure per unit time-rather than expenditure per circadian cycle-is conserved in the mutant animals. Therefore, we infer that energy expenditure in hamsters is primarily under homeostatic, not circadian, control. Further research is necessary to determine whether this inference can be applied to other species.

Animals↗
PubMed1998

Total daily energy expenditure in free-living older African-Americans and Caucasians.

Low rates of daily energy expenditure, increased energy intake, or a combination of both contribute to obesity in African-Americans. We examined whether African-Americans have lower rates of free-living daily energy expenditure than Caucasians. One hundred sixty-four (> 55 yr) volunteers (37 African-American women, 52 Caucasian women, 28 African-American men, and 47 Caucasian men) were characterized for total daily energy expenditure, resting metabolic rate, and physical activity energy expenditure from the doubly labeled water method and indirect calorimetry. Absolute total daily energy expenditure was lower in women than men but was not different between African-Americans and Caucasians. However, we found race and gender differences in total daily energy expenditure after controlling for differences in fat-free mass. Total daily energy expenditure was 10% lower (P < 0.01) in African-Americans compared with Caucasians due to a 5% lower resting metabolic rate (P < 0.01) and 19% lower physical activity energy expenditure (P = 0.08). Moreover, total daily energy expenditure was 16% lower (P < 0.01) in women compared with men due to a 6% lower resting metabolic rate (P = 0.09) and a 37% lower physical activity energy expenditure (P = 0.06). Low rates of energy expenditure may be a predisposing factor for obesity, particularly in African-American women.

Aged↗
PubMed2000

Catecholamine release, growth hormone secretion, and energy expenditure during exercise vs. recovery in men.

We examined the relationship between energy expenditure (in kcal) and epinephrine (Epi), norepinephrine (NE), and growth hormone (GH) release. Ten men [age, 26 yr; height, 178 cm; weight, 81 kg; O(2) uptake at lactate threshold (LT), 36.3 ml. kg(-1). min(-1); peak O(2) uptake, 49.5 ml. kg(-1). min(-1)] were tested on six randomly ordered occasions [control, 5 exercise: at 25 and 75% of the difference between LT and rest (0.25LT, 0.75LT), at LT, and at 25 and 75% of the difference between LT and peak (1.25LT, 1.75LT) (0900-0930)]. From 0700 to 1300, blood was sampled and assayed for GH, Epi, and NE. Carbohydrate (CHO) expenditure during exercise and fat expenditure during recovery rose proportionately to increasing exercise intensity (P = 0.002). Fat expenditure during exercise and CHO expenditure during recovery were not affected by exercise intensity. The relationship between exercise intensity and CHO expenditure during exercise could not be explained by either Epi (P = 1.00) or NE (P = 0.922), whereas fat expenditure during recovery increased with Epi and GH independently of exercise intensity (P = 0. 028). When Epi and GH were regressed against fat expenditure during recovery, only GH remained statistically significant (P < 0.05). We conclude that a positive relationship exists between exercise intensity and both CHO expenditure during exercise and fat expenditure during recovery and that the increase in fat expenditure during recovery with higher exercise intensities is related to GH release.

Adult↗