| 1.Background and ObjectiveDiabetes mellitus(DM)has become a severe problem threatening the global public health.Its morbidity and mortality are increasing year by year.Lifestyle,high-calorie diets,and life stress play an increasingly important role in the development of this disease.With the development of society and the improvement of living standard,the harm of DM to developing countries is more and more serious.The main group of patients with DM is concentrated in developing countries,with type 2 diabetes mellitus(T2DM)the main type.The treatment of DM is diversified,among which nutritional therapy is the basis.The most important part of nutritional therapy is the assessment of energy expenditure.Resting energy expenditure(REE)accounts for 60%-70%of the total energy expenditure of the whole day,which is the major part of the total energy expenditure of the whole day and of great significance for the estimate of the energy expenditure.Because indirect calorimetry is simple and easy to obtain,it has been widely used in clinic and has become the gold standard of evaluating to evaluate the energy consumption.The determination of REE is critical to nutritional assessment,weight loss planning and optimal medical care.Energy balance in patients with T2DM is a complex issue.Energy imbalance exists in patients with T2DM,which plays an important role in the development of T2DM.In recent years,people gradually attach importance to the research of energy metabolism.Further studies on the relationship between T2DM and REE have revealed the increasing value of REE in the development of T2DM.For example,REE in patients with T2DM has been found to be a risk factor for diabetic retinopathy,and it’s also associated with urinary albumin loss and anemia in patients with diabetic nephropathy.In this study,the level of REE in patients with T2DM was measured by indirect energy measurement system(metabolic car)to provide evidence for nutritional therapy.At the same time,the relationship between REE and metabolic index,body composition was explored to find out the influencing factors,further clarifying its role in the occurrence and development of T2DM,which would provide help for the treatment of T2DM.2.Objects and methods2.1 objects:83 patients with T2DM who were treated in the Second Affiliated Hospital of Zhengzhou University from July 2019 to July 2020 were selected as the research objects,(36 males and 47 females).The diagnostic criteria were in line with the Chinese guidelines for the prevention and treatment of type 2 diabetes(2017version).At the same time,48 healthy persons of similar age and weight,including21 males and 27 females,were selected as the control group.Furthermore,the diabetes group was divided into groups according to the gender,body mass index(BMI),fasting plasma glucose(FPG),hemoglobin A1c(Hb A1c).Exclusion criteria:(1)patients with severe cardiopulmonary,hepatic and renal dysfunction;(2)patients with Gout;(3)patients with recent severe infection,surgery,trauma,acute complications of diabetes,tumor,etc;(4)patients with abnormal thyroid function such as hyperthyroidism and hypothyroidism;(5)patients with speech impairment,consciousness disturbance and non-cooperation;(6)patients with type 1 diabetes mellitus,special type diabetes Mellitus,gestational diabetes mellitus and acute hyperglycemia.2.2 methods:Sex,age,duration of diabetes,height,weight,waist circumference and hip circumference were recorded,and BMI(=weight in kg/height in m~2)and waist-to-hip ratio(WHR)(=waist circumference in cm/hip circumference in cm)were calculated.Venous blood was collected with an empty stomach for more than 8hours,then recording triglyceride(TG),total cholesterol(THO),high-density lipoprotein(HDL-C),low density Lipoprotein(LDL-C),FPG,Hb A1c,serum uric acid(SUA),free triiodothyronine(FT3),free thyroid hormone(FT4),thyroid-stimulating hormone(TSH).Besides,fat mass(FM),fat free mass(FFM)and REE were measured in the morning,with empty stomach,and complete defecation.2.3 statistical methods:Statistical analysis was carried out with SPSS 21.0statistical software.The data were expressed by the mean±standard deviation((?)±s).The data of the two groups were compared by independent sample t test,and the three groups were analyzed by one-way Anova.Chi-square test was used between the classified data.Pearson Correlation Analysis was used to analyze the relationship between REE and clinical indicators,and then multiple linear stepwise regression was used to analyze the influencing factors of REE.P<0.05 suggested that the difference was statistically significant.3.Results3.1 There was no significant difference in sex,age,height,weight and BMI between the two groups(P>0.05),but the REE of the diabetes group was higher than that of the control group,which is statistically significant(P<0.05).3.2 For the diabetic subgroups according to the gender,there was no significant difference in BMI,FM and age between the two groups(P>0.05).The height,weight and FFM of the male group were higher than the female group(P<0.05),the difference was statistically significant(P<0.05);The REE of male group was higher than that of female group(P<0.05).3.3 The diabetes group was divided into normal group(<24kg/m~2),overweight group(24-28kg/m~2)and obesity group(≥28kg/m~2),according to BMI.There were no significant differences in sex,age and height among the three groups(P>0.05).Body weight,FM and FFM increased with the increase of BMI,in which the difference was statistically significant(P<0.05).The difference of REE between the three groups was statistically significant(P<0.05),and REE increased with the increase of BMI.There was no significant difference between the normal group and the overweight group(P>0.05),but the REE of obesity Group was significantly higher than that of normal group and overweight group,in which the difference was statistically significant(P<0.05).3.4 For the diabetic subgroups according to FPG,there were no significant differences in sex,age,BMI,height,weight,FM and FFM among different FPG groups(P>0.05).REE in patients with FPG over 7.0 mmol/L was higher than that in patients with FPG≤7.0 mmol/L,and the difference was statistically significant(P<0.05).3.5 For the diabetic subgroups according to Hb A1c,there were no significant differences in sex,age,height and FFM among different Hb A1c groups(P>0.05),but the body weight,BMI,FM and REE of patients with Hb A1c≥7%were higher than those of patients with Hb A1c<7%(P<0.05).3.6 Pearson correlation analysis was performed between REE and age,height,weight,BMI,HBA1C,FPG,THO,TG,LDL-C,HDL-C,SUA,TSH,FT3,FT4,waist circumference,hip circumference,WHR,FM,FFM and it suggested that REE was positively correlated with height,weight,BMI,Hb A1c,SUA,waist circumference,WHR,FM,FFM(r=0.695,0.719,0.443,0.449,0.494,0.567,0.248,0.349,0.789,P<0.05),while it was negatively correlated with age and TSH(r=-0.549,-0.475,P<0.05).3.7 Multiple Linear stepwise regression showed that FFM,height and SUA were the influencing factors of REE(P=0.000,0.003,0.036).From the standardizedβ,the contribution of FFM is the largest,which is 0.533,and SUA is the smallest,which is 0.153.The equation containing the above three variables can explain 0.683of REE variability.4.Conclusions1.In patients with T2DM,there is a pathological state of increased REE,and obesity,high fasting blood glucose and poor blood glucose control may cause the elevation of REE in patients with T2DM.2.FFM,height and SUA are the influencing factors of REE in patients with T2DM. |
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