Rationale: Predictive equations for resting energy expenditure (REE) are used in the treatment of overweight and obesity, but the validity of these equations in overweight older adults is unknown. This study evaluates which predictive REE equation is the best alternative to indirect calorimetry in overweight older adults with and without diabetes. Methods: In total 273 adults aged ≥55 years with a BMI of ≥25 kg/m2 were included. REE (by indirect calorimetry), body weight, body height, age, gender, and fat-free and fat mass (from air-displacement plethysmography) were measured. The measured REE was used as a reference and compared with 28 existing REE equations. The accuracy of the equations was evaluated by the percentage accurate predictions (within 10% of REE measured), the root mean squared error (RMSE), and the mean percentage difference (bias) between predicted and measured REE. Subgroup analyses were performed for type 2 diabetics (T2D) and non-T2D. Results: Mean age was 64 ± (SD 6) years, 42% had T2D (n = 116), and mean BMI was 32.8 ± (SD 4.5) with range 25–54 kg/m2. The adjusted Harris & Benedict (1984) provided the highest percentage accurate predictions in all adults (70%) and in T2D (74%), and second best in non-T2D (67%). RMSE was 184, 175 and 191 kcal/day, and bias −1.2%, −1.5% and −1.0% for all adults, T2D and non-T2D, respectively. Conclusion: For Dutch overweight older adults with and without diabetes the adjusted Harris–Benedict (1984) predictive equation for REE seems to be the best alternative to indirect calorimetry.
Aims: This systematic review and meta-analysis evaluates the additional effect of exercise to hypocaloric diet on body weight, body composition, glycaemic control and cardio-respiratory fitness in adults with overweight or obesity and type 2 diabetes. Methods: Embase, Medline, Web of Science and Cochrane Central databases were evaluated, and 11 studies were included. Random-effects meta-analysis was performed on body weight and measures of body composition and glycaemic control, to compare the effect of hypocaloric diet plus exercise with hypocaloric diet alone. Results: Exercise interventions consisted of walking or jogging, cycle ergometer training, football training or resistance training and duration varied from 2 to 52 weeks. Body weight and measures of body composition and glycaemic control decreased during both the combined intervention and hypocaloric diet alone. Mean difference in change of body weight (−0.77 kg [95% CI: −2.03; 0.50]), BMI (−0.34 kg/m2 [95% CI: −0.73; 0.05]), waist circumference (−1.42 cm [95% CI: −3.84; 1.00]), fat-free mass (−0.18 kg [95% CI: −0.52; 0.17]), fat mass (−1.61 kg [95% CI: −4.42; 1.19]), fasting glucose (+0.14 mmol/L [95% CI: −0.02; 0.30]), HbA1c (−1 mmol/mol [95% CI: −3; 1], −0.1% [95% CI: −0.2; 0.1]) and HOMA-IR (+0.01 [95% CI: −0.40; 0.42]) was not statistically different between the combined intervention and hypocaloric diet alone. Two studies reported VO2max and showed significant increases upon the addition of exercise to hypocaloric diet. Conclusions: Based on limited data, we did not find additional effects of exercise to hypocaloric diet in adults with overweight or obesity and type 2 diabetes on body weight, body composition or glycaemic control, while cardio-respiratory fitness improved.
Over a million people in the Netherlands have type 2 diabetes (T2D), which is strongly related to overweight, and many more people are at-risk. A carbohydrate-rich diet and insufficient physical activity play a crucial role in these developments. It is essential to prevent T2D, because this condition is associated with a reduced quality of life, high healthcare costs and premature death due to cardiovascular diseases. The hormone insulin plays a major role in this. This hormone lowers the blood glucose concentration through uptake in body cells. If an excess of glucose is constantly offered, initially the body maintains blood glucose concentration within normal range by releasing higher concentrations of insulin into the blood, a condition that is described as “prediabetes”. In a process of several years, this compensating mechanism will eventually fail: the blood glucose concentration increases resulting in T2D. In the current healthcare practice, T2D is actually diagnosed by recognizing only elevated blood glucose concentrations, being insufficient for identification of people who have prediabetes and are at-risk to develop T2D. Although the increased insulin concentrations at normal glucose concentrations offer an opportunity for early identification/screening of people with prediabetes, there is a lack of effective and reliable methods/devices to adequately measure insulin concentrations. An integrated approach has been chosen for identification of people at-risk by using a prediabetes screening method based on insulin detection. Users and other stakeholders will be involved in the development and implementation process from the start of the project. A portable and easy-to-use demonstrator will be realised, based on rapid lateral flow tests (LFTs), which is able to measure insulin in clinically relevant samples (serum/blood) quickly and reliably. Furthermore, in collaboration with healthcare professionals, we will investigate how this screening method can be implemented in practice to contribute to a healthier lifestyle and prevent T2D.
