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Exercise or Physical Activity and Energy Balance or Metabolism in Health and Disease

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (20 April 2023) | Viewed by 137194

Special Issue Editor


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Guest Editor
Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM, EA 7424), Université Savoie Mont Blanc, Chambéry, France
Interests: Rehabilitation exercise; sports science; endurance training; exercise metabolism; muscle characteristics

Special Issue Information

Dear Colleagues,

Exercise or physical activity require a tremedous demand for metabolic energy. First, this high energy demand may challenge the energy balance. While this may be beneficial in cases of overweight and obesity, for example, this may be more detrimental in the case of long-duration exercises (e.g., ultra endurance events or military missions). To circumvent/avoid possible deleterious effects, various nutritional strategies before, during or even after exercise can be implemeted. Second, different sources of energy are mobilized during exercise and the involvement of these different energy sources varies/changes according to exercise duration and intensity as well as the nutritional/energetic/metabolic status of the subject/patient. This metabolic flexibity is important to fuel the exercising muscles and consequently for athletic performance. If physical training modifes/improves the metabolic flexility, this latter may be impeded by various factors including energy stores and disease. Papers dealing with energy balance or metabolism, metabolic flexibility, nutritional strategies before, during of after exercise or physical acitvity in health and disease are welcome.

Dr. Laurent A. Messonnier
Guest Editor

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Keywords

  • Exercise
  • Physical Activity
  • Sport
  • Endurance Training
  • Energy metabolism

Published Papers (12 papers)

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Editorial

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4 pages, 210 KiB  
Editorial
Physical Exercise or Activity and Energy Balance or Metabolism in the Context of Health and Diseases
by Laurent A. Messonnier
Nutrients 2023, 15(23), 4909; https://doi.org/10.3390/nu15234909 - 24 Nov 2023
Viewed by 789
Abstract
Regular long-lasting physical exercise demands a tremendous amount of metabolic energy [...] Full article

Research

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18 pages, 4912 KiB  
Article
Biomarkers of Redox Balance Adjusted to Exercise Intensity as a Useful Tool to Identify Patients at Risk of Muscle Disease through Exercise Test
by Pierre-Edouard Grillet, Stéphanie Badiou, Karen Lambert, Thibault Sutra, Maëlle Plawecki, Eric Raynaud de Mauverger, Jean-Frédéric Brun, Jacques Mercier, Fares Gouzi and Jean-Paul Cristol
Nutrients 2022, 14(9), 1886; https://doi.org/10.3390/nu14091886 - 29 Apr 2022
Cited by 3 | Viewed by 1886
Abstract
The screening of skeletal muscle diseases constitutes an unresolved challenge. Currently, exercise tests or plasmatic tests alone have shown limited performance in the screening of subjects with an increased risk of muscle oxidative metabolism impairment. Intensity-adjusted energy substrate levels of lactate (La), pyruvate [...] Read more.
The screening of skeletal muscle diseases constitutes an unresolved challenge. Currently, exercise tests or plasmatic tests alone have shown limited performance in the screening of subjects with an increased risk of muscle oxidative metabolism impairment. Intensity-adjusted energy substrate levels of lactate (La), pyruvate (Pyr), β-hydroxybutyrate (BOH) and acetoacetate (AA) during a cardiopulmonary exercise test (CPET) could constitute alternative valid biomarkers to select “at-risk” patients, requiring the gold-standard diagnosis procedure through muscle biopsy. Thus, we aimed to test: (1) the validity of the V’O2-adjusted La, Pyr, BOH and AA during a CPET for the assessment of the muscle oxidative metabolism (exercise and mitochondrial respiration parameters); and (2) the discriminative value of the V’O2-adjusted energy and redox markers, as well as five other V’O2-adjusted TCA cycle-related metabolites, between healthy subjects, subjects with muscle complaints and muscle disease patients. Two hundred and thirty subjects with muscle complaints without diagnosis, nine patients with a diagnosed muscle disease and ten healthy subjects performed a CPET with blood assessments at rest, at the estimated 1st ventilatory threshold and at the maximal intensity. Twelve subjects with muscle complaints presenting a severe alteration of their profile underwent a muscle biopsy. The V’O2-adjusted plasma levels of La, Pyr, BOH and AA, and their respective ratios showed significant correlations with functional and muscle fiber mitochondrial respiration parameters. Differences in exercise V’O2-adjusted La/Pyr, BOH, AA and BOH/AA were observed between healthy subjects, subjects with muscle complaints without diagnosis and muscle disease patients. The energy substrate and redox blood profile of complaining subjects with severe exercise intolerance matched the blood profile of muscle disease patients. Adding five tricarboxylic acid cycle intermediates did not improve the discriminative value of the intensity-adjusted energy and redox markers. The V’O2-adjusted La, Pyr, BOH, AA and their respective ratios constitute valid muscle biomarkers that reveal similar blunted adaptations in muscle disease patients and in subjects with muscle complaints and severe exercise intolerance. A targeted metabolomic approach to improve the screening of “at-risk” patients is discussed. Full article
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12 pages, 670 KiB  
Article
Lower Amounts of Daily and Prolonged Sitting Do Not Lower Free-Living Continuously Monitored Glucose Concentrations in Overweight and Obese Adults: A Randomised Crossover Study
by Daniel P. Bailey, Charlotte A. Stringer, Benjamin D. Maylor and Julia K. Zakrzewski-Fruer
Nutrients 2022, 14(3), 605; https://doi.org/10.3390/nu14030605 - 30 Jan 2022
Cited by 5 | Viewed by 2234
Abstract
This study compared the short-term continuously monitored glucose responses between higher and lower amounts of prolonged sitting in overweight and obese adults under free-living conditions. In a randomised crossover design, 12 participants (age 48 ± 10 years, body mass index 33.3 ± 5.5 [...] Read more.
This study compared the short-term continuously monitored glucose responses between higher and lower amounts of prolonged sitting in overweight and obese adults under free-living conditions. In a randomised crossover design, 12 participants (age 48 ± 10 years, body mass index 33.3 ± 5.5 kg/m2) completed two four-day experimental regimens while wearing a continuous glucose monitor, as follows: (1) uninterrupted sitting (participants were instructed to sit for ≥10 h/day and accrue ≥7, 1 h sitting bouts each day), and (2) interrupted sitting (participants were instructed to interrupt sitting every 30 min during ten of their waking hours with 6–10 min of activity accrued in each hour). Linear mixed models compared outcomes between regimens. None of the continuously monitored glucose variables differed between regimens, e.g., 24 h net incremental area under the glucose curve was 5.9 [95% CI: −1.4, 13.1] and 5.6 [95% CI: −1.7, 12.8] mmol/L∙24 h, respectively (p = 0.47). Daily sitting (−58 min/day, p = 0.001) and sitting bouts lasting ≥30 min (−99 min/day, p < 0.001) were significantly lower and stepping time significantly higher (+40 min/day, p < 0.001) in the interrupted sitting than the uninterrupted sitting regimen. In conclusion, lower amounts of daily and prolonged sitting did not improve free-living continuously measured glucose among overweight and obese adults. Full article
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14 pages, 522 KiB  
Article
Lower Muscle and Blood Lactate Accumulation in Sickle Cell Trait Carriers in Response to Short High-Intensity Exercise
by Laurent A. Messonnier, Samuel Oyono-Enguéllé, Lucile Vincent, Hervé Dubouchaud, Benjamin Chatel, Hervé Sanchez, Alexandra Malgoyre, Cyril Martin, Frédéric Galactéros, Pablo Bartolucci, Patrice Thiriet and Léonard Féasson
Nutrients 2022, 14(3), 501; https://doi.org/10.3390/nu14030501 - 24 Jan 2022
Cited by 3 | Viewed by 2707
Abstract
It remains unclear whether sickle cell trait (SCT) should be considered a risk factor during intense physical activity. By triggering the polymerization-sickling-vaso-occlusion cascade, lactate accumulation-associated acidosis in response to high-intensity exercise is believed to be one of the causes of complications. However, our [...] Read more.
It remains unclear whether sickle cell trait (SCT) should be considered a risk factor during intense physical activity. By triggering the polymerization-sickling-vaso-occlusion cascade, lactate accumulation-associated acidosis in response to high-intensity exercise is believed to be one of the causes of complications. However, our understanding of lactate metabolism in response to high-intensity exercise in SCT carriers is incomplete. Thirty male SCT carriers (n = 15) and healthy subjects (n = 15) with and without α-thalassemia performed a 2-min high-intensity exercise. Blood and muscle lactate concentrations were measured at exercise completion. Time courses of blood lactate and glucose concentrations were followed during the subsequent recovery. Additional biochemical analyses were performed on biopsies of the vastus lateralis muscle. SCT was associated with lower blood and muscle lactate concentrations in response to the short high-intensity exercise. Compared to controls, the muscle content among SCT carriers of lactate transporter MCT4 and β2-adrenergic receptor were higher and lower, respectively. During recovery, the lactate removal ability was higher in SCT carriers. In the present study, no effect of α-thalassemia was observed. The lower blood and muscle lactate accumulations in SCT carriers may, to some extent, act as protective mechanisms: (i) against exercise-related acidosis and subsequent sickling, that may explain the relatively rare complications observed in exercising SCT carriers; and (ii) against the deleterious effects of intracellular lactate and associated acidosis on muscle function, that might explain the elevated presence of SCT carriers among the best sprinters. Full article
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10 pages, 789 KiB  
Article
Characterization of Individualized Glycemic Excursions during a Standardized Bout of Hypoglycemia-Inducing Exercise and Subsequent Hypoglycemia Treatment—A Pilot Study
by Jan Brož, Matthew D. Campbell, Jana Urbanová, Marisa A. Nunes, Ludmila Brunerová, Dario Rahelić, Denisa Janíčková Žďárská, Arian Taniwall, Marek Brabec, Vojtěch Berka, Juraj Michalec and Jan Polák
Nutrients 2021, 13(11), 4165; https://doi.org/10.3390/nu13114165 - 21 Nov 2021
Cited by 3 | Viewed by 2316
Abstract
The glycemic response to ingested glucose for the treatment of hypoglycemia following exercise in type 1 diabetes patients has never been studied. Therefore, we aimed to characterize glucose dynamics during a standardized bout of hypoglycemia-inducing exercise and the subsequent hypoglycemia treatment with the [...] Read more.
The glycemic response to ingested glucose for the treatment of hypoglycemia following exercise in type 1 diabetes patients has never been studied. Therefore, we aimed to characterize glucose dynamics during a standardized bout of hypoglycemia-inducing exercise and the subsequent hypoglycemia treatment with the oral ingestion of glucose. Ten male patients with type 1 diabetes performed a standardized bout of cycling exercise using an electrically braked ergometer at a target heart rate (THR) of 50% of the individual heart rate reserve, determined using the Karvonen equation. Exercise was terminated when hypoglycemia was reached, followed by immediate hypoglycemia treatment with the oral ingestion of 20 g of glucose. Arterialized blood glucose (ABG) levels were monitored at 5 min intervals during exercise and for 60 min during recovery. During exercise, ABG decreased at a mean rate of 0.11 ± 0.03 mmol/L·min−1 (minimum: 0.07, maximum: 0.17 mmol/L·min−1). During recovery, ABG increased at a mean rate of 0.13 ± 0.05 mmol/L·min−1 (minimum: 0.06, maximum: 0.19 mmol/L·min−1). Moreover, 20 g of glucose maintained recovery from hypoglycemia throughout the 60 min postexercise observation window. Full article
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9 pages, 1823 KiB  
Article
Acute Low-Intensity Treadmill Running Upregulates the Expression of Intestinal Glucose Transporters via GLP-2 in Mice
by Kai Aoki, Takuji Suzuki, Fang Hui, Takuro Nakano, Koki Yanazawa, Masato Yonamine, Shinichiro Fujita, Takehito Sugasawa, Yasuko Yoshida, Naomi Omi, Yasushi Kawakami and Kazuhiro Takekoshi
Nutrients 2021, 13(5), 1735; https://doi.org/10.3390/nu13051735 - 20 May 2021
Cited by 3 | Viewed by 3336
Abstract
The effects of exercise on nutrient digestion and absorption in the intestinal tract are not well understood. A few studies have reported that exercise training increases the expression of molecules involved in carbohydrate digestion and absorption. Exercise was also shown to increase the [...] Read more.
The effects of exercise on nutrient digestion and absorption in the intestinal tract are not well understood. A few studies have reported that exercise training increases the expression of molecules involved in carbohydrate digestion and absorption. Exercise was also shown to increase the blood concentration of glucagon-like peptide-2 (GLP-2), which regulates carbohydrate digestion and absorption in the small intestine. Therefore, we investigated the effects of exercise on the expression of molecules involved in intestinal digestion and absorption, including GLP-2. Six-week-old male mice were divided into a sedentary (SED) and low-intensity exercise (LEx) group. LEx mice were required to run on a treadmill (12.5 m/min, 1 h), whereas SED mice rested. All mice were euthanized 1 h after exercise or rest, and plasma, jejunum, ileum, and colon samples were collected, followed by analysis via IHC, EIA, and immunoblotting. The levels of plasma GLP-2 and the jejunum expression of the GLP-2 receptor, sucrase-isomaltase (SI), and glucose transporter 2 (GLUT2) were higher in LEx mice. Thus, we showed that acute low-intensity exercise affects the expression of molecules involved in intestinal carbohydrate digestion and absorption via GLP-2. Our results suggest that exercise might be beneficial for small intestine function in individuals with intestinal frailty. Full article
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Review

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11 pages, 733 KiB  
Review
Concepts of Lactate Metabolic Clearance Rate and Lactate Clamp for Metabolic Inquiry: A Mini-Review
by Chi-An W. Emhoff and Laurent A. Messonnier
Nutrients 2023, 15(14), 3213; https://doi.org/10.3390/nu15143213 - 20 Jul 2023
Cited by 1 | Viewed by 1941
Abstract
Lactate is known to play a central role in the link between glycolytic and mitochondrial oxidative metabolism, as well as to serve as a primary gluconeogenic precursor. Blood lactate concentration is sensitive to the metabolic state of tissues and organs as lactate rates [...] Read more.
Lactate is known to play a central role in the link between glycolytic and mitochondrial oxidative metabolism, as well as to serve as a primary gluconeogenic precursor. Blood lactate concentration is sensitive to the metabolic state of tissues and organs as lactate rates of appearance and disposal/disappearance in the circulation rise and fall in response to physical exercise and other metabolic disturbances. The highest lactate flux rates have been measured during moderate intensity exercise in endurance-trained individuals who exhibit muscular and metabolic adaptations lending to superior oxidative capacity. In contrast, a diminished ability to utilize lactate is associated with poor metabolic fitness. Given these widespread implications in exercise performance and health, we discuss the concept of lactate metabolic clearance rate, which increases at the onset of exercise and, unlike flux rates, reaches a peak just below the power output associated with the maximal lactate steady state. The metabolic clearance rate is determined by both disposal rate and blood concentration, two parameters that are mutually interdependent and thus difficult to parse during steady state exercise studies. We review the evolution of the in vivo lactate clamp methodology to control blood lactate concentration and discuss its application in the investigation of whole-body lactate disposal capacities. In conclusion, we assert that the lactate clamp is a useful research methodology for examining lactate flux, in particular the factors that drive metabolic clearance rate. Full article
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22 pages, 382 KiB  
Review
Toward an Integrated Consideration of 24 h Movement Guidelines and Nutritional Recommendations
by Elora Fournier, Edyta Łuszczki, Laurie Isacco, Emilie Chanséaume-Bussiere, Céline Gryson, Claire Chambrier, Vicky Drapeau, Jean-Philippe Chaput and David Thivel
Nutrients 2023, 15(9), 2109; https://doi.org/10.3390/nu15092109 - 27 Apr 2023
Cited by 4 | Viewed by 1496
Abstract
While physical activity, sleep and sedentary behaviors are almost always considered independently, they should be considered as integrated human behaviors. The 24 h Movement approach proposes a concomitant consideration of these behaviors to promote overall health. Not only do these behaviors impact energy [...] Read more.
While physical activity, sleep and sedentary behaviors are almost always considered independently, they should be considered as integrated human behaviors. The 24 h Movement approach proposes a concomitant consideration of these behaviors to promote overall health. Not only do these behaviors impact energy expenditure, but they have also been shown to separately impact energy intake, which should be further explored when considering the entire integration of these movement behaviors under the 24 h movement approach. After an evaluation of the prevalence of meeting the 24 h Movement and dietary recommendations, this review summarizes the available evidence (using English publications indexed in PubMed/MEDLINE) regarding the association between the 24 h Movement Guidelines and eating habits. Altogether, the results clearly show the beneficial impact of promoting the 24 h guidelines simultaneously, highlighting that the higher the number of respected movement recommendations, the better eating behaviors in both children and adults. Importantly, our results point out the importance of emphasizing the need to reach sedentary guidelines for better eating habits. Movement and dietary behaviors appear closely related, and giving recommendations on one might impact the other. Combining the 24 h Movement with dietary Guidelines might be more efficient than promoting them separately in public health strategies. Full article
43 pages, 4741 KiB  
Review
Beyond the Calorie Paradigm: Taking into Account in Practice the Balance of Fat and Carbohydrate Oxidation during Exercise?
by Jean-Frédéric Brun, Justine Myzia, Emmanuelle Varlet-Marie, Eric Raynaud de Mauverger and Jacques Mercier
Nutrients 2022, 14(8), 1605; https://doi.org/10.3390/nu14081605 - 12 Apr 2022
Cited by 14 | Viewed by 105603
Abstract
Recent literature shows that exercise is not simply a way to generate a calorie deficit as an add-on to restrictive diets but exerts powerful additional biological effects via its impact on mitochondrial function, the release of chemical messengers induced by muscular activity, and [...] Read more.
Recent literature shows that exercise is not simply a way to generate a calorie deficit as an add-on to restrictive diets but exerts powerful additional biological effects via its impact on mitochondrial function, the release of chemical messengers induced by muscular activity, and its ability to reverse epigenetic alterations. This review aims to summarize the current literature dealing with the hypothesis that some of these effects of exercise unexplained by an energy deficit are related to the balance of substrates used as fuel by the exercising muscle. This balance of substrates can be measured with reliable techniques, which provide information about metabolic disturbances associated with sedentarity and obesity, as well as adaptations of fuel metabolism in trained individuals. The exercise intensity that elicits maximal oxidation of lipids, termed LIPOXmax, FATOXmax, or FATmax, provides a marker of the mitochondrial ability to oxidize fatty acids and predicts how much fat will be oxidized over 45–60 min of low- to moderate-intensity training performed at the corresponding intensity. LIPOXmax is a reproducible parameter that can be modified by many physiological and lifestyle influences (exercise, diet, gender, age, hormones such as catecholamines, and the growth hormone-Insulin-like growth factor I axis). Individuals told to select an exercise intensity to maintain for 45 min or more spontaneously select a level close to this intensity. There is increasing evidence that training targeted at this level is efficient for reducing fat mass, sparing muscle mass, increasing the ability to oxidize lipids during exercise, lowering blood pressure and low-grade inflammation, improving insulin secretion and insulin sensitivity, reducing blood glucose and HbA1c in type 2 diabetes, and decreasing the circulating cholesterol level. Training protocols based on this concept are easy to implement and accept in very sedentary patients and have shown an unexpected efficacy over the long term. They also represent a useful add-on to bariatric surgery in order to maintain and improve its weight-lowering effect. Additional studies are required to confirm and more precisely analyze the determinants of LIPOXmax and the long-term effects of training at this level on body composition, metabolism, and health. Full article
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14 pages, 334 KiB  
Review
Plasma Free Fatty Acid Concentration as a Modifiable Risk Factor for Metabolic Disease
by Gregory C. Henderson
Nutrients 2021, 13(8), 2590; https://doi.org/10.3390/nu13082590 - 28 Jul 2021
Cited by 54 | Viewed by 5521
Abstract
Plasma free fatty acid (FFA) concentration is elevated in obesity, insulin resistance (IR), non-alcoholic fatty liver disease (NAFLD), type 2 diabetes (T2D), and related comorbidities such as cardiovascular disease (CVD). Furthermore, experimentally manipulating plasma FFA in the laboratory setting modulates metabolic markers of [...] Read more.
Plasma free fatty acid (FFA) concentration is elevated in obesity, insulin resistance (IR), non-alcoholic fatty liver disease (NAFLD), type 2 diabetes (T2D), and related comorbidities such as cardiovascular disease (CVD). Furthermore, experimentally manipulating plasma FFA in the laboratory setting modulates metabolic markers of these disease processes. In this article, evidence is presented indicating that plasma FFA is a disease risk factor. Elevations of plasma FFA can promote ectopic lipid deposition, IR, as well as vascular and cardiac dysfunction. Typically, elevated plasma FFA results from accelerated adipose tissue lipolysis, caused by a high adipose tissue mass, adrenal hormones, or other physiological stressors. Reducing an individual’s postabsorptive and postprandial plasma FFA concentration is expected to improve health. Lifestyle change could provide a significant opportunity for plasma FFA reduction. Various factors can impact plasma FFA concentration, such as chronic restriction of dietary energy intake and weight loss, as well as exercise, sleep quality and quantity, and cigarette smoking. In this review, consideration is given to multiple factors which lead to plasma FFA elevation and subsequent disruption of metabolic health. From considering a variety of medical conditions and lifestyle factors, it becomes clear that plasma FFA concentration is a modifiable risk factor for metabolic disease. Full article

Other

10 pages, 603 KiB  
Opinion
What the Lactate Shuttle Means for Sports Nutrition
by George A. Brooks
Nutrients 2023, 15(9), 2178; https://doi.org/10.3390/nu15092178 - 03 May 2023
Cited by 4 | Viewed by 4253
Abstract
The discovery of the lactate shuttle (LS) mechanism may have two opposite perceptions, It may mean very little, because the body normally and inexorably uses the LS mechanism. On the contrary, one may support the viewpoint that understanding the LS mechanism offers immense [...] Read more.
The discovery of the lactate shuttle (LS) mechanism may have two opposite perceptions, It may mean very little, because the body normally and inexorably uses the LS mechanism. On the contrary, one may support the viewpoint that understanding the LS mechanism offers immense opportunities for understanding nutrition and metabolism in general, as well as in a sports nutrition supplementation setting. In fact, regardless of the specific form of the carbohydrate (CHO) nutrient taken, the bodily CHO energy flux is from a hexose sugar glucose or glucose polymer (glycogen and starches) to lactate with subsequent somatic tissue oxidation or storage as liver glycogen. In fact, because oxygen and lactate flow together through the circulation to sites of utilization, the bodily carbon energy flow is essentially the lactate disposal rate. Consequently, one can consume glucose or glucose polymers in various forms (glycogen, maltodextrin, potato, corn starch, and fructose or high-fructose corn syrup), and the intestinal wall, liver, integument, and active and inactive muscles make lactate which is the chief energy fuel for red skeletal muscle, heart, brain, erythrocytes, and kidneys. Therefore, if one wants to hasten the delivery of CHO energy delivery, instead of providing CHO foods, supplementation with lactate nutrient compounds can augment body energy flow. Full article
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17 pages, 2825 KiB  
Systematic Review
Effects of Acute Heat and Cold Exposures at Rest or during Exercise on Subsequent Energy Intake: A Systematic Review and Meta-Analysis
by Juliette Millet, Julien Siracusa, Pierre-Emmanuel Tardo-Dino, David Thivel, Nathalie Koulmann, Alexandra Malgoyre and Keyne Charlot
Nutrients 2021, 13(10), 3424; https://doi.org/10.3390/nu13103424 - 28 Sep 2021
Cited by 5 | Viewed by 3573
Abstract
The objective of this meta-analysis was to assess the effect of acute heat/cold exposure on subsequent energy intake (EI) in adults. We searched the following sources for publications on this topic: PubMed, Ovid Medline, Science Direct and SPORTDiscus. The eligibility criteria for study [...] Read more.
The objective of this meta-analysis was to assess the effect of acute heat/cold exposure on subsequent energy intake (EI) in adults. We searched the following sources for publications on this topic: PubMed, Ovid Medline, Science Direct and SPORTDiscus. The eligibility criteria for study selection were: randomized controlled trials performed in adults (169 men and 30 women; 20–52 years old) comparing EI at one or more meals taken ad libitum, during and/or after exposure to heat/cold and thermoneutral conditions. One of several exercise sessions could be realized before or during thermal exposures. Two of the thirteen studies included examined the effect of heat (one during exercise and one during exercise and at rest), eight investigated the effect of cold (six during exercise and two at rest), and three the effect of both heat and cold (two during exercise and one at rest). The meta-analysis revealed a small increase in EI in cold conditions (g = 0.44; p = 0.019) and a small decrease in hot conditions (g = −0.39, p = 0.022) for exposure during both rest and exercise. Exposures to heat and cold altered EI in opposite ways, with heat decreasing EI and cold increasing it. The effect of exercise remains unclear. Full article
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