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24-h energy expenditure in people with type 1 diabetes: impact on equations for clinical estimation of energy expenditure



Type 1 diabetes (T1D) is associated with an increase in resting metabolic rate (RMR), but the impact of T1D on other components of 24-h energy expenditure (24-h EE) is not known. Also, there is a lack of equations to estimate 24-h EE in patients with T1D. The aims of this analysis were to compare 24-h EE and its components in young adults with T1D and healthy controls across the spectrum of body mass index (BMI) and derive T1D-specific equations from clinical variables.


Thirty-three young adults with T1D diagnosed ≥1 year prior and 33 healthy controls matched for sex, age and BMI were included in this analysis. We measured 24-h EE inside a whole room indirect calorimeter (WRIC) and body composition with dual x-ray absorptiometry.


Participants with T1D had significantly higher 24-h EE than healthy controls (T1D = 2047 ± 23 kcal/day vs control= 1908 ± 23 kcal/day; P < 0.01). We derived equations to estimate 24-h EE with both body composition (fat free mass + fat mass) and anthropometric (weight + height) models, which provided high coefficients of determination (R2 = 0.912 for both). A clinical model that did not incorporate spontaneous physical activity yielded high coefficients of determination as well (R2 = 0.897 and R2 = 0.880 for body composition and anthropometric models, respectively).


These results confirm that young adults with established T1D have increased 24-h EE relative to controls without T1D. The derived equations from clinically available variables can assist clinicians with energy prescriptions for weight management in patients with T1D.

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Fig. 1: Differences in energy expenditure, substrate oxidation and physical activity between young adults with type 1 diabetes and healthy control matches assessed inside a whole room indirect calorimeter (WRIC).
Fig. 2: Concordance and agreement of anthropometric and body composition energy expenditure models for people with Type 1 diabetes.

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Data can be available upon reasonable request and approval of the principal investigator of each study involved in this publication.


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We sincerely thank to Christopher P. Bock for his help running the WRIC studies.


The main dataset of this analysis was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113358). Additionally, a data subset was funded by Eli Lilly and Company (NCT02211586), NIDDK (R01DK105829) and Nutrition Sciences Initiative (NCT01967563).

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EAC and REP were involved in the conception, design and the analysis and interpretation of the results. EAC wrote the first draft of the manuscript, and all authors edited, reviewed, and approved the final version of the manuscript. REP is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Elvis A. Carnero.

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All procedures were approved by AdventHealth Institutional Review Board which follows the Declaration of Helsinki for medical research involving human subjects.

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Carnero, E.A., Corbin, K.D., Casu, A. et al. 24-h energy expenditure in people with type 1 diabetes: impact on equations for clinical estimation of energy expenditure. Eur J Clin Nutr (2024).

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