Energy Metabolism and Nutrient Absorption in Lean and Obese Individuals
Condition: Obesity
MeSH terms: Obesity
Study type: Observational

Summary: 
      This study will examine whether there are differences in energy (calories) losses in stool
      and urine between lean and obese people. People gain weight when the amount of calories in
      the food they eat is greater than the amount of calories their body uses to support its
      functions and activities. The balance between caloric intake and expenditure may be affected
      by the amount of calories from food that is not absorbed but is lost in stool and urine. This
      study will examine whether differences in food absorption are related to obesity.

      Healthy normal volunteers between 18 and 45 years of age with a body mass index (BMI) of
      18-25 kg/m2 or less than 35 kg/m2 may be eligible for this 15-day study. Participants are
      admitted to the Clinical Research Unit at the Phoenix Indian Medical Center for the study.

      Participants undergo the following tests and procedures:

        -  Experimental diets with dye marker: Subjects are fed a 2400-calorie diet and a
           3400-calorie diet for 3 days each. On the first of the day of each diet, a blue dye
           marker is added to the breakfast meal. A red marker is added to the breakfast meal of
           the first day after the diet period. Urine is collected beginning after breakfast on the
           first day of the diet and until before breakfast on the last day of the diet. Stool
           samples are collected during the entire diet period, and until the appearance of the red
           dye in the stool.

        -  24-hour metabolic rate in the respiratory chamber: After the first diet period, subjects
           spend 24 hours in a respiratory chamber to measure the number of calories the body burns
           a day and to assess the energy balance between intake and expenditure.

        -  Stool sample: Stool samples are collected on days 1 and 2 of the study to look for
           parasites or internal bleeding that may affect nutrient absorption.

        -  DXA scanning: This scan uses a low dose of X-rays to measure body fat.

        -  Oral glucose tolerance test: For this test for diabetes, an I.V. line (needle attached
           to a small plastic tube) is inserted into an arm vein. The subject drinks a sugar
           solution. Small blood samples are drawn from the I.V. before the subject drinks the
           solution and at five intervals during the 3 (Omega)-hour test period.

        -  Fasting blood tests: On the first day of each diet and on the day after each diet is
           completed a blood sample is drawn before breakfast to measure hormones that may affect
           the ability to absorb food.

      At the end of the study, some participants may be asked to repeat the experimental diets and
      stool and urine collections.

      ...
    

Detailed description: 
      The prevalence of obesity has risen to epidemic proportions in the world, resulting from both
      excessive energy intake and low levels of energy expenditure. The effect of nutrient
      absorption on energy balance, that is, the relative amount of nutrients consumed vs. the
      amount excreted in stool, has been reported only in small studies in which energy waste in
      feces and urine between lean and obese individuals was not found to be different. However,
      these studies were limited by small sample sizes and were not specifically designed to
      examine whether stool energy loss varied between lean and obese individuals. In addition,
      little is known about the reproducibility of the measurements of energy loss in stool and
      urine. We propose to investigate (i) whether there are significant differences in energy loss
      (as measured in stool and urine) between obese and lean individuals, and (ii) to examine the
      reproducibility of these measurements. Because the literature suggests a role for enteric
      bacterial flora in obesity, we will also examine differences in such flora between these
      groups. We plan to study 25 obese and 25 lean healthy non-smoking Caucasian men age 18 - 45
      years old, not taking any medications (including medications for weight loss, antibiotics or
      probiotics) for the examination of differences in nutrient energy loss. Of these subjects, 10
      lean and 10 obese individuals will be invited to repeat the study to test the reproducibility
      of these measurements. All participants will be admitted to the Clinical Research Unit for 15
      days. During their stay, subjects will be fed a weight maintaining diet for 3 days, followed
      in a random cross-over design by two experimental diets: a 2400 kcal/d or 3400 kcal/d diet
      for 3 days. Twenty four-hour urine and feces collections will take place each day of the
      experimental diet period. The energy content of these waste products as well as that of the
      diet (using duplicate plate analysis) will be measured by bomb calorimetry. Bacterial
      components in feces will be extracted by repeated fractional centrifugation to obtain
      bacterial mass and by using 16S rDNA-based oligonucleotide probes to obtain bacterial flora.
      Primary results will examine the differences in energy loss between lean and obese
      individuals as well as the reproducibility of the measurements of stool and urine energy
      content.
    

Keywords: Fecal Energy; Urine Energy; Bomb Calorimetry; Gut Maintenance Flora; Obesity; Energy Metabolism