References: Ward et al, 1999

Am J Clin Nutr. 1999 May;69(5):913-9.
Energy expenditure and substrate utilization in adults with cystic fibrosis and diabetes mellitus.
Ward SA, Tomezsko JL, Holsclaw DS, Paolone AM.
Pediatric Pulmonary Center, Hahnemann University Hospital, Philadelphia, USA. sward@vger.nsu.edu
Abstract
BACKGROUND: The onset of cystic fibrosis-related diabetes mellitus (CFDM) is often associated with a decline in clinical and nutritional status.
OBJECTIVE: The purpose of this study was to characterize energy expenditure (EE) and substrate utilization during rest, exercise, and recovery from exercise in patients with CF diagnosed with diabetes mellitus.
DESIGN: EE, substrate utilization, minute ventilation, tidal volume, and respiratory rate were calculated by indirect calorimetry durng rest; a 30-min, low-to-medium-intensity exercise bout on a treadmill; and a 45-min postexercise recovery period (in reclining position) in 10 CF, 7 CFDM, and 10 control subjects between 18 and 45 y of age.
RESULTS: In all 3 periods, minute ventilation was higher in the CF and CFDM groups than in the control subjects (P < 0.01). During rest and exercise, the CF and CFDM groups maintained EE values at the high end of the normal range of the control subjects. However, during recovery, EE was higher in the CF and CFDM groups than in the control group (P < 0.01).
CONCLUSIONS: EE may be higher than usual for the patients with CF and CFDM during periods of recovery from mild exercise or activity because of increased work of breathing consistent with higher ventilatory requirements. This information may be useful for patients receiving nutritional counseling who may choose to exercise regularly, but are concerned about possible weight loss.

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