Original articleRelation between body mass index and resting metabolic rate, cardiorespiratory fitness and insulin sensitivity in Sasang typology for young male persons: An observational study
Introduction
The prevalence of obesity has increased dramatically worldwide which has brought the global burden of obesity-linked health problems such as cardiovascular diseases and metabolic disorders [1]. It has been suggested that the imbalance of energy intake and energy expenditure (EE) in the long term determines the tendency to gain or lose weight [2]. Preliminary work on human EE has demonstrated that the obese individuals have lower EE per unit of body composition, which consequently may be a trigger for weight gain [3], [4]. This leads to a plausible concept of metabolic efficiency, in which a more efficient metabolism refers to a tendency to store absorbed energy component as fat rather than to dissipate it by heat, whereas those who have a less efficient metabolism are prone to burn calories as heat. A previous twin study demonstrated that individuals may differ in metabolic efficiency [5]. Total EE is composed of three components, the resting metabolic rate (RMR) which refers to the energy needed to remain the body functions at rest and which accounts for 60–80% of the total EE [6], the thermic effect of food (TEF) which is defined as the increase of RMR induced by food consumption and which accounts for 10% of the total EE [7], and the energy cost of physical activity. Numerous studies focusing on RMR and TEF have attempted to explain the role of low EE in obesity and found the reduction in RMR and TEF in obese individuals [8], [9], [10], [11], [12], [13].
Evidence showed that low physical activity is a good predictor of metabolic syndrome [14], [15] and increase of physical activities may bring health benefits even if the obesity remains [16]. Cardiorespiratory fitness (CRF) measured by an indirect calorimeter has been the most objective and reproducible method for the evaluation of physical activity [17].
Individual differences in obesity and physical activities have been suggested to be partially determined by genetic factors. Studies revealed that genetic propensity accounted for 70% of the variability of body mass index (BMI) [18] and this heritability in association with the FTO gene may increase throughout the childhood due to the interaction with selecting obesogenic environments [19]. A twin study reported that physical activity levels were significantly determined by genetic factors, especially in males, and that may be due to inherited motor and somatic features [20].
Sasang typology, the so-called Sasang Constitutional Medicine (SCM) – a unique form of traditional Korean medicine, classifies humans into four constitutions: TaeYang (TY), TaeEum (TE), SoEum (SE), and SoYang (SY) types. These types differ in terms of (i) sensitivity to certain groups of herbs and medicines, (ii) equilibrium among internal organic functions, (iii) physical features, and (iv) psychological characteristics [21]. It has been hypothesized that two main axes in the physiopathology of Sasang typology, namely food intake/waste discharge and consuming/storing Qi and body fluids, are equivalent to the processes of internal–external exchange and catabolism/anabolism in modern physiology, respectively [22]. Accordingly, the TE type which is susceptible to obesity and metabolic disorders [23], [24] was assumed to have low EE, whereas the SE type was considered to have a poor food intake state. So far, however, there have been no studies which used objective and reliable methods such as indirect calorimeters to examine the characteristics of EE in Sasang typology. A few studies using indirect calorimeters to examine the physical fitness in Sasang typology have provided ambiguous results [25], [26]. This discrepancy may be due to the heterogeneity of participant's characteristics of age, gender, and habitual physical activities.
Different anthropometric profiles which include weight, fat mass, and BMI [27], [28] are the factors which determine the distinctive characteristics of Sasang types. BMI is accepted as the most practical predictor for obesity-related health risks, but its effect varies between individuals. We, therefore, assume that Sasang types differ in their metabolic profiles, physical fitness, and metabolic-related biomarkers and that the variation in the relationships between these variables and anthropometric profiles, especially BMI, is contributed by Sasang typology.
The aim of this study, therefore, was to investigate the EE profile (RMR and TEF), physical fitness (CRF), and metabolic-related biomarkers including insulin resistance across Sasang types in young Korean males. We also evaluated the association of these variables with body composition indices such as body mass index (BMI), fat and non-fat mass using Sasang perspective.
Section snippets
Participants
All male participants in their twenties who were the participants of the Sasang Constitutional Bank project from March 2009 to December 2010 and who had their Sasang types confirmed (n = 295: TY type n = 0; TE type n = 126; SY type n = 72, SE type n = 97) were selected. A total of 230 participants were recruited in 2009 and their data has been used in our previous publication [28]. All participants were recruited and their Sasang types were determined following the same protocol as described previously
Results
Of the 63 participants (TE n = 21, SE n = 20, and SY n = 22) who met the inclusion criteria and took part, 12 were excluded due to their not achieving RMR steady-state (n = 3), technical difficulties (n = 1), and a baseline RMR being higher their postprandial RMR more than 5% (n = 8). The final data comprised 51 participants (TE n = 17; SE n = 17; SY n = 17) who completed the experiment fully and were included in the analysis.
In this population, the TE type had higher body weight, BMI, FFM, BFM than those of the
Discussion
Previous research has demonstrated that the individuals’ variation of metabolic and physical capacity may be determined by inherited genetic factors [5], [20], and that metabolic efficiency and low physical fitness may be implicated in the increasing prevalence of obesity and metabolic disorders [8], [9], [10], [11], [12], [13], [14], [15]. We have assumed that Sasang types, which are believed to have genetic inherence, may have distinctive characteristic in metabolic and physical capacity [22]
Conflict of interest statement
No conflict of interest declared.
Acknowledgements
This work was supported by the National Research Foundation of Korea (NRF) and the grant funded by the Korea Ministry of Education, Science and Technology (MEST) (No. 20110027738(and by the project “Development of Standard on Constitutional Health Status” of the Korea Institute of Oriental Medicine (No. K11070).
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