How is energy used? Metabolic flexibility is the body's ability to adjust to changes in energy, and it plays an important role in people with diabetes and obesity.
? There are two key approaches: hyperinsulinemic-euglycemic clamps — currently considered the gold standard — and whole-room indirect calorimetry. Both methods center on substrate challenges to evaluate transition from fasting to fed state .determined state of hyperinsulinemia, followed by infusing a variable amount of glucose to maintain euglycemia.
With whole-room indirect calorimetry, the traditional approach evaluates the change in RER from fasting to fed stimulated conditions, similar to the indirect calorimetry performed during clamps. But the meal challenge is more physiologic than the glucose infusion during a clamp, and the of whole-room calorimeters for evaluating RER leads to a more reliable assessment of substrate oxidation.of RER from fasted to fed states at various times of the day using 24-hour whole-room indirect calorimetry to reveal the comprehensive dynamics of metabolic flexibility. Currently, there are no reliable clinically accessible diagnostics for metabolic inflexibility, although there are commercial products and programs that purport the ability to test and treat metabolic flexibility.
that improve insulin sensitivity also improve fuel utilization and, thus, metabolic flexibility. These include exercise and caloric restriction .to improve metabolic flexibility by targeting key players in metabolism such as AMP-activated protein kinase, sirtuins, mammalian target of rapamycin , and peroxisome proliferator–activated receptors .
Viewing energy metabolism as a linear energy-in/energy-out paradigm excludes the journey that energy takes within the body as it is used. Although the efficiency and appropriateness of this journey may not affect body weight directly, it is an important consideration for metabolic health.
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