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Updated: Aug 11, 2026

Using a Combination of Indirect Calorimetry, Infrared Thermography, and Blood Glucose Levels to Measure Brown Adipose Tissue Thermogenesis in Humans
Published on: June 2, 2023
Association between fasting substrate utilization and adipose tissue distribution
Andrea Foppiani1, Federica Sileo1, Francesca Menichetti2
1Department of Food, Environmental and Nutritional Sciences (DeFENS), International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), University of Milan, Milan, 20133, Italy; Department of Endocrine and Metabolic Diseases, IRCCS Auxologico, Clinical Nutrition Unit, Milan, 20145, Italy.
Higher fasting glucose oxidation, indicated by respiratory exchange ratio (RER), is linked to more visceral fat and less subcutaneous fat in normal-weight individuals. This suggests RER may predict metabolic risk before obesity develops.
Area of Science:
- Metabolic Health
- Body Composition Analysis
- Nutritional Physiology
Background:
- Metabolic flexibility is vital for maintaining health.
- Reduced fatty acid utilization is linked to obesity, but its role in fat distribution among non-obese individuals is not well understood.
- Understanding substrate utilization patterns is key to identifying metabolic dysfunction.
Purpose of the Study:
- To investigate the association between fasting substrate utilization (respiratory exchange ratio - RER) and abdominal fat distribution (visceral and subcutaneous adipose tissue).
- To examine these relationships across different Body Mass Index (BMI) categories.
- To identify potential early markers of metabolic risk.
Main Methods:
- Retrospective analysis of 15,022 participants.
- Fasting respiratory exchange ratio (RER) measured by indirect calorimetry to determine metabolic phenotype (Predominant Fat Oxidation vs. Predominant Glucose Oxidation).
- Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) assessed via ultrasound, with adjustments for age, sex, and menopausal status.
Main Results:
- In underweight/normal weight individuals, predominant glucose oxidation (higher RER) was significantly associated with higher VAT and lower SAT compared to predominant fat oxidation.
- A similar trend was observed in overweight individuals, though attenuated.
- In obese individuals, predominant glucose oxidation was linked to lower overall body fat, suggesting a different metabolic profile.
Conclusions:
- A higher fasting RER, indicating predominant glucose oxidation, is associated with unfavorable abdominal fat distribution (increased visceral fat, decreased subcutaneous fat), particularly in normal-BMI individuals.
- Fasting RER may serve as a non-invasive indicator of metabolic risk and ectopic fat deposition.
- Further research is warranted to explore RER's potential as an early diagnostic tool for metabolic disturbances preceding obesity.
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