Implications of nonshivering thermogenesis for energy balance regulation in humans.

The incidence of the metabolic syndrome has reached epidemic levels in the western world. With respect to the energy balance most attention has been given to reducing energy (food) intake. Increasing energy expenditure is an important alternative strategy. Facultative thermogenesis, which is the increase in energy expenditure in response to cold or diet, may be an effective way to affect the energy balance. The recent identification of functional brown adipose tissue (BAT) in adult humans promoted a renewed interest in non-shivering thermogenesis (NST). The purpose of this review is to highlight the recent insight in NST, general aspects of its regulation, the major tissues involved and its metabolic consequences. Sustainable NST in adult humans amounts to 15 percent of the average daily energy expenditure. Calculations based on the limited available literature show that BAT thermogenesis can amount up to 5% of the basal metabolic rate. It is likely that at least a substantial part of NST can be attributed to BAT, but it is possible that other tissues contribute to NST. Several studies on mitochondrial uncoupling indicate that skeletal muscle is another potential contributor to facultative thermogenesis in humans. The general and synergistic role of the sympathetic nervous system and the thyroid axis in relation to NST is discussed. Finally future perspectives on BAT and skeletal muscle NST are given