van Marken Lichtenbelt · The New England journal of medicine 2009 · Non-randomized cross-sectional physiological trial · n=24

Cold-activated brown adipose tissue in healthy men.

Cited 3475 times in the scientific literature.

Level 3 - non-randomized controlled study

Non-randomized physiological controlled study comparing lean and overweight/obese cohorts under controlled temperature exposures.

PubMed 19357405 · doi:10.1056/NEJMoa0808718 · record verified 2026-08-27

What was done

Researchers evaluated 24 healthy men (10 lean with BMI < 25, and 14 overweight or obese with BMI ≥ 25) to determine the presence, distribution, and activity of brown adipose tissue (BAT). Participants were examined under thermoneutral conditions (22°C) and during mild cold exposure (16°C). BAT activity was measured using integrated 18F-fluorodeoxyglucose positron-emission tomography and computed tomography (18F-FDG PET-CT), body composition via dual-energy x-ray absorptiometry (DEXA), and energy expenditure via indirect calorimetry.

What was found

BAT activity was detected in 23 of the 24 participants (96%) during cold exposure, but was undetectable under thermoneutral conditions. BAT activity was significantly lower in overweight or obese men compared to lean men (P = 0.007). In addition, BAT activity correlated negatively with BMI and body fat percentage, and correlated positively with resting metabolic rate.

Why it matters

This study provided definitive evidence that functional brown adipose tissue is prevalent and cold-inducible in adult humans, rather than restricted to infants, while establishing that its activity is blunted in obesity.

Limits

The study had a small sample size (n = 24) and included only young male participants, limiting generalizability to women and older demographics. Long-term metabolic outcomes were not evaluated.

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