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 Dietary Supplements: Modifiers of Metabolism: Overnutrition, Undernutrition, and Disease States 
F. Pi-Sunyer, Xavier MD, MPH ©

Surgery and Trauma
Energy expenditure is increased in response to surgery and trauma. The stress that occurs leads to increased levels of catecholamines, cortisol, and glucagon. These, particularly catecholamines, are thermogenic hormones. Also, some cytokine effects lead to fever and anorexia. Energy expenditure tends to be increased proportionate to the degree of injury. A catabolic response occurs that can rapidly deplete muscle mass, again mediated by hormonal response to injury.

Pulmonary Disease
Patients with chronic obstructive pulmonary disease and emphysema tend to be very thin. Studies that have been published on their RMR suggest that it is elevated. This has been ascribed to the increased energy cost of breathing. TEA is decreased in these patients because of their difficulty breathing. Therefore, generally, their total 24-hour energy expenditure may be low, normal, or high, depending on the balance between these two conditions.

Diabetes Mellitus
When diabetes is out of control, with high fasting and postprandial blood glucose levels, energy expenditure is increased above the predicted level for the individual because of an increased RMR. Such an increased RMR has been ascribed primarily to the protein catabolism that occurs in this condition. The protein that is broken down needs to be replaced so that protein synthesis can be increased. This increased protein turnover is metabolically costly and raises the energy expenditure, which returns to normal with diet and drug therapy, as glucose metabolism comes under control.


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