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Antioxidants?
Which of the following is an antioxidant?
Vitamin E
Vitamin B
Calcium


 
 
 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.


References

1. Devlin MJ, Walsh T. Kral J. Heymsfield SB, Pi-Sunyer FX. Metabolic abnormalities in bulimia nervosa. Arch Gen Psych 1990;47:144-8.

2. Golay A, Schutz Y. Meyer HU, Thiebaud D, Curchod B. et al. Glucose induced therrnogenesis in nondiabetic and diabetic obese subjects. Diabetes 1982;11:1023-8.

3. Grunfeld C, Pang M, Shimizu L, Shigenaga JK, Jensen P. Feingold KR. Resting energy expenditure, caloric intake, and short-term change in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Am J Clin Nutr 1992;55:455-60.

4. Heshka S. Yang MU, Wang J. Burt P. Pi-Sunyer FX. Weight loss and change in resting metabolic rate. Am J Clin Nutr 1990;52:981-6.

5. Kern KA, Norton JA. Cancer cachexia. J Parenter Ent Nutr 1988;12:286-98.

6. Keys A, Brozek J. Henschel A, Mickelsen O. Taylor HL. Human starvation. Minneapolis: University of Minnesota Press, 1951.

7. Knox LS, Crosby LO, Feurer ID, et al. Energy expenditure in malnourished cancer patients. Ann Surg 1983;197:152 61.

8. Macallan DC, Noble C, Baldwin C, Jebb SA, Prentice AM, et al. Energy expenditure and wasting in human immunodeficiency virus infection. N Engl J Med 1995;333:83-8.

9. Ravussin E, LillioJa S. Anderson TE, Christin L, Bogardus C. Determinants of 24-hour energy expenditure in man. J Clin Invest 1986;78: 1568-78.

10. Roubenoff R. Roubenoff RA, Cannon JG, Kehayias JJ, Shuang H. Dawson-Hughes B. Dinarello CA, Rosenberg IH. Rheumatoid cachexia: cytokine-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest 1994;93:2379-86.

11. Segal KR, Gutin B. Nyman AM, Pi-Sunyer FX. Thermic effect of food at rest, during exercise, and after exercise in lean and obese men of similar body weight. J Clin Invest 1985;76:1107-12. 12. Segal KR, Albu J. Chun A, Edano A, Legaspi B. Pi-Sunyer FX. Independent effects of obesity and insulin resistance on postprandial thermogenesis in men. J Clin Invest 1992;89:824-33.

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