Energy balance and body weight are sustained in health by the consumption of dietary energy (calories) in an amount equal to the daily expenditure of energy. Simply put, undernutrition results from the intake or absorption of fewer calories than energy spent, and overnutrition represents less expenditure of energy than calories consumed.
In healthy individuals, daily total energy expenditure (TEE) is composed of basal or resting energy expenditure (REE, about 60% of total), the thermic cost of digestion (about 10% of total), and modest physical activity (about 30% of total). The REE represents the cost of all intrinsic metabolic reactions and is directly related to the fat-free mass (FFM) of the body. The human body stores about 15 to 25% of its energy as fat (greater in women than men), which is available for the release of stored fatty acids during starvation. The remaining FFM is composed of extracellular and intracellular water, the bony skeleton, glycogen, and skeletal and visceral protein. Aside from body fat, energy reserves are also provided by intracellular glycogen and protein, which, together with intracellular water, constitute the body cell mass (BCM). Thus, in addition to the enzymes that support the normal metabolic machinery of the body, the BCM provides reserve protein for energy production by gluconeogenesis during the stress response.
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