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PubMed1993

Higher total energy expenditure contributes to growth faltering in breast-fed infants living in rural Mexico.

To investigate the energy requirements of infants living under unfavorable environmental conditions in rural Mexico, we measured the total energy expenditure (TEE) of 40 Otomi infants at approximately 4 or approximately 6 mo of age. Total energy expenditure was estimated by the doubly labeled water method: 100 mg 2H2O/kg and 250 mg 18O/kg were administered orally, after which urine was collected serially for 7 or 10 d. Isotopic enrichment of urine samples was analyzed by gas-isotope-ratio mass spectrometry. Weight and length were measured monthly from birth to 6 mo. Fat free mass was estimated from 18O dilution spaces. Total energy expenditures (mean +/- SD) were 310 +/- 58 and 318 +/- 29 kJ.kg-1 x d-1 at approximately 4 and approximately 6 mo, respectively. Total energy expenditure was higher than that previously observed for breast-fed infants reared under more protected environments (268 +/- 29 kJ.kg-1 x d-1). Weight, length and weight gain were 5.9 +/- 0.8 kg, 60 +/- 2 cm and 2.9 +/- 2.4 g.kg-1 x d-1 at 4.25 mo and 7.1 +/- 0.8 kg, 65 +/- 2 cm and 1.0 +/- 1.2 g.kg-1 x d-1 at 6.27 mo. Growth faltering was evident at 6 mo by clinically significant declines in growth velocities and National Center for Health Statistics Z-scores. Body fat of the Otomi infants averaged 21 +/- 6 and 18 +/- 5 g/100 g at approximately 4 and approximately 6 mo, respectively. Higher rates of TEE narrowed the margin of energy available for growth and thereby contributed to growth faltering in the Otomi infants.

Adolescent↗
PubMed2000

The diurnal rhythm of energy expenditure differs between obese and glucose-intolerant rats and streptozotocin-induced diabetic rats.

Otsuka Long Evans Tokushima Fatty (OLETF) rats were developed as a model of noninsulin-dependent diabetes mellitus (NIDDM) with mild obesity. Changes in carcass composition and in the daily profile of energy expenditure were examined before and after manifestation of diabetes (8 and 24 wk, respectively), and compared with the normal control Long Evans Tokushima (LETO) rats and streptozotocin (STZ)-induced diabetic LETO rats. OLETF rats had greater body weights than LETO rats and significantly greater absolute and relative fat weights. A diurnal rhythm of energy expenditure associated with two peaks was observed in LETO rats, but the two peaks were not apparent in OLETF rats at 24 wk of age. A diurnal rhythm associated with one peak was observed in STZ-induced diabetic LETO rats. Energy derived from fat constituted this peak; the pattern of the daily energy expenditure was significantly different from that of either nontreated LETO or OLETF rats at 24 wk of age. NIDDM in OLETF rats at 24 wk of age has only a small role in modification of the diurnal rhythm of energy expenditure, whereas STZ-induced diabetes significantly affected the rhythm.

Animals↗
PubMed2001

Energy expenditure in infants with pulmonary insufficiency: is there evidence for increased energy needs?

The observed growth failure in infants with pulmonary insufficiency is postulated to be a consequence of elevated rates of energy expenditure. Assessment of energy expenditure by the classical technique of indirect calorimetry has yielded conflicting results. The adoption of the newer, doubly labeled water technique has provided evidence to support increased rates of energy expenditure in infants with chronic lung disease, congenital heart disease and in minimally ill, extremely low birth weight infants. The doubly labeled water technique holds great promise for the detailed study of energy expenditure in a variety of clinical conditions, including very ill as well as free-living subjects.

Body Water↗
PubMed2002

Dietary intake, resting energy expenditure, weight loss and survival in cancer patients.

Anorexia, hypermetabolism and weight loss are common in advanced cancer. The progressive wasting may be due to diminished dietary intake as well as to increased energy expenditure mediated by metabolic alterations caused by the tumor. We studied dietary intake, resting energy expenditure and weight loss in 297 patients with generalized malignant disease and their relation to survival. Patients were examined cross-sectionally at entry into an outpatient palliative care program that included anti-inflammatory treatment and nutritional counseling. Survivors were studied longitudinally after 4 mo during palliative care. We found at entry that the patients' mean dietary intake was low. Weight loss of >10% was present in 43% of the patients, and hypermetabolism was present in 48%. Dietary intake did not differ between normometabolic and hypermetabolic patients, nor was tumor type or gender related to energy and protein intake. Weight loss could not be accounted for by diminished dietary intake alone. Increased resting energy expenditure was not compensated for by an increase in spontaneous food intake. These findings indicate that feedback regulation of dietary intake in relation to energy expenditure is frequently lost in patients with cancer. Hypermetabolism and weight loss were significant predictors of decreased survival. Mean survival time was about 8 mo; 189 patients survived 4 mo or more, and 153 could be reexamined. At the 4-mo follow-up during palliative care, group mean weight was nearly maintained, with large individual variations. Weight loss during follow-up predicted decreased survival. Energy intake increased slightly, also with great variation, and an increased energy intake predicted longer survival.

Cross-Sectional Studies↗
PubMed2006

Normalization of energy expenditure data for differences in body mass or composition in children and adolescents.

The most appropriate model for normalization of energy expenditure (EE) data for body mass or composition in growing children and adolescents has not been studied extensively. In this study, we investigated allometric modeling for the normalization of EE data for body mass or composition in a large cohort of children (n = 833), ages 5-19 y for a wide range of physical activities. Anthropometry was performed by standard techniques, and total body fat-free mass (FFM) and fat mass (FM) were determined by dual-energy X-ray absorptiometry (DXA). Weight status was defined as nonoverweight or overweight based on the 95th percentile for BMI. Total energy expenditure (TEE), basal energy expenditure (BEE), sleeping energy expenditure (SEE), and cycling EE were measured during 24-h room respiration calorimetry. Walking and maximal EE (MaxEE) were measured according to a treadmill protocol. Allometric or power function models were used to identify appropriate scaling parameters for EE. For BEE and lower levels of EE, weight scaled to 0.5. For cycling and treadmill walking/running, the weight exponent approached 0.7. Scaling EE for FFM resulted in exponents of 0.6 for lower rates of EE and 0.8-1.0 for higher rates of EE. Appropriate scaling of EE for body weight and composition of children and adolescents varied primarily as a function of the level of EE. In some instances, the exponents for scaling EE by body weight or composition were influenced by gender and weight status, but not by age.

Adolescent↗
PubMed1994

Measured energy expenditure in mechanically ventilated very low birth weight infants.

Forty-nine calorimetric studies were performed on 24 very low birth weight infants with respiratory distress syndrome on mechanical ventilation during the first seven postnatal days. Mean resting energy expenditure for the entire study was 59 +/- 21 kilocalories/kg daily, with a respiratory quotient of 0.93 +/- 0.1, reflecting the predominance of carbohydrate calories. A comparison of mean energy intake with mean resting energy expenditure showed a mean caloric deficit of 31 kcal/k daily during the first 4 postnatal days, followed by 3 days where resting energy expenditure was met by equivalent caloric intake. Wide variation was noted in resting energy expenditure.

Energy Metabolism↗
PubMed1996

"Lifestyle" interventions for promoting physical activity: a kilocalorie expenditure-based home feasibility study.

The Centers for Disease Control and Prevention and the American College of Sports Medicine in cooperation with the President's Council of Physical Fitness and Sports recommended short periods of daily kilocalorie (calorie) expenditure with moderate-intensity physical activities to complement the currently existing recommendations. In this study the feasibility (adherence and safety) of employing calorie expenditure as the basis for prescribing a home-based walking program to healthy, community-dwelling men and women was examined. This was a 16-week pretest-posttest feasibility study of a home-based calorie-expenditure walking program conducted in an outpatient clinic in an academic medical center. Participants included 20 healthy, elderly, community-dwelling men and women. A 16-week home-based walking program was individually prescribed as a weekly amount of calorie expenditure increasing from an initial 300 calories per week to 1,200 calories per week (approximately 30 minutes of walking daily) during the final 6 weeks of the study. Adherence to the program was recorded individually in a diary (kept daily and reviewed at each visit), body weight, and walking pace. All but one participant were able to complete this 16-week program (95 percent adherence). That a calorie-based approach to promote physical activity among the elderly has a high adherence rate is suggested by these findings. Additional studies are necessary to define the potential role for this approach in promoting physical activity and improving health outcomes among the elderly.

Aged↗
PubMed1997

Cost-effective reduction of neuromuscular-blocking drug expenditures.

BACKGROUND: Anesthetic drug expenditures have been a focus of cost-containment efforts. The aim of this study was to determine whether expenditures for neuromuscular-blocking agents could be reduced without compromising outcome, and to determine whether such a cost-effective pattern of neuromuscular blocker use could be sustained. METHODS: Education, practice guidelines, and paperwork barriers were used to persuade anesthesiologists to substitute low-cost neuromuscular-blocking drugs (pancuronium or a metocurine-pancuronium combination) for a more costly neuromuscular-blocking drug (vecuronium). Neuromuscular-blocking drug use in all patients during a historical control period (6 months; n = 4,804) was compared with that during two consecutive 1-yr periods of intervention (n = 9,761/n = 10,695). Expenditures for vecuronium and for all neuromuscular-blocking drugs were compared for the control and intervention periods. The rate of complications related to neuromuscular-blocking drugs was determined by an ongoing continuous quality improvement program. RESULTS: Vecuronium use decreased by 76% during the first and second yr of intervention, compared with the historical period (P < 0.01). The cost of neuromuscular-blocking drugs decreased by 31% (P < 0.01) and 47% (P < 0.01) for the first and second yr, respectively. The complication rate related to neuromuscular-blocking drugs was 0.081% in the historical period and 0.11% and 0.093% during the intervention periods (P = 0.29 and 0.41). CONCLUSION: Practice guidelines, education, and paperwork barriers used together substantially reduced the expenditures for neuromuscular-blocking drugs for 2 yr without adversely affecting clinical outcome.

Adult↗
PubMedDate not supplied

Chemical paralysis reduces energy expenditure in patients with burns and severe respiratory failure treated with mechanical ventilation.

Predictive formulas often overestimate energy requirements, particularly in patients being treated with mechanical ventilation, resulting in significant overfeeding. The purpose of this study was to quantify the effect of chemical paralysis on energy expenditure in patients with burn injuries receiving ventilation treatment, and compare measured energy expenditure with estimates of energy expenditure based on predictive formulas. The study was a retrospective review of 14 patients with burn injuries treated with mechanical ventilation that required chemical paralysis to reduce inspiratory pressures or improve oxygenation. Indirect calorimetry was performed before, during, and after paralysis. Measured energy expenditure (MEE) was compared with the energy predictions of the Harris-Benedict (HBEE) and Curreri (CEE) estimates. During paralysis, mean MEE was significantly lower than pre- or postparalysis (19.65 +/- 1.65 versus 26.00 +/- 2.42 and 29.49 +/- 2.83 kcal/kg/24 hr, respectively). Mean HBEE (2031 +/- 145 kcal/24 hr) approximated MEE pre-(1989 +/- 350 kcal/24 hr) and postparalysis (2237 +/- 269 kcal/24 hr), but overestimated MEE during paralysis (1532 +/- 208 kcal/24 hr; p < 0.05). Mean CEE (2957 +/- 229 kcal/ 24 hr) estimates significantly overestimated MEE before, during, and after paralysis (1989 +/- 350, 1532 +/- 208, and 2237 +/- 269, respectively p < 0.05). Predictive formulas significantly overestimate measured energy requirements in these patients. Indirect calorimetry should guide nutrition support in patients requiring prolonged mechanical ventilation.

Adult↗
PubMed1994

What are the clinical determinants of early energy expenditure in critically injured adults?

The clinical determinants of energy expenditure in critically injured adults require definition. Among adult blunt trauma victims who required mechanical ventilation, the resting energy expenditure was calculated with the Harris-Benedict equation (HBEE) and the early (< or = 5 days postinjury) energy expenditure was measured by indirect calorimetry (MEE) (n = 115). The MEE was 2052 +/- 531 kcal/day and MEE/HBEE ("stress factor") was 1.24 +/- 0.2. The MEE was correlated with HBEE, age, height, weight, sex, temperature, and paralytic agents (p < 0.01). However, MEE did not correlate with ISS, admission GCS score, admission base deficit, initial systolic blood pressure, or the number of units of packed red blood cells transfused in the first 24 hours after injury (p = NS). Temperature and paralysis correlated with MEE/HBEE (p < 0.01). A regression model of MEE was developed with the clinical variables HBEE, temperature, and the presence or absence of paralytic agents (r2 = 0.62; p < 0.001): MEE (kcal/d) = 1.4(HBEE) + 71.4(temperature) + 274(paralytics; + = 1, - = 2) - 3485. In mechanically ventilated trauma victims, both the early energy expenditure and the stress factor are determined by host factors but are independent of the severity of the anatomic and physiologic insult. The degree of hypermetabolism observed in this population was less than previously reported.

Adult↗
PubMed1984

Insurance effects on employer group dental expenditures.

As the number of dental insureds and the amount of insured expenditures have increased over the past decade, so has interest in determining insurance effects on dental demand among employer groups and their insureds. Using Pennsylvania Blue Shield (PBS) employer group data representing 50-65% of all PBS insureds, the authors estimate the own-effect of basic insurance rates (diagnostic, preventive, restorative, endodontic, extraction services) and the cross-effects of riders A (crowns and oral surgery), B (prosthodontics), C (periodontics), and D (orthodontics) insurance rates on annual basic expenditures for 1975-1979. Results indicate a consistently positive relationship between basic insurance rates and expenditures. Orthodontic insurance rates have positive cross-effects on basic expenditures, suggesting basic-orthodontic complementarities. Although not statistically significant, potential substitution relationships may exist between basic and oral surgery, prosthodontic, and periodontic services. The implications of these findings for plan design and public oral health are discussed.

Blue Cross Blue Shield Insurance Plans↗
PubMed1997

Exercise mode and gender comparisons of energy expenditure at self-selected intensities.

The purpose of this study was to compare oxygen consumption (VO2) and energy expenditure after 20 min of self-selected submaximal exercise for four modes of exercise. Eighteen subjects (9 male and 9 female) first completed a test of VO2max during treadmill running. On separate days, subjects then completed 20 min submaximal treadmill running (TR), simulated cross-country skiing (XC), cycle ergometry (CE), and aerobic riding (AR) exercise. Total VO2 and energy expenditure were significantly higher for TR than all other modes for both males and females (43.6 +/- 10.4, 39.1 +/- 9.7, 36.1 +/- 7.6, 28.4 +/- 6.1 LO2, for TR, XC, CE, and AR, respectively, P < 0.0001). For males and females, heart rate was similar during TR and XC and lower during CE and AR (154.8 +/- 14.2, 152 +/- 13.1, 143.4 +/- 14.9, and 126.2 +/- 12.0 beats.min-1 for TR, XC, CE, and AR, respectively, P < 0.0001). Compared with females, males had significantly greater VO2 (P < 0.005) and energy expenditure (P < 0.004), while females had higher heart rates (P < 0.003). Ratings of perceived exertion (RPE) were not different between TR, XC, and CE, but were significantly lower during AR (13.4 +/- 1.3, 13.6 +/- 0.8, 13.2 +/- 0.9, and 12.6 +/- 1.0 for TR, XC, CE, and AR, respectively, P < 0.003). TR elicited the greatest VO2 and energy expenditure during self-selected exercise despite and RPE similar to XC and CE. Therefore, treadmill exercise may be the modality of choice for individuals seeking to improve cardiorespiratory endurance and expend a larger number of kjoules.

Adult↗
PubMed2001

Energy expenditure during 2 wk of an ultra-endurance run around Australia.

PURPOSE: For ultra-endurance athletes, whose energy expenditure is likely to be at the extremes of human tolerance for sustained periods of time, there is increased concern regarding meeting energy needs. Due to the lack of data outlining the energy requirements of such athletes, it is possible that those participating in ultra-endurance exercise are compromising performance, as well as health, as a result of inadequate nutrition and energy intake. To provide insight into this dilemma, we have presented a case study of a 37-yr-old ultra-marathon runner as he runs around the coast of Australia. METHODS: Total energy expenditure was measured over a 2-wk period using the doubly labeled water technique. RESULTS: The average total energy expenditure of the case subject was 6321 kcal x d(-1). Based on the expected accuracy and precision of the doubly labeled water technique the subject's total energy expenditure might range between 6095 and 6550 kcal x d(-1). The subject's average daily water turnover was 6.083 L over the 14-d period and might range between 5.9 L and 6.3 L x d(-1). CONCLUSIONS: This information will provide a guide to the energy requirements of ultra-endurance running and enable athletes, nutritionists, and coaches to optimize performance without compromising the health of the participant.

Adult↗
PubMed2002

Determining energy expenditure during some household and garden tasks.

PURPOSE: This study: a) calculated the reproducibility (intraclass correlation coefficient, ICC) and precision (technical error of measurement, TEM) for VO2 during moderate paced walking, self-paced sweeping, window cleaning, vacuuming and lawn mowing; b) determined which of the five activities rated >or= 3.0 when exercise intensity was calculated in METs (1 MET or metabolic equivalent = VO2 of 3.5 mL.kg-1.min-1) and multiples of the measured resting metabolic rate (RMR); and c) expanded the limited database on energy expenditure during household and garden activities. METHODS: Twelve men and 12 women (mean +/- SD: 39.3 +/- 3.4 yr; 171.6 +/- 9.6 cm; 81.0 +/- 15.5 kg) were measured for RMR and VO2 during the five activities on two separate days via indirect calorimetry by using the Douglas bag method. RESULTS: The interday ICCs and TEMs for the five activities ranged from 0.81 to 0.97 and from 2.1 to 7.0%, respectively. The means were significantly (P < 0.001) above 3.0 for moderate paced walking (range = 3.3-8.7), sweeping (2.9-6.7), window cleaning (3.0-6.0), vacuuming (2.6-4.4), and lawn mowing (4.9-7.5) when VO2 was divided by measured RMR, but one and five subjects scored below 3.0 for sweeping and vacuuming, respectively. Division of exercise VO2 by the convention of 3.5 mL O2.kg-1.min-1 significantly decreased (P < 0.001) each mean, and lawn mowing (5.0 METs) was the only activity where all subjects scored above 3.0 METs (P < 0.001; 3.8-6.4); nevertheless, the means for walking (3.7 METs), sweeping (3.2 METs), and window cleaning (3.6 METs) were also in the moderate intensity category of 3-6 METs. CONCLUSIONS: These data: a) emphasize that the VO2 during self-paced moderate intensity walking and self-paced household and garden activities can be measured with reproducibility and precision, b) demonstrate that expressing energy expenditure in conventional METs yields lower values than when it is presented as a multiple of measured RMR, c) suggest that all activities except vacuuming are performed at moderate intensity when energy expenditure is expressed in conventional METs, and d) highlight the biological variability in energy expenditure when different people perform the same task.

Activities of Daily Living↗
PubMedDate not supplied

Comparison of measured resting energy expenditure versus predictive equations in pediatric burn patients.

Many equations have been developed to estimate resting energy expenditure (REE) in thermally injured patients. A consensus has not been reached on the accuracy of these equations in children. The purpose of our study was to compare three predictive equations: Harris Benedict x 2 multiplier (HB x 2), Mayes (MG), and the WorId Health Organization x 2 multiplier (WHO x 2) with measured resting energy expenditure x I.3 multiplier (MREE x 1.3) in pediatric burn patients. MREE was measured by open-circuit indirect calorimetry in 10 burned children (6 boys, 4 girls) aged 2 to 10 years with TBSA burn ranges from 35% to 97%. MREE x 1.3 was compared with values obtained by HB x 2, MG, and WHO x 2 predictive equations. When comparing MREE x 1.3 with all three equations, significant differences were found when compared with HB x 2 and MG, but there were no significant difference between MREE x 1.3 vs WHO x 2. The HB x 2 and MG equations overpredicted MREE x 1.3 by 29% and 19%, respectively. Many predictive equations have been developed to predict energy expenditure in burns, but their accuracy in predicting MREE x 1.3 is variable. A larger study comparing/contrasting predictive equations and resting energy expenditure measured by indirect calorimetry is needed to improve the prediction of energy needs in burned children.

Basal Metabolism↗
PubMed2004

Resting energy expenditure and respiratory quotient in adolescents following spinal fusion surgery.

STUDY DESIGN: Prospective, 2-factor design. The first factor was the group with 2 levels, spine surgery and control. The second factor was timing with 3 levels, baseline, 1-week follow-up, and 6-week follow-up. OBJECTIVES: The purpose of this study was to assess changes in caloric requirements and the body's nutritional substrate utilization following spinal surgery in adolescents. SUMMARY OF BACKGROUND DATA: In an effort to optimize recovery from and assure best possible outcomes after spinal surgery in adolescents, the nutritional requirements of spine surgery patients were evaluated. METHODS: Indirect calorimetry was used to measure resting energy expenditure, a measure of caloric requirements, and respiratory quotient, an indication of percentages of fat, protein, and carbohydrate utilization. Twenty-three patients undergoing spinal fusion surgery were evaluated immediately before surgery, at an average of 4.8 days after surgery, and at an average 53 days follow-up. A control group of 15 patients completed the same series of 3 tests: baseline, 1-week later, and 6-weeks later. RESULTS: Resting energy expenditure increased significantly by 150 kcal/day (2.7 kcal/kg/day) following spinal fusion surgery in adolescents. By 6 weeks postoperation, patient's caloric requirements returned to baseline level. No changes in resting energy expenditure occurred in the control group between the 3 test periods. Anterior/posterior surgeries and single surgeries had similar kcal/kg/day requirements after surgery. Respiratory quotient decreased significantly following surgery (0.79 to 0.70), indicating a shift to fat oxidation after surgery. At 6 weeks postoperation, the respiratory quotient returned to baseline level. The control group demonstrated no change in the respiratory quotient during the 3 testing periods. CONCLUSIONS: Substrate utilization shifts to fat oxidation in adolescents following spinal surgery, indicating lipids would be the alimentation of choice immediately after surgery. Caloric requirements increase 9% above the baseline measurements. Anterior/posterior surgeries and single surgeries (anterior or posterior alone) have the same increase in kcal/kg/day. Because of the substrate utilization change by the body after surgery, a preponderance of these calories should initially be given as lipids. After approximately 6 weeks, both resting energy expenditure and respiratory quotient returned to preoperative levels following spinal surgery in adolescents, indicating special nutrition is not required beyond 6 weeks.

Adolescent↗
PubMed2003

Measuring the relationship between employees' health risk factors and corporate pharmaceutical expenditures.

This study demonstrates the relationship between self-reported health risk factors on a health risk appraisal and pharmaceutical expenditures for a large employer. A total of 3554 employees who were participants in a pharmacy benefit plan for the entire year of 2000 completed a health risk appraisal. As the number of self-reported health risk factors increased from zero to six or more, corporate pharmaceutical costs increased in a stepwise manner: US dollars 345, 443, 526, 567, 750, 754, and 1121 US dollars, respectively. After controlling for age, gender, and the number of self-reported diseases, each additional risk factor was associated with an average annual increase in pharmacy claims costs of 76 US dollars per employee. Specific health risks were associated with significantly higher expenditures. The results provide estimates of incremental expenditures associated with common, potentially modifiable risk factors. Pharmaceutical expenditures should be considered by corporations in their estimates of total health-related costs and in prioritizing disease management initiatives based on health risk appraisal data.

Adult↗
PubMed1992

Effects of oral testosterone undecanoate on growth, body composition, strength and energy expenditure of adolescent boys.

OBJECTIVE: We determined the effect of 3 months of daily, 40 mg oral testosterone undecanoate on growth, body composition, hand grip and quadriceps muscle strength, and total free-living daily energy expenditure in boys with constitutionally delayed puberty. DESIGN: Double blind, placebo controlled study. PATIENTS: Eighteen boys with constitutionally delayed puberty, mean (SD) age 13.2 (1.6) years. MEASUREMENTS: Body composition measurements were made by skinfold thickness, bioelectrical impedance and stable isotope dilution (H2(18)O) methods. Energy expenditure was assessed by the doubly-labelled water (2H2(18)O) technique. RESULTS: Height velocity increased from 5.4 (0.8) to 8.1 (0.6) cm/year (P < 0.05) in the 3 months after active therapy. Fat-free mass increased more with therapy (2.7 (0.3) kg) over the 6-month study period than with placebo (1.7 (0.4) kg, P < 0.5). Height velocity increases correlated with daily increases in fat-free mass (r = 0.68, P = 0.005) in the study group as a whole. Energy expenditure and muscle strength increased similarly in both groups. Predicted adult height decreased in the group which was treated with testosterone undecanoate. CONCLUSIONS: Testosterone undecanoate (40 mg daily for 3 months) significantly increased height velocity and fat-free mass velocities after 6 months but not muscle strength, endurance or total daily energy expenditure.

Administration, Oral↗