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A fundamental principle of nutrition and metabolism is that evaporation. ES is the rate of change in the bodys macronutrient
body weight change is associated with an imbalance between the stores. The energy balance equation (ES = EI EO) is a statement
Am J Clin Nutr 2012;95:98994. Printed in USA. 2012 American Society for Nutrition 989
990 HALL ET AL
averages for metabolizable energy, which is the amount of fuel ac- takes many specific forms and, as with glycogen, is associated with
tually available to cells for conducting biological processes. water but at a lower value per gram. Lipid in the form of tri-
Digestibility depends on the composition of the food item and on glyceride is the largest source of stored energy in most adults and
its content of fiber and other indigestible components. Such has no water associated with it.
components can mechanically limit the access of digestive enzymes Any imbalance between the intake and utilization of these mac-
to food that would potentially be digestible. For example, nuts and ronutrients will lead to an alteration in body composition. The energy
other plant materials have cell walls that cannot be digested by gut stored per unit body weight of carbohydrate, fat, and protein varies
enzymes, and they thereby protect the cell contents from digestion considerably, especially when accounting for the associated in-
if not masticated sufficiently to disrupt the cell structure. These tracellular water. Furthermore, dietary carbohydrate intake has an
effects can have a large impact on the absorption of ingested impact on renal sodium excretion, which results in changes in ex-
macronutrients. The variability in absorptive efficiency depends on tracellular fluid. Therefore, changes in body weight are expected
many additional factors (eg, gut flora, food preparation, diet when the macronutrient composition of the diet is altered, even when
composition), which may explain the individual differences in the energy content of the diet is held constant.
metabolizable EI. The long-term stability of body weight is often considered
a marker of zero ES, and thus energy balance. However, as described
above, changes in body weight also include changes in body water,
Components of expenditure (EO) which may be variable, and therefore weight change may not di-