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3941 Furthermore, many toxic chemicals that may be ingested during nutrient intake (eg, heavy metals, persistent organic pollutants, air pollutants, alcohol, and toxins obtained from smoking, etc.) impair the normal absorption and metabolism of both macro- and micronutrients, predisposing individuals toward impaired metabolism

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International journal of molecular sciences 2021;22

Figure 2 3 Immune activation and inflammatory response The onset of PEM is closely linked not only to mitochondrial dysfunction and energy deficiency but also to the dysregulated activation of the immune system and inflammatory reactions