Children with acute lymphoblastic leukaemia (ALL) typically gain weight at excessive rates during and after therapy, and a high proportion of young adult survivors are obese. Previous studies have failed to identify the abnormalities in energy balance that predispose these children to obesity. The aim of this study was to determine the cause of excess weight gain in children treated for ALL by testing the hypothesis that energy expenditure is reduced in these patients. Twenty children [9 boys, 11 girls; mean age 10.9 (3.2) y] treated for ALL who had shown excess weight gain, but were not obese [mean body mass index SD score 0.70 (1.04)], were closely and individually matched with 20 healthy control children [9 boys, 11 girls; mean age 10.7 (3.0) y; mean body mass index SD score 0.27 (0.91)]. In each child we measured total energy expenditure by doubly-labeled water method, resting energy expenditure, energy expended on habitual physical activity, and energy intake. Total energy expenditure was significantly higher in control subjects than in patients: mean paired difference 1185 kJ/d (282 kcal/d), 95% confidence interval (CI) 218-2152. This difference was largely due to reduced energy expended on habitual physical activity in the patients. Resting energy expenditure was lower in the patients: mean paired difference 321 kJ/d (76 kcal/d), 95% CI 100-541. Energy intake was also lower in the patients: mean paired difference 1001 kJ/d (238 kcal/d), 95% CI 93-1909. Children treated for ALL are predisposed to excess weight gain, and subsequently obesity, by reduced total energy expenditure secondary to reduced habitual physical activity. Prevention of obesity in ALL should focus on modest increases in habitual physical activity, modest restriction of dietary intake, and monitoring of excess weight gain.

Acute respiratory exacerbations have been proposed to contribute to the negative energy balance which causes undernutrition in cystic fibrosis. However, no studies have measured their effect on all components of energy balance. The aim of this study was to measure the effect of an acute respiratory exacerbation on energy balance.Fourteen children (six females, eight males, meanSD age 9.92.4 yrs) were studied when well and during the course of an acute respiratory exacerbation treated with intravenous antimicrobial therapy. The total energy expenditure was measured using the doubly-labelled water method, resting energy expenditure by ventilated hood indirect calorimetry, energy intake by household measures records, and fat malabsorption from measurements of dietary fat intake and faecal fat output.The exacerbation was associated with a significant reduction in energy intake (mean paired difference 47 kJ . kg of body weight -1 . day -1 , p<0.01). Changes in fat malabsorption and resting energy expenditure were negligible. The absence of significant changes in body weight and composition, together with the trend towards lower total energy expenditure, suggested no marked negative energy balance during the exacerbation.In conclusion, treatment of acute respiratory exacerbation with intravenous antimicrobial therapy represents a relatively minor challenge to energy balance and nutritional status in children with cystic fibrosis. Eur Respir J 1999; 13: 804±809. Undernutrition is common in children and adolescents with cystic fibrosis (CF), and it has a number of adverse clinical consequences including impairment of the lung and immune function [1,2]. Undernutrition is the result of negative energy balance (energy intake less than the sum of the energy outputs), but the causes of negative energy balance in CF are complex and poorly understood. In particular, the relative contribution of increased energy expenditure, insufficient energy intake, and malabsorption, to undernutrition is unknown [2]. The cumulative adverse effect of acute respiratory exacerbations on energy balance has been proposed as an important element in the aetiology of undernutrition in CF [2,3]. If confirmed, this hypothesis would require more aggressive nutritional therapy during or after acute respiratory exacerbations and/or greater emphasis on prevention of respiratory exacerbations.A successful strategy to identify the causes of negative energy balance is to simultaneously measure all components of energy balance (energy intake, faecal losses, total and resting energy expenditure) in the same patients, and to compare these during a period of clinical stability with a period of clinical deterioration [2,4].In CF, acute pulmonary exacerbations are periods of clinical deterioration that are believed to have important consequences for energy balance. Energy intake might decrease, at least initially [5,6]. Resting energy expenditure has been reported to increase temporarily in certain patients by some authors [7,8], but not by others [9] a...

A survey of the concentrations of cortisol in blood and urine samples taken from thoroughbred and standardbred horses after racing is presented. Statistical analysis showed the only significant difference between thoroughbred and standardbred horses was a higher cortisol concentration in thoroughbred urine. Urine volume and pH had no significant influence on the urinary cortisol concentration, however 9.5% of the urinary cortisol variation could be explained due to the influence of plasma cortisol concentration. The results of cortisol and ACTH administrations are also shown and compared with the survey results.