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1. In a previous study of the effects of methandienone (Dianabol) on men undergoing athletic training, strength and performance increased, but not significantly more when the subjects were taking the drug than when they were taking placebo. The subjects did, however, gain more weight on the drug, with increases in total body potassium and muscle dimensions. It remained an open question whether the muscles had gained normal tissue or intracellular fluid. 2. In an attempt to distinguish between these possibilities the trial has been repeated, using as subjects seven male weight-lifters in regular training, and including measurements of total body nitrogen. As before, a dose of 100 mg of methandienone/day was given alternately with the placebo in a double-blind crossover experiment. The treatment periods lasted 6 weeks and were separated by an interval of 6 weeks. Body weight, potassium and nitrogen, muscle size, and leg performance and strength increased significantly during training on the drug, but not during the placebo period. 3. The finding of increased body nitrogen suggested that the weight gain was not only intracellular fluid. The increases in body potassium (436 +/- SEM 41 mmol) and nitrogen (255 +/- 69 g) were too large in proportion to the weight gain (2.3 +/- 0.4 kg) for this to be attributed to gain of normal muscle or other lean tissue, and imply gain of nitrogen-rich, phosphate-poor substance. Although this action of methandienone might be described as anabolic, the weight gain produced is not normal muscle.

Estimation of weight loss plays a key role in the nutritional assessment of patients. The loss is usually calculated by subtracting the patient's observed weight (O) either from his recalled weight (R) or from his predicted weight (P) taken from standard tables or equations. We have compared these two assessments of weight loss (R-O, P-O) in a cross-sectional study of patients in the surgical wards of a teaching hospital. There are large differences (up to 15 kg) between average predicted weights taken from the various published tables. We have obtained predicted weights using equations derived from a healthy local population. We have devised a general technique with which the measured, R and P weights in a group can be used to give random errors of R, P, and true weight loss. In our patients there were 3.6, 10.7, and 6.0 kg respectively. As the random error of R was smaller than that of P in our patients, R-O gave better estimates of the mean and SD of the weight losses of the group of patients than did P-O, and R-O was a more precise estimate of the true weight loss of an individual. Nevertheless, R-O is only an estimate of the true weight loss and had a large random error (up to 7.2 kg). This error which can be calculated for any group of patients, must be borne in mind when using R-O to estimate the weight loss in an individual, and when selecting patients with a given weight loss. In 100 patients such as ours, 24 would have R-O greater than 10 kg, but only 18 of these would have lost 10 kg, and nine other patients who had lost 10 kg would be missed.

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