Ten subjects aged 19-35 years (four men and six women) underwent two measurements of 24 h energy expenditure (EE) in a whole-body respiration calorimeter, one at a temperature of 28" and one at 20". Choice of clothing was allowed. Dietary intake was standardized and subjects were asked to follow the same pattern of activity during both measurements. Mean 24 h EE was significantly greater a t the cooler temperature by 5.0 (SD 5.5) ' 3' 0, with individual differences ranging from 4.6 YO lower to 12.6 % higher.The difference in E E a t the two temperatures was similar during the day and the night and occurred even though subjects wore more clothes and used more bedding at 20". No relationship was observed between response to 20" and body-weight status. In conclusion, the assumption that mild cold is unlikely to affect EE in subjects wearing normal clothing may be incorrect.Energy expenditure: Environmental temperature

Free-living energy expenditure (EE) was measured in 11 smokers (6 females, 5 males) and 10 nonsmokers (6 females, 4 males) by using three methods. Factorial measures (FEE) used measured basal metabolic rate (BMR), records of time spent in six activity categories over 28 d, and average published energy costs of activities. Intake-balance measures (IBEE) used recorded dietary energy intake and changes in energy stores over 28 d. Doubly labeled water measures (DLWEE) used a two-point method over 8-12 d. Level of activity (1.54 +/- 0.07 and 1.55 +/- 0.06 x BMR) and FEE (9573 +/- 1501 and 9540 +/- 1663 kJ/d) were not different between smokers and nonsmokers, respectively. DLWEE was higher than FEE in both smokers (25.9 +/- 13.5%, P < 0.001) and nonsmokers (10.4 +/- 13.8%, P < 0.05), suggesting factorial underestimation in both groups, although the difference between DLWEE and FEE was significantly greater in smokers than in nonsmokers (P < 0.02). IBEE was higher than FEE in smokers (7.5 +/- 10.1%, P < 0.05) but not different from FEE in nonsmokers (2.7 +/- 16.6%), suggesting factorial underestimation in smokers only. DLWEE was higher than IBEE in smokers (13.8 +/- 12.6%, P < 0.01) but not significantly different from IBEE in nonsmokers (6.2 +/- 16.0%). The discrepancies between DLWEE and IBEE in smokers and DLWEE and FEE in nonsmokers preclude conclusion about absolute levels of daily EE. However, both DLWEE-FEE and IBEE-FEE comparisons suggest that our factorial method underestimates free-living EE in smokers relative to nonsmokers, although the effect is larger with the DLWEE-FEE than with the IBEE-FEE comparison.

The present study investigated trends in reported energy intake, macronutrient intake, physical activity level (PAL) and body weight and effects of excluding under-reporters (UR). Dietary intake and time spent in sixteen activity categories were recorded by 887 female university students (median age 29 years) from 1988 to 2003. Energy expenditure (EE) and PAL were measured using a factorial method. All data collected were self-reported. Individuals with reported EI:EE , 0·76 were classified as UR. The remainder were classified as nonunder-reporters (NUR). Trends were determined from simple linear regression of median data for each year for the entire cohort (ALL) and for NUR and UR separately, and from multiple regression analysis with the subgroups (NUR and UR) as an additional predictor (BOTH). Prevalence of under-reporting and overweight increased between 1988 and 2003. In ALL and BOTH there were trends to increased body mass, protein intake (g/d and % energy) and carbohydrate intake (% energy only) and decreased fat and alcohol intakes (g/d and % energy). In BOTH there were also increases in reported EI and carbohydrate intake (g/d). None of the trends in NUR was significantly different from those in UR, but some trends in ALL and/or BOTH were not significant when UR were excluded. Trends remaining significant in NUR were increased reported energy intake, protein (g/d) and carbohydrate (g/d) intakes, and decreased fat (% energy only) intake. There were no significant trends in PAL. We conclude that some, but not all, dietary trends were affected by exclusion of UR.

Summary A double‐blind, randomised, placebo‐controlled study was performed to assess the antiemetic efficacy of ondansetron in women receiving morphine from a patient‐controlled analgesia system after total abdominal hysterectomy. Sixty‐six ASA grade 1 or 2 patients scheduled for total abdominal hysterectomy were randomly allocated into one of two groups. All patients received a standardised anaesthetic and postoperative patient‐controlled analgesia regimen. Group 1 received ondansetron 4 mg at induction of anaesthesia, repeated 8 h later. Group 2 received saline as a placebo at the same times. Pain scores, nausea scores, episodes of vomiting, use of rescue antiemetics and recollection of nausea and vomiting were not different between the groups. Only 15% of patients who received ondansetron and 30% of patients who received the placebo recorded no nausea or vomiting in the first 24 h. We conclude that ondansetron, in the dose studied, does not reduce nausea and vomiting in women receiving morphine from a patient‐controlled analgesia system after total abdominal hysterectomy.

I . Weight loss, resting metabolic rate and nitrogen loss were measured in forty obese inpatients on reducing diets.2. Five subjects ate 3.55 MJ/d for 6 weeks (Expt I). Twenty-one subjects ate 4.2 MJ/d for the first week, 2.0 MJ/d for the second week and 4 2 MJ/d for the third week (Expt 2). Fourteen subjects ate 3.4 MJ/d for the first week and then 0.87 MJ protein or carbohydrate for the second or third weeks, using a cross-over design for alternate patients (Expt 3).3. Patients in Expt I had highest weight loss and N loss in the first z weeks, but adapted to the energy restriction over the remaining weeks. On average subjects were in N balance at the end of the study. 4. In Expt z patients eating 2.0 MJ/d in week 2 showed increased weight loss compared with week I . N loss was not raised but it failed to decrease as it had in Expt I. Weight loss and N loss were reduced on return to 4.2 MJ/d for a third week. 5.In Expt 3 patients eating 0.87 MJ protein showed significantly more weight loss and less N loss than patients eating 087 MJ carbohydrate.6. Resting metabolic rate decreased with time on the low-energy diet, but the manipulations of energy or protein content did not significantly affect the pattern of decrease.7. Both weight loss and N loss were greater the lower the energy intake, and both decreased with time. Diets with a high protein:energy value give a favourable value for N:weight loss at each level of energy intake.If the energy intake of an obese patient is reduced below the level of energy expenditure the energy stores of the body must decrease, and this is usually reflected in a decrease in bodyweight. The obese person has too high a fat:lean tissue value, so it is desirable that the weight loss should be mainly at the expense of fat. Since fat loss is a slow process, such patients yearn for treatment which will produce rapid weight loss. This can be achieved by treatments which cause the loss of water or lean tissue which are attractive to the patient in the short term, but only make matters worse in the long run. Resting metabolic rate (RMR) is the factor which chiefly determines how quickly obese patients can lose weight (Garrow et al. 1978) and this in turn is most closely related to lean body mass (Halliday et al. 1979) so treatment which causes excessive loss of lean tissue is self-defeating in the end. Calloway & Spector (I 954) made a comprehensive review of the effect of restricted energy and protein intake on N balance, and concluded that active young men in negative energy balance would inevitably be in negative nitrogen balance whatever the protein intake.