Many chronically ill mental patients show rapid and severe weight loss leading to severe nutritional debilitation. Excessive energy requirements secondary to hypermetabolism or hyperactivity have been proposed as the cause. This hypothesis was tested using the new doubly-labelled water (2H218O) technique to obtain accurate estimates of total energy expenditure (TEE) in 14 such patients. Mean TEE was very low (6.1 +/- 1.3 MJ/day). None of the subjects was in significant negative energy balance when studied. Mean resting metabolic rate (RMR) was lower than predicted from standard equations based on healthy elderly subjects. The energy cost of physical activity plus thermogenesis was also low (1.7 +/- 0.9 MJ/day) in all except one subject. The data refute the initial hypothesis and suggest that negative energy balance may be episodic, perhaps during periods of infection and subsequent recovery.

Anthropometric and biochemical indices of nutrition were measured in 450 elderly women in six groups spanning a wide range of physical dependency. Data from the group of active subjects living at home was used to derive reference ranges for elderly women. Although the index values of this group did not differ greatly from those seen in young subjects, there were large differences between this and some of the other elderly groups where the frequency of low values was as high as 50% for some parameters. Food intakes were measured in four of the six groups and relationships were found between energy, protein and vitamin C intake and body weight, plasma protein levels and vitamin C concentration, respectively. Our findings suggest that, among elderly women, low levels of nutrient intake make a significant contribution to poor anthropometric and biochemical nutritional status. Improvements in diet should be reflected in the indices measured and might, in turn, have beneficial effects on health.

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SynopsisSixty-four children taken to court for failure to attend school were reliably classified into 4 groups, according to whether they exhibited the features of ‘school refusal’ and/or ‘truancy’. About a fifth of them were found to exhibit ‘school refusal’; a third showed ‘truancy’; less than a sixth exhibited both ‘school refusal’ and ‘truancy’ combined; and over a third had the characteristics of neither condition. Differences between these categories were found in manifestations of psychiatric disturbance and in responsiveness to a court adjournment procedure.

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