Ambulatory estimates of maximal aerobic power from foot -ground contact times and heart rates in running humans.

Seeking to develop a simple ambulatory test of maximal aerobic power (VO(2 max)), we hypothesized that the ratio of inverse foot-ground contact time (1/t(c)) to heart rate (HR) during steady-speed running would accurately predict VO(2 max). Given the direct relationship between 1/t(c) and mass-specific O(2) uptake during running, the ratio 1/t(c). HR should reflect mass-specific O(2) pulse and, in turn, aerobic power. We divided 36 volunteers into matched experimental and validation groups. VO(2 max) was determined by a treadmill test to volitional fatigue. Ambulatory monitors on the shoe and chest recorded foot-ground contact time (t(c)) and steady-state HR, respectively, at a series of submaximal running speeds. In the experimental group, aerobic fitness index (1/t(c). HR) was nearly constant across running speed and correlated with VO(2 max) (r = 0.90). The regression equation derived from data from the experimental group predicted VO(2 max) from the 1/t(c). HR values in the validation group within 8.3% and 4.7 ml O(2) x kg(-1) x min(-1) (r = 0.84) of measured values. We conclude that simultaneous measurements of foot-ground constant times and heart rates during level running at a freely chosen constant speed can provide accurate estimates of maximal aerobic power.

Endocrine markers of semistarvation in healthy lean men in a multistressor environment.

We tested the hypothesis that key endocrine responses to semistarvation would be attenuated by changing only the food intake in a multistressor environment that also included sustained workload, inadequate sleep, and thermal strain. Serum hormones were compared within and between two groups of healthy young male volunteers participating in the 8-wk US Army Ranger course, with four repeated cycles of restricted energy intakes and refeeding: group 1 (n = 49) and group 2 (n = 48); energy deficits averaged 1,200 and 1,000 kcal/day, respectively. After 8 wk, most of group 1 achieved a minimum body fat, serum 3,5,3'-triiodothyronine (T(3)) was below normal (78 +/- 20 ng/dl), testosterone (T) approached castrate levels (4.5 +/- 3.9 nmol/l), insulin-like growth factor I (IGF-I) declined by one-half (75 +/- 25 microg/l), and cholesterol rose from 158 +/- 31 to 217 +/- 39 mg/dl. Bioavailable T(3) and T were further reduced by increases in their specific binding proteins in response to declining insulin. Refeeding, even with continuation of the other stressors, produced prompt recovery of T(3), T, and IGF-I. Higher energy intakes in group 2 attenuated the subclinical hypothyroidism and hypercholesterolemia, whereas consistent luteinizing hormone suppression indicated centrally mediated threshold effects on gonadal hormone suppression. We conclude that low T, T(3), and IGF-I remained reliable markers of acute energy deficits in the presence of other stressors; elevated cholesterol and cortisol provided information about chronic status, corresponding to diminishing body fat stores.

Ambulatory physiological status monitoring during a mountaineering expedition.

OBJECTIVE: To evaluate an ambulatory physiological monitoring system during a mountaineering expedition. We hypothesized that the Environmental Symptoms Questionnaire, combined with frequent measurement of oxygen saturation and core temperature, would accurately identify cases of environmental illness. METHODS: Twelve military mountaineers took a daily Environmental Symptoms Questionnaire, monitored fingertip oxygen saturations, and recorded core temperatures while climbing a 4,949-m peak. Illnesses identified by the system were compared with those identified by spontaneous reports. RESULTS: The system correctly identified one case of high-altitude pulmonary edema and two illnesses that were not reported to the physician (one case of acute mountain sickness and one of self-limited symptomatic desaturation). However, it did not identify two illnesses that were severe enough to preclude further climbing (one case of sinus headache and one of generalized fatigue). CONCLUSIONS: Our monitoring system may complement, but cannot replace, on-site medical personnel during mountaineering expeditions.

Energy expenditure and balance during spaceflight on the space shuttle.

The objectives of this study were as follows: 1) to measure human energy expenditure (EE) during spaceflight on a shuttle mission by using the doubly labeled water (DLW) method; 2) to determine whether the astronauts were in negative energy balance during spaceflight; 3) to use the comparison of change in body fat as measured by the intake DLW EE, 18O dilution, and dual energy X-ray absorptiometry (DEXA) to validate the DLW method for spaceflight; and 4) to compare EE during spaceflight against that found with bed rest. Two experiments were conducted: a flight experiment (n = 4) on the 16-day 1996 life and microgravity sciences shuttle mission and a 6 degrees head-down tilt bed rest study with controlled dietary intake (n = 8). The bed rest study was designed to simulate the flight experiment and included exercise. Two EE determinations were done before flight (bed rest), during flight (bed rest), and after flight (recovery). Energy intake and N balance were monitored for the entire period. Results were that body weight, water, fat, and energy balance were unchanged with bed rest. For the flight experiment, decreases in weight (2.6 +/- 0.4 kg, P < 0.05) and N retention (-2. 37 +/- 0.45 g N/day, P < 0.05) were found. Dietary intake for the four astronauts was reduced in flight (3,025 +/- 180 vs. 1,943 +/- 179 kcal/day, P < 0.05). EE in flight was 3,320 +/- 155 kcal/day, resulting in a negative energy balance of 1,355 +/- 80 kcal/day (-15. 7 +/- 1.0 kcal. kg-1. day-1, P < 0.05). This corresponded to a loss of 2.1 +/- 0.4 kg body fat, which was within experimental error of the fat loss determined by 18O dilution (-1.4 +/- 0.5 kg) and DEXA (-2.4 +/- 0.4 kg). All three methods showed no change in body fat with bed rest. In conclusion, 1) the DLW method for measuring EE during spaceflight is valid, 2) the astronauts were in severe negative energy balance and oxidized body fat, and 3) in-flight energy (E) requirements can be predicted from the equation: E = 1.40 x resting metabolic rate + exercise.

Telemetry pill measurement of core temperature in humans during active heating and cooling.

PURPOSE: This study compared the agreement between core temperature measurements obtained using an ingestible temperature pill telemetry system (Tpill) with those obtained from rectal (Tre) and esophageal (Tes) thermocouples under conditions of increasing and decreasing body temperature. METHODS: Four men and five women (age 25+/-2 yr, BSA 1.81+/-0.05 m2, VO2 peak 3.1+/-0.4 L x min[-1]) participated in four 3-h trials: cold (18 degrees C) water rest (CWR), cold water exercise (CWE), warm (36 degrees C) water rest (WWR), and warm water exercise (WWE). Subjects were immersed to the neck for each trial. During resting trials, subjects sat quietly. During exercise trials, subjects completed three bouts of 15 min of rest, followed by 45 min of exercise on a cycle ergometer at 50% of peak oxygen uptake. The temperature pill was taken 10-12 h before testing, after which the subjects fasted. RESULTS: The trials created conditions of constantly decreasing (CWR) or increasing (WWR) core temperature, as well as periods of oscillating core temperature (CWE and WWE). Root mean squared deviation (RMSD) was calculated for each pair of measurements (Tpill vs Tre, Tpill vs Tes, Tre vs Tes) for each trial. An RMSD of "0" indicates perfect agreement; as RMSD increases, agreement worsens. On CWR, the RMSD for Tpill-Tes (0.23+/-0.04) was lower (P < 0.05) than for Tpill-Tre (0.43+/-0.10) or Tre-Tes (0.46+/-0.09). There were no significant differences in RMSD between measurement pairs on any other trial (average RMSD = 0.26 degrees C). Telemetry pill temperature and response time tended to be intermediate between Tre and Tes. CONCLUSION: These results suggest the telemetry pill system provides a valid measurement of core temperature during conditions of decreasing as well as increasing body temperature and during steady state.

Development and biomedical testing of military operational rations.

This article gives a brief history of military nutrition research in this century and reviews recent advances made through field testing. Although modern rations are nutritionally complete, ration developers are challenged to improve palatability to promote increased intakes in field training and combat settings. The principal goal for military nutritionists is to identify the optimal macronutrient mix and specific ration components that sustain a soldier's performance in the face of operational stressors such as sleep deprivation, intense physical activity, climatic extremes, and hypobaric hypoxia. Energy expenditures during typical field-training exercises average approximately 4000 kcal/day, whereas energy intakes are usually 3000 kcal/day or less when operational rations are consumed. One way to ameliorate the effects of this shortfall is to provide soldiers with a carbohydrate beverage supplement.

Exercise responses after altitude acclimatization are retained during reintroduction to altitude.

Following 2 to 3 wk of altitude acclimatization, ventilation is increased and heart rate (HR), plasma volume (PV), and lactate accumulation ([La]) are decreased during submaximal exercise. The objective of this study was to determine whether some degree of these exercise responses associated with acclimatization would be retained upon reintroduction to altitude (RA) after 8 d at sea level (SL). Six male lowlanders (X +/- SE; 31 +/- 2 yr, 82.4 +/- 4.6 kg) exercised to exhaustion at the same relative percentages of peak oxygen uptake (VO2peak) at SL, on acute altitude (AA) exposure, after a 16-d chronic altitude (CA) exposure on Pikes Peak (4,300 m), and during a 3- to 4-h RA in a hypobaric chamber (4,300 m; 446 mm Hg) after 8 d at SL. The submaximal exercise to exhaustion time (min) was the same at SL (66.0 +/- 1.6), AA (67.7 +/- 7.3), CA (79.9 +/- 6.2), and RA (67.9 +/- 1.9). At 75% VO2peak: (1) arterial oxygen saturation (SaO2) increased from AA to CA (67.0 +/- 1.5 vs 78.5 +/- 1.8%; P < 0.05) and remained increased at RA (77.0 +/- 2.0%); (2) HR decreased from SL to CA (171 +/- 6 vs 152 +/- 9 beats x min-1; P < 0.05) and remained decreased at RA (157 +/- 5 beats x min-1); (3) calculated PV decreased 6.9 +/- 10.0% at AA, 21.3 +/- 11.1% at CA, and 16.7 +/- 5.4% at RA from SL baseline values, and (4) [La] decreased from AA to CA (5.1 +/- 0.9 vs 1.9 +/- 0.4 mmol x L-1; P < 0.05) and remained decreased at RA (2.6 +/- 0.6 mmol x L-1). Upon RA after 8 d at SL, the acclimatization responses were retained 92 +/- 9% for SaO2, 74 +/- 8% for PV, and 58 +/- 3% for [La] at 75% VO2peak. In conclusion, although submaximal exercise to exhaustion time is not improved upon reintroduction to altitude after 8 d at sea level, retention of beneficial exercise responses associated with altitude acclimatization is likely in individuals whose work, athletic competition, or recreation schedules involve intermittent sojourns to high elevations.

Effects of chronic hypoxia on the pharmacokinetics of caffeine and cardio-green in micro swine.

METHODS: The pharmacokinetics of caffeine and cardio-green (ICG) were examined in four micro swine at sea level (SEA) and following 21 d continuous exposure to 4600 m (ALT) in a hypobaric chamber. Caffeine (84.7 mg) and ICG (10 mg) were administered as separate intravenous boluses and sequential blood samples collected. RESULTS: Caffeine clearance significantly (p < 0.05) increased in ALT (96.8 +/- 20.0 ml.min-1) as compared to SEA (53.6 +/- 24.8 ml.min-1), demonstrating that liver function increased in ALT. There was no significant change in the ratio of primary metabolites to caffeine, suggesting that the increase in clearance was not due to a change in the rate of caffeine metabolism. ICG clearance significantly increased in ALT (179.8 +/- 57.4 ml.min-1) as compared to SEA (84.4 +/- 28.9 ml.min-1) indicating that hepatic blood flow (HBF) increased. CONCLUSION: These results demonstrate that chronic exposure to 4600 m increases the clearance of caffeine and ICG in the micro swine model and suggests that the increase in caffeine clearance is related to HBF.

Effects of altitude (4300 m) on the pharmacokinetics of caffeine and cardio-green in humans.

The effects of chronic exposure to high altitude on the pharmacokinetics of caffeine and cardio-green (ICG) were examined in eight healthy males (23-35 y) at sea level (SEA) and following 16 days residence at 4300 m (ALT). ICG (0.5 mg. kg-1) was administered as an intravenous bolus and caffeine (4 mg. kg-1) in an orally ingested solution. The concentration of ICG, caffeine, and the primary metabolites of caffeine (MET) were determined in serial blood samples and their pharmacokinetics computed. In comparison to SEA, ALT resulted in a significant decrease in a caffeine half-life (t1/2, 4.7 vs 6.7 h) and area under the curve (2.5 vs 3.7 g.l-1.min-1), and increased clearance (117 vs 86 ml.min-1.70 kg-1). In ALT the area under the curve the ICG significantly decreased (85 vs 207 mg.l-1.min-1) and the volume of distribution and clearance increased (5.2 vs 2.4 l and 532 vs 234 ml.min-1 respectively) compared to SEA. There was a significant increase in the AUC ratio of MET to caffeine indicating that either metabolite formation or elimination was increased in ALT. These results demonstrate that in humans, chronic exposure to 4300 m results in the modification of the pharmacokinetics of caffeine and ICG.

Lower limit of body fat in healthy active men.

We examined body composition changes in 55 normal young men during an 8-wk Army combat leadership training course involving strenuous exercise and low energy intake, with an estimated energy deficit of 5.0 +/- 2.0 MJ/day and a resultant 15.7 +/- 3.1% weight loss. Percent body fat (BF) measured by dual-energy X-ray absorptiometry (DEXA) averaged 14.3% (range 6-26%) and 5.8 +/- 1.8% (range 4-11%) at the beginning and end of the course, respectively. Men who achieved a minimum percent BF (4-6%) by 6 wk demonstrated only small additional total and subcutaneous fat losses in the final 2 wk and sacrificed increasingly larger proportions of fat-free mass. Percent BF estimated from skinfold thicknesses reflected relative changes in fat mass, although actual percent BF was overestimated. Instead of reaching a plateau after fat stores were substantially depleted, abdominal, hip, and thigh girths continued to decline with body weight loss. Final percent BF for the leanest men was similar to that observed after a 25% body weight reduction in the 1950 Minnesota study (5.2% by underwater weighting), and height-corrected final fat mass was the same (1.0 +/- 0.2 vs. 0.9 +/- 0.7 kg fat/m2), suggesting that these values represent a minimal body fat content in healthy men and that weight loss subsequent to achieving this level is contributed from the fat-free mass. Our results suggest that 4-6% BF or approximately 2.5 kg fat represents the lower limit for healthy men, as assessed by DEXA or by underwater weighing.

Ambulatory foot contact monitor to estimate metabolic cost of human locomotion.

The rate of metabolic energy expenditure during locomotion (Mloco) is proportional to body weight (Wb) divided by the time during each stride that a single foot contacts the ground (tc) (Nature Lond. 346: 265-267, 1990). Using this knowledge, we developed an electronic foot contact monitor. Our objective was to derive and cross-validate an equation for estimation Mloco from Wb/tc. Twelve males were tested [age = 19.4 +/- 1.4 (SD) yr, Wb = 78.4 +/- 8.0 kg] during horizontal treadmill walking (0.89, 1.34, and 1.79 m/s) and running (2.46, 2.91, and 3.35 m/s). Measured Mloco was defined as the total rate of energy expenditure, measured by indirect calorimetry, minus the estimated rate of resting energy expenditure. The equation to estimate Mloco was derived in six randomly selected subjects: Mloco = 3.702.(Wb/tc) - 149.6 (r2 = 0.93). Cross-validation in the remaining six subjects showed that estimated and measured Mloco were highly correlated (r2 = 0.97). The average individual error between estimated and measured Mloco was 0% (range -22 to 29%). In conclusion, Mloco can be accurately estimated from Wb and measurements of tc made by an ambulatory foot contact monitor.

Doubly labeled water measurement of human energy expenditure during exercise at high altitude.

Estimates of total daily energy expenditure (TDEE) by the doubly labeled water (DLW, 2H(2)18O) and intake balance (I-B) methods were compared in six male soldiers studied over 6 days that included 5 days of strenuous winter exercise at 2,500- to 3,100-m elevation. Use of body energy stores [-9.54 +/- 1.54 (SD) MJ/day or -2,280 +/- 368 kcal/day] was estimated from changes in body weight, body density (hydrodensitometry), and total body water (H(2)18O dilution). The subjects wore computerized activity monitors and kept daily records of ration consumption (9.87 +/- 3.60 MJ/day or 2,359 +/- 860 kcal/day). Accuracy of individual DLW and I-B TDEE values was estimated from the correlations of TDEE with fat-free mass (FFM) or total weight (body wt + load). The DLW and I-B estimates of TDEE differed by -12.0 to 15.2% but provided comparable estimates of group mean TDEE (DLW = 19.07 +/- 2.37 MJ/day or 4,558 +/- 566 kcal/day; I-B = 19.41 +/- 3.72 MJ/day or 4,639 +/- 889 kcal/day; P > 0.05). The DLW TDEE was correlated with both FFM (r2 = 0.89, P < 0.01, power = 0.95) and total weight (r2 = 0.95, P < 0.01, power = 0.99), whereas I-B TDEE was correlated only with total weight (r2 = 0.75, P < 0.03, power = 0.81). Under adverse field conditions the DLW method provided individual TDEE estimates that were probably more accurate than those provided by the I-B method.

Use of bioelectrical impedance to assess body composition changes at high altitude.

This study determined the feasibility of using bioelectrical impedance analysis (BIA) to assess body composition alterations associated with body weight (BW) loss at high altitude. The BIA method was also evaluated relative to anthropometric assessments. Height, BW, BIA, skinfold (SF, 6 sites), and circumference (CIR, 5 sites) measurements were obtained from 16 males (23-35 yr) before, during, and after 16 days of residence at 3,700-4,300 m. Hydrostatic weighings (HW) were performed pre- and postaltitude. Results of 13 previously derived prediction equations using various combinations of height, BW, age, BIA, SF, or CIR measurements as independent variables to predict fat-free mass (FFM), fat mass (FM), and percent body fat (%Fat) were compared with HW. Mean BW decreased from 84.74 to 78.84 kg (P less than 0.01). As determined by HW, FFM decreased by 2.44 kg (P less than 0.01), FM by 3.46 kg (P less than 0.01), and %Fat by 3.02% (P less than 0.01). The BIA and SF methods overestimated the loss in FFM and underestimated the losses in FM and %Fat (P less than 0.01). Only the equations utilizing the CIR measurements did not differ from HW values for changes in FFM, FM, and %Fat. It was concluded that the BIA and SF methods were not acceptable for assessing body composition changes at altitude.

Effects of high altitude and exercise on marksmanship.

The effects of exercise and high altitude (3,700 m to 4,300 m) on marksmanship accuracy and sighting time were quantified in 16 experienced marksmen. Subjects dry-fired a disabled rifle equipped with a laser-based system from a free-standing position. The 2.3-cm circular target was at a distance of 5 m. Marksmanship was assessed under the following conditions: 1) at rest at sea level; 2) immediately after a 21-km run/walk ascent from 1,800 m to 4,300 m elevation; 3) at rest during days 1 to 3 at altitude; 4) at rest during days 14 to 16 at altitude; and 5) immediately after a second ascent after 17 d at altitude. Exercise reduced marksmanship accuracy (p less than 0.05) but did not affect sighting time. Acute altitude exposure reduced marksmanship accuracy, and decreased sighting time (p less than 0.05). However, after residence at altitude, accuracy and sighting time at rest returned to sea level values. Exercise and acute altitude exposure had similar but independent detrimental effects on marksmanship.

Hypobaric hypoxia (380 Torr) decreases intracellular and total body water in goats.

The effects of prolonged hypoxia on body water distribution was studied in four unanesthetized adult goats (Capra lircus) at sea level and after 16 days in a hypobaric chamber [(380 Torr, 5,500 m, 24 +/- 1 degrees C); arterial PO2 = 27 +/- 2 (SE) Torr]. Total body water (TBW), extracellular fluid volume (ECF), and plasma volume (PV) were determined with 3H2O, [14C]inulin, and indocyanine green dye, respectively. Blood volume (BV) [BV = 100PV/(100 - hematocrit)], erythrocyte volume (RCV) (RCV = BV - PV), and intracellular fluid (ICF) (ICF = TBW - ECF) and interstitial fluid (ISF) (ISF = ECF - PV) volumes were calculated. Hypoxia resulted in increased pulmonary ventilation and arterial pH and decreased arterial PCO2 and PO2 (P less than 0.05). In addition, body mass (-7.1%), TBW (-9.1%), and ICF volume (-14.4%) all decreased, whereas ECF (+11.7%) and ISF (+27.7%) volumes increased (P less than 0.05). The decrease in TBW accounted for 89% of the loss of body mass. Although PV decreased significantly (-15.3%), BV was unchanged because of an offsetting increase in RCV (+39.5%; P less than 0.05). We conclude that, in adult goats, prolonged hypobaric hypoxia results in decreases in TBW volume, ICF volume, and PV, with concomitant increases in ECF and ISF volumes.

Doubly labeled water measurement of human energy expenditure during strenuous exercise.

The energy expenditures (EE) of 23 adult male Marines were measured during a strenuous 11-day cold-weather field exercise at 2,200- to 2,550-m elevation by both doubly labeled water (2H2 18O, DLW) and intake balance methods. The DLW EE calculations were corrected for changes in baseline isotopic abundances in a control group that did not receive 2H2 18O. Intake balance EE was estimated from the change in body energy stores and food intake. Body energy-store changes were calculated from anthropometric [-1,574 +/- 144 (SE) kcal/day] and isotope dilution (-1,872 +/- 293 kcal/day) measurements made before and after the field exercise. The subjects kept daily logbook records of ration consumption (3,132 +/- 165 kcal/day). Mean DLW EE (4,919 +/- 190 kcal/day) did not differ significantly from intake balance EE estimated from food intake and either anthropometric (4,705 +/- 181 kcal/day) or isotope dilution (5,004 +/- 240 kcal/day) estimates of the change in body energy stores. The DLW method can be used with at least the same degree of confidence as the intake balance method to measure the EE of active free-living humans.

Field use of D2 18O to measure energy expenditure of soldiers at different energy intakes.

To test the application of doubly labeled water under adverse field conditions, energy expenditures of 16 special operations soldiers were measured during a 28-day field training exercise. Subjects were matched by fat-free mass and divided equally between an ad libitum ready-to-eat meal diet and a 2,000 kcal/day lightweight ration. Subjects recorded intakes daily, and body composition was measured before and after the exercise. At the beginning of the study, subjects moved to a new northerly location and, therefore, a new water supply. To compensate for this, a group of soldiers who did not receive heavy water was followed to measure isotopic base-line changes. Energy expenditure by doubly labeled water was in agreement with intake/balance (3,400 +/- 260 vs. 3,230 +/- 520 kcal/day). The overall coefficient of variation of energy expenditure by doubly labeled water was half that of intake/balance (7.6 vs. 16.1%). The coefficient of variation of repeat measures with doubly labeled water was 7.3%. Energy expenditure of the ready-to-eat meal group, 3,540 +/- 180 kcal/day, was not significantly different from the lightweight ration group, 3,330 +/- 301 kcal/day. Doubly labeled water was valid under field conditions.

Protein and energy metabolism during prolonged exercise in trained athletes.

UNLABELLED: Eight elite triathlon athletes participated in a laboratory study of the effects of endurance exercise on protein and energy metabolism. The study consisted of 3 h of cycling and 5 h of treadmill running; 3.5 h before beginning the exercise, a primed constant infusion of 1-13C leucine and 6,6(-2)H glucose was begun. Serial blood samples were collected during the rest and exercise periods for isotopic analysis. Respiratory gas exchange was determined every half hour. RESULTS: the subjects exercised at an average of 53% +/- 3% of peak VO2. During the 8-h exercise period there was a decline in glucose utilization and an increase in lipid oxidation. For the first part of the exercise, most of the glucose oxidized was of muscle origin. Hepatic glucose production increased with exercise from 20 g/h to a maximum of about 60 g/h after 4 h of exercise and then decreased toward the pre-exercise rate. The plasma urea concentration was unchanged during the study. The leucine flux decreased during the first 4 h of exercise and then attained a new plateau about 20% lower than the pre-exercise value indicating an adaptive reduction in protein turnover.

Determination of energy expenditure during heavy exercise, normal daily activity, and sleep using the doubly-labelled-water (2H2 18O) method.

Energy expenditure of four subjects was measured by the doubly-labelled-water (2H2 18O) method to determine if energy expenditure could be determined over short periods. Three subjects were studied while they performed 8 h of heavy exercise in a laboratory environment. Urine and blood samples were taken before and after exercise. Estimated energy expended during 8 h of high-intensity exercise (55% VO2 max) for three subjects was 757 +/- 118 kcal/h by the doubly-labelled-water method using urine and a two-point calculation, which compared favorably with 735 +/- 82 kcal/h obtained by respiratory gas exchange. For the fourth subject, daytime, nighttime, and daily energy expenditure was calculated by both the two-pair method and decay-curve analysis of urine and saliva samples collected in the morning and at night. Daytime and nighttime energy expenditures differed significantly (p less than 0.05).

Pulmonary function abnormalities in homozygous beta-thalassemia.

Pulmonary function tests were performed on 19 patients with homozygous beta-thalassemia ranging in age from 10 to 29 years. These included patients who had and had not received transfusions. None of the 19 subjects had completely normal pulmonary function. Residual volume (in 16 of 19 patients), ratio of residual volume to total lung capacity (12 of 19), and airway resistance (16 of 19) were abnormally increased; maximum expiratory flow (15 of 19) and peak flow (10 of 19) were abnormally reduced. Single-breath carbon monoxide diffusion was normal in 16 of 19. These results indicate that mild to moderate small airway obstruction and hyperinflation are common in thalassemia and that patient age, transfusion history, and iron accumulation are not important factors in the genesis of these pulmonary abnormalities.