Malnutrition is associated with an increased incidence of perioperative morbidity and mortality. To evaluate the effect of malnutrition on the metabolic and inflammatory response to surgery in patients with oesophageal cancer, we studied the effects of oesophagectomy in six patients with major (13·9 (se 1·3) %) weight loss and five patients with minor (0·7 (se 0·6) %) weight loss in the 6 months before to surgery. Rates of appearance (Ra) of glucose, glycerol, leucine and urea were determined by stable isotopically labelled tracer infusion before and after surgery. C-reactive protein was measured as an inflammation marker. BMI was lower in the patients with major weight loss than those with minor weight loss (20·3 (se 0·7) and 24·9 (se 1·5) kg/m2, P = 0·02). With the exception of greater glucose Ra in the major weight loss than minor weight loss subjects (11·1 (se 0·3) v. 9·5 (se 0·3) μmol/kg per min, P = 0·01), there were no differences in substrate kinetics before surgery between groups. Surgery increased glucose Ra, leucine Ra and urea Ra by 41, 24 and 58 %, respectively, in the total group. Changes in substrate kinetics in response to surgery were not different between patients with major and minor weight loss. Surgery increased C-reactive protein concentrations to a comparable extent in both groups. In conclusion, major upper gastrointestinal tract surgery in patients with oesophageal cancer elicits a catabolic response, characterized by increased inflammation, glucose production and protein breakdown. However, this catabolic response does not seem to be influenced by pre-operative nutritional status.

The concept of political legitimacy has hitherto tended to occupy a rather modest place in the historiography of twentieth-century Europe. In contrast to the attention paid by historians of pre-modern and non-European societies to issues of political culture and, more especially, to the ways in which the exercise of power by all rulers, be they sacred or secular, putative or actual, has to be located in a complex matrix of conventional beliefs, rituals and practices, historians of contemporary Europe have tended to regard issues of political legitimacy as of secondary importance compared with other more tangible factors. Political power in Europe during the nineteenth and twentieth centuries has been perceived by historians as being the product of an amalgam of ideological projects, forms of state (internal and external) aggrandisement and nationalist struggles for emancipation. Modernity – so it seems to be assumed – transformed the exercise of power, creating both new needs and justifications for active government and massively increased resources to bring these to reality, as well as flattening much of the pre-existing undergrowth of ancien régime convention and pre-industrial tradition. Government became incommensurably stronger, but also simultaneously starker. In the new world that emerged between the mid-nineteenth and the mid-twentieth centuries, the powerful forces of ideological or national messianism and the democratic (or assumed) mandate of the people lifted state power to new heights. Consequently, governmental authority flowed remorselessly downwards through the new structures of civilian and military bureaucracy and legal authority, reducing social organisations, local communities and above all the individual citizen to the role of disciplined, though not necessarily powerless, subjects. Legitimacy, in so far as it surfaces in such accounts, is regarded as having been largely constructed by rulers themselves and subsequently conveyed by the modern institutions of social control – notably mass education, conscription and state propaganda – to the population. Thus, French peasants were made into Frenchmen, Russian workers into agents of Bolshevik power and German bureaucrats into functionaries of the Nazi state.

Diet composition and energy content modulate free fatty acid (FFA) release. The aim of this study was to evaluate the dose–response effects of euenergetic variations in dietary carbohydrate and fat content on postabsorptive FFA release. The rate of appearance (Ra) of palmitate was measured by infusion of [2,2-2H2]palmitate after an overnight fast in six healthy men on three separate occasions, i.e. after 7 d on euenergetic control, high-carbohydrate and high-fat diets. The protein content and composition was identical for each diet. Postabsorptive plasma fatty acid concentrations were not different between the high-carbohydrate and control diets (0·36 (SE 0·07) V. 0·43 (se 0·04) mmol/l), but were increased after the high-fat diet (0·75 (se 0·09) mmol/l, (P<0·01 compared with the other diets). Ra palmitate was not different between the high-carbohydrate and control diets (1·36 (se 0·20) v. 1·47 (se 0·15) μmol/kg per min). However, Ra palmitate was increased to 2·36 (se 0·26) μmol/kg per min after the high-fat diet (P<0·01 compared with the other diets). The fatty acid flux and whole-body fat oxidation were not affected by the high-carbohydrate diet compared with the control diet, but were increased by 67 and 47 % respectively, on the high-fat diet (P<0·01 compared with the other diets). A euenergetic high-fat diet results in increased postabsorptive FFA release and fat oxidation, whereas a euenergetic high-carbohydrate diet does not affect these variables of fat metabolism.