Intake of polyunsaturated fat in relation to mortality among statin users and non-users in the Southern Community Cohort Study.

BACKGROUND AND AIMS: Consumption of polyunsaturated fatty acids (PUFA), especially the n3-series, may protect against cardiovascular disease (CVD), but recent randomized studies have failed to demonstrate these benefits. One of the prevailing hypotheses is that PUFA intake may not confer benefits beyond those provided by statins, but studies comparing statin users to non-users with regard to effects of PUFA are lacking. METHODS AND RESULTS: Black and white men and women (n = 69,559) in the Southern Community Cohort Study were studied. Cox regression models adjusting for age, sex, race, BMI, recruitment site, education, income, smoking, diabetes, and dietary variables were used. RESULTS: At baseline the mean ± SD age was 52 ± 9 years, 60% of participants were women, 54% had hypertension and 16% used statins. We observed modest inverse associations between n3-PUFA and n6-PUFA intake with mortality among non-statin users but not among statin users. In adjusted analyses, the HRs (95% CIs) for all-cause mortality (6,396 deaths over a median of 6.4 years) comparing the highest to the lowest quintile were 0.90 (0.82-1.00) for n3-PUFA and 0.80 (0.70-0.92) for n6-PUFA among non-statin users, whereas they were 1.06 (0.87-1.28) and 0.96 (0.78-1.19) for n3-PUFA and n6-PUFA, respectively, among statin users. CONCLUSIONS: Our results suggest potential benefits of PUFA consumption on mortality which are only apparent in the absence of statin therapy. It seems prudent to consider the potential benefit of PUFA consumption in the primary prevention of CVD among patients who are not candidates for statin therapy but are at increased risk for CVD and mortality.

Antimicrobial residues in foods of animal origin in Africa: public health risks.

The authors report on the current status of work on residues of veterinary medicinal products and, in particular, antimicrobial residues in foods of animal origin. This review focuses on residues of veterinary antimicrobials, antimicrobials used in livestock production, the concept of residues, and antimicrobial residues in foods of animal origin. Only one antimicrobial substance has been approved in the West African Economic and Monetary Union, compared with 16 substances in Benin and 56 in the European Union. The issue of antimicrobial residues in foods of animal origin has rarely been a serious concern in developing countries, in contrast to the situation in Europe. However, while the prevalence of veterinary drug residues in foods of animal origin is less than 1% in Europe, in some African countries it can be as high as 94%. Antimicrobial residues in foods of animal origin can cause allergies, cancer, alterations in the intestinal flora, bacterial resistance and the inhibition of fermentation in the dairy industry. The harmonisation of regulations in Africa could reduce the circulation of prohibited antimicrobials and lead to the implementation of a plan for the control and surveillance of residues from veterinary medicinal products in foods of animal origin.

A review on aflatoxin contamination and its implications in the developing world: a sub-Saharan African perspective.

Mycotoxins contamination in some agricultural food commodities seriously impact human and animal health and reduce the commercial value of crops. Mycotoxins are toxic secondary metabolites produced by fungi that contaminate agricultural commodities pre- or postharvest. Africa is one of the continents where environmental, agricultural and storage conditions of food commodities are conducive of Aspergillus fungi infection and aflatoxin biosynthesis. This paper reviews the commodity-wise aetiology and contamination process of aflatoxins and evaluates the potential risk of exposure from common African foods. Possible ways of reducing risk for fungal infection and aflatoxin development that are relevant to the African context. The presented database would be useful as benchmark information for development and prioritization of future research. There is need for more investigations on food quality and safety by making available advanced advanced equipments and analytical methods as well as surveillance and awareness creation in the region.

The effects of anthracycline drugs on the conformational distribution of mouse P-glycoprotein explains their transport rate differences.

P-glycoprotein (Pgp) is an ATP-dependent efflux transporter and plays a major role in anti-cancer drug resistance by pumping a chemically diverse range of cytotoxic drugs from cancerous tumors. Despite numerous studies with the transporter, the molecular features that drive anti-cancer drug efflux are not well understood. Even subtle differences in the anti-cancer drug molecular structure can lead to dramatic differences in their transport rates. To unmask these structural differences, this study focused on two closely-related anthracycline drugs, daunorubicin (DNR), and doxorubicin (DOX), with mouse Pgp. While only differing by a single hydroxyl functional group, DNR has a 4 to 5-fold higher transport rate than DOX. They both non-competitively inhibited Pgp-mediated ATP hydrolysis below basal levels. The Km of Pgp-mediated ATP hydrolysis extracted from the kinetics curves was lower for DOX than DNR. However, the dissociation constants (KDs) for these drugs determined by fluorescence quenching were virtually identical. Acrylamide quenching of Pgp tryptophan fluorescence to probe the tertiary structure of Pgp suggested that DNR shifts Pgp to a "closed" conformation, while DOX shifts Pgp to an "intermediate" conformation. The effects of these drugs on the Pgp conformational distributions in a lipid bilayer were also examined by atomic force microscopy (AFM). Analysis of AFM images revealed that DNR and DOX cause distinct and significant shifts in the conformational distribution of Pgp. The results were combined to build a conformational distribution model for anthracycline transport by Pgp.

Sudden cardiac death in the United States, 1989 to 1998.

BACKGROUND: Sudden cardiac death (SCD) is a major clinical and public health problem. METHODS AND RESULTS: United States (US) vital statistics mortality data from 1989 to 1998 were analyzed. SCD is defined as deaths occurring out of the hospital or in the emergency room or as "dead on arrival" with an underlying cause of death reported as a cardiac disease (ICD-9 code 390 to 398, 402, or 404 to 429). Death rates were calculated for residents of the US aged >/=35 years and standardized to the 2000 US population. Of 719 456 cardiac deaths among adults aged >/=35 years in 1998, 456 076 (63%) were defined as SCD. Among decedents aged 35 to 44 years, 74% of cardiac deaths were SCD. Of all SCDs in 1998, coronary heart disease (ICD-9 codes 410 to 414) was the underlying cause on 62% of death certificates. Death rates for SCD increased with age and were higher in men than women, although there was no difference at age >/=85 years. The black population had higher death rates for SCD than white, American Indian/Alaska Native, or Asian/Pacific Islander populations. The Hispanic population had lower death rates for SCD than the non-Hispanic population. From 1989 to 1998, SCD, as the proportion of all cardiac deaths, increased 12.4% (56.3% to 63.9%), and age-adjusted SCD rates declined 11.7% in men and 5.8% in women. During the same time, age-specific death rates for SCD increased 21% among women aged 35 to 44 years. CONCLUSIONS: SCD remains an important public health problem in the US. The increase in death rates for SCD among younger women warrants additional investigation.

Prediction of mortality risk by different methods of indexation for left ventricular mass.

OBJECTIVES: We sought to compare the predictive value of echocardiographically determined left ventricular hypertrophy on death from all causes and cardiac mortality using various methods of indexation for left ventricular mass. BACKGROUND: Considerable controversy exists regarding the optimal method for indexing left ventricular mass to body size in the clinical setting. METHODS: The study included 988 consecutive patients who had both coronary angiograms and echocardiographic examinations in an inner-city public hospital in Chicago, Illinois. Patients were followed up for a mean of 7 years (range 2 to 11). RESULTS: Various left ventricular mass indexes (e.g., mass indexed for height, height2, height2.13, height2.7, body surface area and body surface area1.5 were highly correlated (r = 0.90 to 0.99). Used as a continuous measure, an increase in any left ventricular mass index was associated with similar risk of death from all causes and cardiac diseases. Although left ventricular hypertrophy assessed by mass indexed for body surface area using the published conventional partition values provided somewhat better prediction, the adjusted relative risk was in general not significantly different from hypertrophy based on other indexes. Patients with left ventricular hypertrophy defined concordantly by indexes based on both body surface area and height (or height2.7) had, by definition, the highest average mass indexes among all groups and experienced as much as a threefold greater risk of death than those without hypertrophy. A small proportion of patients (12%) who were classified into the hypertrophy group by height-based indexes alone, but not by body surface area, had a moderate increase in mass and showed no increase in risk, even though being overweight was extremely prevalent in this group. CONCLUSIONS: Because of the high correlation among various body size indexes, left ventricular hypertrophy, defined by different indexes for left ventricular mass, similarly confers increased risk of mortality in patients with or without coronary artery disease.

Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension.

Ratio of stroke volume (SV, M-mode echocardiography) to pulse pressure (PP) has been proposed as an estimate of total arterial compliance and has been shown to be related to body size, age, and heart rate in normal adults. SV/PP was estimated in 294 hypertensive patients (98 women) as a raw value by use of SV/body surface area (SVi) and by the ratio of SV/PP to the value predicted by a previously developed equation (%SV/PP). At baseline, the 50 patients who had cardiovascular events over the following 10 years exhibited higher PP and lower SV/PP, SVi/PP, and %SV/PP (all P<0.008) than patients without events. Crude risk of follow-up total and fatal cardiovascular events increased with increasing level of PP and decreasing SV/PP, SVi/PP, and %SV/PP (all P<0.002). In multivariate logistic regression models with continuous covariates, the risk of total cardiovascular events was independently related to increasing age (P<0.0001) and left ventricular (LV) mass index (P<0.003) and decreasing values of %SV/PP (P<0.006) but not to increasing systolic, pulse, or mean blood pressure or gender. Similar although less strong results were obtained with the use of SVi/PP (P<0.02), whereas SV/PP did not enter the model as an independent predictor. Risk of cardiovascular death was only predicted by age and LV mass index. The %SV/PP was also an independent predictor of total cardiovascular events in Cox proportional hazards analysis (exp[b]: 2.49, P<0.001) independent of age (exp[b]: 1.05, P<0.003) and LV mass index (exp[b]: 1.02, P<0.0003), whereas no effect was detected for height. Thus, in patients with arterial hypertension, a reduced ratio of M-mode echocardiographic SV/PP as a percentage of the value predicted by demographic variables is a predictor of cardiovascular morbid events independent of age and LV mass index.

Comparison of classification of the severity of hypertension by blood pressure level and by World Health Organization criteria in the prediction of concurrent cardiac abnormalities and subsequent complications in essential hypertension.

OBJECTIVE: To determine whether classification of the severity of hypertension according to the World Health Organization (WHO) system, which utilizes additional clinical and laboratory findings, is superior to classification by blood pressure level alone in predicting prognostically important cardiac structural abnormalities and the risk of subsequent complications in asymptomatic subjects. DESIGN: Two-hundred and twenty adults with uncomplicated essential hypertension underwent baseline clinical evaluation and echocardiography; 88% were subsequently followed for a mean of 11.6 years. SETTING: University hospital. RESULTS: Left ventricular mass index and relative wall thickness were slightly greater in patients in the highest diastolic or systolic blood pressure stratum than in WHO stage II hypertensives, but these results were statistically non-significant. High peripheral resistance index was best identified by diastolic blood pressure level. Receiver operating characteristic curve analysis showed that all three methods had similar test performance in predicting abnormal left ventricular mass index, left ventricular geometry, relative wall thickness and peripheral resistance. During follow-up the proportion of patients who had a clinical event or died increased with increasing severity stratum in all three clinical classification systems, but the trends were statistically non-significant. Risk stratification by echocardiographic left ventricular mass index was most successful in identifying patients at very high and very low risk of subsequent morbid events and all-cause mortality. CONCLUSION: Classification of hypertension severity by blood pressure level has similar, although limited, effectiveness at a lower cost than the WHO criteria in identifying patients with adverse cardiac changes and an impaired long-term prognosis. Echocardiographic measurement of left ventricular mass index was more successful than other classifications in predicting subsequent morbid events.

Prognostic implications of the compensatory nature of left ventricular mass in arterial hypertension.

OBJECTIVE: To test whether inappropriate echocardiographic left ventricular (LV) mass (i.e. higher than predicted by individual body size, sex and cardiac load [delta%LVM]) is associated with an increased rate of cardiovascular events, and whether values of LV mass lower than appropriate confer protection. DESIGN: Prospective, longitudinal. SETTING: Institutional, hospital outpatient clinic. PATIENTS: A total of 294 hypertensive patients, 84 with inappropriate and 21 with low LV mass (lower than appropriate). MAIN OUTCOME MEASURES: Cardiovascular fatal and non-fatal events. RESULTS: Baseline delta%LVM was higher in patients with follow-up total (n = 50) or fatal (n = 14) events than in event-free survivors (all P < 0.0001) and predicted events independently of age and systolic pressure (all P < 0.0001). Although the performance was not better than with use of more traditional definition of LV hypertrophy, delta%LVM remained a predictor even in the subgroup of 126 patients (32 total events, 13 deaths) with clear-cut LV hypertrophy (P < 0.009). Patients with low LV mass exhibited supranormal LV chamber and midwall function, slightly higher heart rate and higher cardiac index (all P< 0.01). These patients had the same rate of events as those with appropriate LV mass. CONCLUSIONS: In hypertensive patients, increase in LV mass beyond values required to compensate cardiac workload at a given body size and sex predicts cardiovascular risk independently of age and blood pressure, in the whole population as well as in the subset of patients with LV hypertrophy. Hypertensive patients with levels of LV mass lower than needed to compensate cardiac workload exhibit hyperdynamic circulatory status and the same risk pattern as patients with higher values of LV mass, possibly due to activation of the sympathetic system.

Pulmonary vein Doppler flow patterns specific for elevated left ventricular filling pressures in older cardiac patients are common in healthy adults < 40 years old.

In older cardiac patients, elevated left-sided heart filling pressures are predicted by both a systolic PV flow fraction < 40% and a greater duration during atrial systole of reversal flow into the PVs than forward flow through the mitral valve. However, this study shows that these Doppler findings are not uncommon in younger subjects without cardiac disease. Use of these PV Doppler flow parameters to assess LV filling pressures should be limited to older patients.

Patterns of body fat deposition in youth and their relation to left ventricular markers of adverse cardiovascular prognosis.

The patterns of body fat deposition in healthy youth and their relation to future development of cardiovascular disease remain incompletely understood. To further evaluate these patterns, we measured indirect indexes of central and general fat deposition in healthy adolescents (mean age 15.4+/-2.3 years) with family histories of hypertension. We examined the relation between these indexes and echocardiographic markers of adverse prognosis as well as the effect of gender and ethnicity. All 225 subjects (64% black and 48% female) had > or =1 biologic parent and 1 grandparent with hypertension. Skinfold thicknesses, waist-to-hip girth ratio, Quetelet index, Ponderal index, conicity, and Z score weight - Z score height were measured. Left ventricular (LV) mass, indexed LV mass, relative wall thickness (RWT), and midwall fractional shortening (MFS) were determined using echocardiography. In both black and white subjects, the adiposity indexes were significantly correlated with posterior wall thickness, total LV mass, and indexed LV mass (p <0.05 for all). Additionally, in black subjects, central adiposity was inversely related to MFS and directly related to RWT and septal thickness. General adiposity independently predicted indexed and nonindexed LV mass, whereas central adiposity predicted MFS and RWT. Compared with subjects with normal LV geometry, those with abnormal geometry were heavier and fatter based on every index of obesity (p <0.03 for all). Thus, indexes of fat deposition are significantly correlated with LV markers of adverse prognosis in healthy youth.

Exercise in sickle cell anemia: effect on inflammatory and vasoactive mediators.

The aim of this study was to determine the response of inflammatory and vasoactive mediators to 3 consecutive days of exercise in African-American women with and without sickle cell anemia (SCA). Circulating inflammatory mediators [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha)] were measured before, and vasoactive mediators [endothelin-1 (ET-1), nitric oxide metabolites (NOx)] before and after each exercise bout in ten subjects with SCA and ten controls. Exercise did not affect ET-1, IL-6 or CRP concentrations (p >.05). TNFalpha was higher in SCA than controls (p < or = .0005) at all times; however, the response pattern was similar for the groups: no change from day 1 to day 2, but a decrease from day 2 to day 3 (p < or = .05). NOx increased significantly after exercise (p < or = .0001) but returned to baseline by 24 h afterward. On the 3rd day, NOx increased after exercise in SCA but not in the controls (p < or = .05). In conclusion, exercise did not cause a harmful inflammatory response in these individuals with SCA. However, NOx increased after exercise on all 3 days in SCA but appeared attenuated after 2 days in controls.

Comparison of left ventricular mass and geometry in black and white patients with essential hypertension.

To assess racial difference in cardiac responses to elevated blood pressure, we compared echocardiographic measurements of left ventricular (LV) mass and the wall thickness to chamber dimension ratio (relative wall thickness) in 380 white and 47 black patients with uncomplicated essential hypertension consecutively enrolled in echocardiographic research studies at The New York Hospital Hypertension Center. Diastolic blood pressure and weight were slightly greater in black as compared with white subjects (104 +/- 18 v 98 +/- 11 mm Hg; P = .014 and 82 +/- 17 v 77 +/- 15 kg; P = .037, respectively), however the groups were similar with respect to age, duration of hypertension, cholesterol level, cigarette smoking, past use of antihypertensive therapy, family history of heart disease, and height. On average, LV mass indexed for body surface area and relative wall thickness were significantly greater in blacks than whites (119 v 105 g/m2; P = .02 and 0.46 v 0.39; P = .003) and blacks had twice the prevalence of LV hypertrophy (41% v 19%; P < .001) or concentric remodeling (21% v 12%; P < .05). The magnitude of increased LV mass and relative wall thickness in blacks was similar in men (132 v 110 g/m2; P = .01 and 0.44 v 0.39; P = .04) and in women (107 v 94 g/m2; P = .11 and 0.48 v 0.39; P = .02). In multivariate analyses, systolic blood pressure, age, and race were consistently predictors of increased LV mass and abnormal cardiac geometry. Cholesterol level was not independently associated with increased LV mass but was weakly associated with increased relative wall thickness.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of beta-adrenergic receptor blockers in blacks.

Beta adrenergic receptor blockers (beta-blockers) are an important class of drugs in the management of patients with cardiovascular diseases. These drugs have been shown to reduce mortality in hypertension and prolong survival in patients with coronary heart disease. Although hypertension and coronary heart disease account for the majority of excess cardiovascular morbidity and mortality in blocks, beta-blockers continue to be underprescribed in this ethnic group. The magnitude of blood pressure reduction in black patients with hypertension has been consistently less during monotherapy with nonselective beta-blockers than with diuretics. However, the highly selective beta-blocker bisoprolol has been shown to be as effective as diuretics and is equally effective in black and nonblack patients with hypertension. In general, no racial differences in efficacy are noted when beta-blockers are used with diuretics as combination therapy for hypertension. Black patients should not be denied beta-blocker therapy because of an anticipated suboptimal response, especially when there are clear indications for treatment (e.g., for migraine, hyperthyroidism, arrhythmia control, and after myocardial infarction).

Acute purulent mediastinitis and sternal osteomyelitis after closed chest cardiopulmonary resuscitation: a case report and review of the literature.

Numerous complications have been associated with cardiopulmonary resuscitation. Acute purulent staphylococcal mediastinitis and sternal osteomyelitis are, however, unusual and do not appear to have been reported previously in association with closed chest resuscitation. Sternal fracture during chest compressions and subsequent hematogenous seeding of the resultant retrosternal hematoma with Staphylococcus aureus led to purulent mediastinitis and sternal osteomyelitis in our patient. The source of bacteremia may have been a resolving phlebitis at an intravenous catheter insertion site. Early diagnosis, aggressive surgical debridement, and antibiotic therapy were key to a successful outcome.

Using angiotensin converting enzyme inhibitors in African-American hypertensives: a new approach to treating hypertension and preventing target-organ damage.

Angiotensin converting enzyme (ACE) inhibitors have been avoided as an initial therapeutic option in the treatment of hypertension in African-Americans. A major reason for this has been the widespread perception of clinicians that these agents have poor blood pressure (BP) lowering efficacy in this population. Remarkably uniform and pervasive interpretations of clinical trial data have formed the basis of this clinical perception and can be summarised as follows: (1) there has been a lesser BP lowering effect of ACE inhibitors in African-Americans compared to whites, particularly at low doses; and (2) short-acting ACE inhibitors like captopril prescribed at the midpoint of its maximal total daily dose lower BP less effectively than higher doses of calcium antagonists in African-Americans. A reinterpretation of published data from these same clinical trials suggests that: (1) the majority of African-Americans have meaningful BP responses to ACE inhibitors, albeit at a higher average dose than in whites; and (2) high levels of dietary sodium intake appear to explain a significant portion of the racial differences in BP response at the lower doses of ACE inhibitors. Thus, ACE inhibitors can effectively lower BP in African-Americans. These data suggest that the clinician should not avoid these agents in African-Americans because of a presumed lack of BP lowering efficacy. Rather, we should recognise the importance of adequate drug dosing and modest reductions in dietary sodium intake in augmenting the BP lowering effect of ACE inhibitors in hypertensive African-Americans.

Spectrum of hypertensive target organ damage in Africa: a review of published studies.

This paper reviews the evidence of hypertensive target organ damage (HTOD) in Africa, and the difficulties of its assessment, with a focus on implications for further research and prevention. Specific examples of HTOD reviewed include left ventricular hypertrophy, heart failure, ischaemic heart disease, arrhythmias and sudden death, kidney failure, cerebrovascular accidents, retinopathy and central as well as peripheral vascular disease. There is evidence that the prevalence of hypertension is increasing in some parts of Africa, thus increasing the number of people who suffer from fatal and nonfatal complications. Analysis of the type, frequency and distribution of HTOD is critical to the design of interventions to prevent and manage hypertension, and in the design of future clinical research. As would be expected, the frequency of atherosclerotic complications, particularly involving the heart, is lower in Africa than in developed countries. Stroke, renal failure and heart failure appear to be the principal adverse outcomes and are likely to be associated with a high case fatality rate. Community-based data on these issues are limited, however, and hospital series cannot estimate the population burden and may be unreliable in describing the case mix. Improved data on HTOD will more accurately reflect the health impact of hypertension, provide the basis for aggressive efforts at prevention, detection and control of high BP and establish their relevance in the overall scheme of resource allocation during fiscal austerity and limited healthcare spending. Additionally, knowledge of the prevalence and relative frequencies of HTOD has direct and important implications for clinical outcomes research in hypertension.

Refining strategies for the prevention and control of hypertension and related complications.

Hypertension is the leading preventable cause of premature morbidity and mortality from coronary heart disease, chronic heart failure, stroke and kidney failure. Despite the remarkable advances made in the design, development, and distribution of antihypertensive drugs and the plethora of published guidelines for hypertension treatment over the last two decades, blood pressure control rates remain rather disappointing. In the United States, Canada, and the United Kingdom, as well as in countries with far less resources devoted to health care, fewer than one in four hypertensives are controlled. This observation remains a major source of frustration for clinicians and health policy makers alike and serves as a constant reminder for more refined strategies for hypertension treatment and control. The 14th International Interdisciplinary Conference on Hypertension in Blacks (ISHIB99), held in Toronto, Canada on July 10-14, 1999 provided a unique forum for the discussion of this issue. The recommendations discussed are summarized herein under 10 specific headings that include: (1) Renewed emphasis on health education for patients and their families; (2) Increased involvement of non-physician health care providers; (3) Aggressive detection, evaluation and control of attendant cardiovascular risk factors; (4) Renewed determination for clinicians to set and achieve blood pressure targets; (5) Increased patient involvement in management decisions; (6) Improved access to quality care for the "working poor" and indigent; (7) Renewed commitment to community participation; (8) Partnership with managed care and professional organizations; (9) Renewed emphasis on the importance of psychosocial factors; (10) Enhanced communication and networking among hypertension care providers and between providers and patients.

Body composition in women with sickle cell disease.

INTRODUCTION: Adults with sickle cell disease (SCD) have increased morbidity and low perceived health status, similar to patients with other chronic conditions. These patients may be sedentary due to exercise intolerance, physical incapacity due to sickle cell-related complications or medical conservatism. Obesity is an indicator of low health status and overall well-being in the general population, and we hypothesize that adults with SCD will have a high total body fat (%BF). The purpose of this study was to assess body composition in women with SCD using dual-energy X-ray absorptiometry (DXA). METHODS: Baseline medical examination, laboratory assessments, and seven-day activity recall to estimate energy expenditure (EE) were obtained for 22 women with SCD. BMI was calculated and whole body DXA was performed [fat mass (FM), fat-free soft tissue (FFST), and bone mineral content (BMC)]. Descriptive statistics were obtained and associations between body composition indices, total hemoglobin (Hb), treatment with hydroxyurea (HU), and EE were determined. RESULTS: Patient age was 30.5+/-9.3 years and total Hb was 8.85+/-1.92 g/dL (mean+/-SD). Mean body mass index (BMI) (22.6 kg/m2) was in the 'acceptable' range, while DXA measurement of mean % fat (32.6%) indicated obesity. Fat-free mass (FFM) was 40.0+/-5.62 and bone mineral density (BMD) was 1.13+/-0.14 g/cm2 (mean+/-SD). There were no correlations between body composition indices and total Hb, HU, or EE. CONCLUSIONS: This is the first report of high levels of adiposity, low FFM, and low BMD in normal weight women with SCD. The findings were not affected by total Hb, EE, HU. Further studies are needed to better define body composition, body composition determinants, and their impact on overall health status in adults with SCD.