Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project.

BACKGROUND: Interventions to increase person-centeredness in hospital care for persons with psychotic illness are needed. Changing care delivery is however a complex venture, requiring staff to reconsider their mindsets and ways of working. A multidisciplinary educational intervention for hospital staff at four wards was launched to increase person-centeredness in the care of patients with schizophrenia and similar psychoses. This study aims to explore staff experiences of working to increase person-centeredness. METHODS: A heterogenic sample of staff (n = 23) from all participating wards were recruited for six focus group interviews. Semi-structured questions covered staff perceptions of person-centered care and the process of increasing person-centeredness. Transcribed data was analyzed using thematic analysis according to Braun and Clarke. RESULTS: Staff viewed person-centered care as an approach rather than a method. They described central aspects of person-centered care, such as recognizing the patient as a capable person who can participate in her/his care. Statements further showed how these core features were put into practice. Changes related to the intervention were presented in terms of evolving patient and staff roles, improved contact with patients, more flexible care routines, and a more positive ward climate. Neither psychotic symptoms nor involuntary status were considered barriers for person-centered care, but organizational factors beyond staff control seemed to impact on implementation. CONCLUSIONS: After implementation, participants displayed good understanding of the core concepts of person-centered care in both thinking and action. They attributed several improvements in the care milieu to an increased level of person-centeredness. Psychotic behavior and involuntary treatment did not present major barriers to person-centered care. Findings suggest person-centered care is feasible in the psychosis inpatient setting and could improve quality of care. TRIAL REGISTRATION: The study is part of a larger study evaluating the intervention Person-Centered Psychosis Care (PCPC). It was registered retrospectively at clinicaltrials.gov , identifier NCT03182283 .

The effect of temperature acclimation on the force-frequency relationship and adrenergic sensitivity of the ventricle of two populations of juvenile sockeye salmon.

We tested the hypothesis that cardiorespiratory differences known to exist among adult sockeye salmon populations also exist in the juveniles. To test this hypothesis, we compared cardiac contractility and adrenergic responsiveness of juvenile sockeye salmon from two geographically isolated populations that were reared from eggs under common garden conditions and at two acclimation temperatures (5 °C and 14 °C). However, we found no substantive differences in the force-frequency response (FFR) and the cardiac pumping capacity of juveniles from Weaver Creek and Chilko River populations, even when we considered wild-reared juveniles from one of the populations. An unexpected discovery for all fish groups at 5 °C was a rather flat FFR during tonic ß-adrenergic stimulation (ßAR) stimulation. Curiously, while active tension nearly doubled with maximum ßAR stimulation at low pacing frequencies for all fish groups, a negative FFR with maximum ßAR stimulation meant that this inotropic benefit was lost at the highest pacing frequency (0.8 Hz). Active tension with tonic ßAR stimulation was similar at 14 °C, but maximum pacing frequency doubled and all fish groups displayed a modest negative FFR. Maximum ßAR stimulation again doubled active tension and this benefit was retained even at the highest pacing frequency (1.6 Hz) at 14 °C. Even though subtle population differences were apparent for the FFR and pumping capacity, their biological significance is unclear. What is clear, however, is that the cardiac pumping capacity of juvenile sockeye would benefit more from ßAR stimulation swimming at 15 °C than when swimming at 5 °C.

Quantification of ventricular ß2 -adrenoceptor density and ligand binding affinity in wild sockeye salmon Oncorhynchus nerka smolts using a novel modification to the tritiated ligand technique.

A new, image-based, tritiated ligand technique for measuring cardiac ß2 -adrenoceptor (ß2 -AR) binding characteristics was developed and validated with adult rainbow trout Oncorhynchus mykiss hearts so that the tissue limitation of traditional receptor binding techniques could be overcome and measurements could be made in hearts nearly 14-times smaller than previously used. The myocardial cell-surface (functional) ß2 -AR density of O. nerka smolts sampled at the headwaters of the Chilko River was 54·2 fmol mg protein(-1) and about half of that previously found in return migrating adults of the same population, but still more than twice that of adult hatchery O. mykiss (21·1 fmol mg protein(-1) ). This technique now opens the possibility of investigating cardiac receptor density in a much wider range of fish species and life stages.

Planning for Uncertainty and Fallbacks Can Increase the Number of Transplants in a Kidney-Paired Donation Program.

A kidney-paired donation (KPD) pool consists of transplant candidates and their incompatible donors, along with nondirected donors (NDDs). In a match run, exchanges are arranged among pairs in the pool via cycles, as well as chains created from NDDs. A problem of importance is how to arrange cycles and chains to optimize the number of transplants. We outline and examine, through example and by simulation, four schemes for selecting potential matches in a realistic model of a KPD system; proposed schemes take account of probabilities that chosen transplants may not be completed as well as allowing for contingency plans when the optimal solution fails. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Donation, the simulations extend over 8 match runs, with 30 pairs and 1 NDD added between each run. Schemes that incorporate uncertainties and fallbacks into the selection process yield substantially more transplants on average, increasing the number of transplants by as much as 40% compared to a standard selection scheme. The gain depends on the degree of uncertainty in the system. The proposed approaches can be easily implemented and provide substantial advantages over current KPD matching algorithms.

Waist-to-height ratios in relation to BMI z-scores in three ethnic groups from a representative sample of New Zealand children aged 5-14 years.

Waist-to-height ratio (WHtR) is purported to offer a simpler index of health risk than body mass index (BMI) in children as it requires no adjustment for age or sex. Little is known regarding the usefulness of WHtR in different ethnic groups. The aim of this study was to compare the WHtR cutpoints associated with BMI definitions of overweight and obesity in a nationally representative sample of New Zealand children. Height, weight and waist circumference were measured in 3006 children (51.5% male) aged 5-14 years (n=1107 Maori, n=985 Pacific and n=924 New Zealand European and Others (NZEO)). A WHtR >0.5 was more common in Pacific (43.4%) and Maori (33.1%) children than in NZEO children (20.8%, P<0.001), with 25.6% of children overall being above this cutoff. Although ethnicity influenced the relationship between BMI and WHtR (P<0.01), differences were clinically insignificant as illustrated by the similarity in WHtR values for a given BMI (WHtR of 0.47 in Maori, 0.46 in Pacific and 0.48 in European boys at the 85th BMI percentile). The present results suggest that having WHtR values >0.5 should be equally useful in evaluating cardiovascular health risks in groups of Maori, Pacific and NZEO children.

Osteoporosis and gait and balance disturbances in older sarcopenic obese New Zealanders.

UNLABELLED: Bone, muscle, and fat may affect gait and balance in older adults. Osteoporosis was prevalent in low muscle mass participants and related to gait and balance deficits. Low muscle combined with high fat mass had more functional deficits and poorer bone health, which has implications for falls risk and fractures. INTRODUCTION: Decreasing bone density and muscle mass and increasing fat mass may act synergistically to affect gait and balance in older adults. METHODS: One hundred eighty-three older adults (age 72.7 +/- 6 years, range 56-93; body mass index 28.2 +/- 4.9, range 16.6-46.0) were recruited from a New Zealand falls prevention intervention trial. Total and appendicular skeletal muscle mass (ASM), percent fat, and bone mineralization were assessed by dual energy X-ray absorptiometry and used to characterize normal lean (NL, n = 51), sarcopenic (SS, n = 18), sarcopenic obese (SO, n = 29), and obese (OO, n = 85) phenotypes. Functional performance was assessed using timed up and go, chair stand, single leg stand, and step test. Regression models were adjusted for age, sex, medications, and physical activity. RESULTS: Femoral neck osteoporosis was present in 22% SS, 17% SO, 12% NL, and 7% OO. Femoral neck osteoporosis with low ASM predicted poor chair stand performance (beta -3.3, standard error 1.6, p = 0.04). SO scored lowest on the chair stand (p = 0.03) and step test (p = 0.03). Higher ASM predicted faster timed up and go performance (p = 0.001). CONCLUSIONS: Osteoporosis was prevalent in low ASM groups (SS and SO) and related to gait and balance deficits, particularly in the SO. This has implications for falls risk, fractures, and interventions.

Dual function labeling of biomolecules based on DsRed-Monomer.

Unavailability of fusion tags that possess both affinity and visualization properties is a hurdle for biomolecular research. Typically, either a choice is made between an affinity tag and a reporter tag or both are employed in tandem if a fusion can be made at both termini of the target biomolecule. In this work, we have developed a site-specific genetic fusion approach employing DsRed-Monomer, a red fluorescent protein, that provides for both affinity and reporter functionality in a single tag. As a proof-of-concept, two fusion proteins, bradykinin-DsRed-Monomer and calmodulin-DsRed-Monomer, were prepared for the study. These fusion proteins were purified using a copper-immobilized column based on the inherent copper-binding property of DsRed-Monomer. Spectroscopic characterization of fusion proteins and comparison with native DsRed-Monomer showed no effect of fusion on the properties of DsRed-Monomer. Further, bradykinin-DsRed-Monomer was employed in the development of a competitive fluorescence immunoassay for the peptide bradykinin. Calmodulin-DsRed-Monomer was used to detect binding of the calmodulin ligand chlorpromazine, based on a change in the fluorescence of DsRed-Monomer upon binding of chlorpromazine to calmodulin. The studies performed demonstrate the application of DsRed-Monomer as a dual function tag indicating the potential usefulness of DsRed-monomer in proteomics and biomolecular research.

The effect of adiposity measured by dual-energy X-ray absorptiometry on lung function.

Respiratory function is impaired in obesity but there are limitations with body mass index and skin-fold thickness in assessing this effect. The present authors hypothesised that the regional distribution of body fat and lean mass, as measured by dual-energy X-ray absorptiometry (DXA), might be more informative than conventional measurements of total body fat. In total, 107 subjects (55 female, 51.4%) aged 20-50 yrs with no respiratory disease were recruited. Respiratory function tests, anthropometric measurements and a DXA scan were performed. Partial correlation and linear regression analyses were used to explore the effect of adiposity and lean body mass on respiratory function. The majority of respiratory function parameters were significantly correlated with DXA and non-DXA measurements of body fat. Neither thoracic nor abdominal fat had a greater effect. There were some differences in the effect of adiposity between the sexes. Respiratory function was negatively associated with lean body mass in females but positively associated in males. This disappeared after adjustment in females but remained in males. The effects of thoracic and abdominal body fat on respiratory function are comparable but cannot be separated from one another.

Children who experience their first fracture at a young age have high rates of fracture.

Rate of fracture was examined according to age at first fracture in 313 New Zealand children (145 girls, 168 boys) under l3 years of age (95.4% of a consecutive series of children treated at one hospital for a recent confirmed fracture at any site). In their lifetimes they had experienced 468 separate fracture events, over half (54.7%) occurring in the 32.3% of children breaking bones on more than one occasion. Children experiencing a first fracture before 4 years of age had 36.7 (95%CI 30.7-44.1) fractures per l00 years of exposure: this was a significantly higher rate than that of children experiencing their first fracture later in life. Thus, using the <4.0 year age group as a reference, we found that rate ratios (adjusted for gender) for groups that had suffered the first fracture at later ages were: first fracture between 4.0 and 6.99 years, 0.77 (95%CI 0.58-1.03); first fracture between 7.0 and 9.99 years, 0.63 (95%CI 0.42-0.94); first fracture between 10.0 and 12.99 years, 0.48 (95% CI 0.32-0.72). Asthma was over-represented (31% seen, 25% expected), and a high proportion of the sample (32.9%) used corticosteroid medications; however, neither characteristic affected age at first fracture. In contrast, the large number (n= 42) of youngsters (13.4% of the sample) reporting adverse reactions to milk were younger at first fracture than children without reactions to milk (P<0.05). We conclude that children experiencing their first fracture at a young age have high rates of fracture and should be targeted for advice to improve their bone strength.

Do young New Zealand Pacific Island and European children differ in bone size or bone mineral?

Although Pacific Island adults have been shown to have larger bones and greater bone mineral density than caucasians, no previous studies have been undertaken to determine whether differences are present in prepubertal children. Forty-one Pacific Island children (both parents of Pacific Island descent) and 38 European children, aged 3 to 7 years, living in New Zealand were studied. Heights and weights were determined by simple anthropometry and body mass index (BMI, kg/m2) was calculated. Body composition, bone size, and bone mineral content (BMC, g) were measured by dual energy X-ray absorptiometry (DXA) of the total body and the non-dominant forearm. Compared to European children, in data adjusted for age and gender, Pacific Island children had significantly greater (P < 0.05) BMC in the total body (12%), the ultradistal radius (16%), and the 33% radius (8%), and also greater total body bone area (10%). Bone mineral density (BMD, g/cm2) was higher only at the ultradistal radius (11%). However, after adjustment for body weight, in particular lean mass, no differences were seen between Pacific Island and European children in any bone measure. The larger bone area and BMC of young Pacific Island children can be explained by their greater height and weight. Therefore, this study has shown that prepubertal Pacific Island children do not have greater bone size or BMC for their weight.

Two-year changes in bone and body composition in young children with a history of prolonged milk avoidance.

No previous longitudinal studies of calcium intake, anthropometry and bone health in young children with a history of avoiding cow's milk have been undertaken. We report the 2-year changes of a group of 46 Caucasian children (28 girls, l8 boys) aged 8.1+/-2.0 years (mean +/- SD) who had low calcium intakes at baseline and were short in stature, with elevated body mass index, poor skeletons and lower Z scores for both areal bone mineral density (BMD, in grams per square centimeter) and volumetric density (bone mineral apparent density, BMAD, in grams per cubic centimeter), compared with a reference population of milk drinkers. At follow-up, adverse symptoms to milk had diminished and modest increases in milk consumption and calcium intake had occurred. Total body bone mineral content (BMC) and bone area assessed by dual energy X-ray absorptiometry had increased (P<0.05), and calcium intake from all sources was associated with both these measures (P<0.05). However, although some catch-up in height had taken place, the group remained significantly shorter than the reference population (Z scores -0.39+/-1.14), with elevated body mass index (Z scores 0.46+/-1.0). The ultradistal radius BMC Z scores remained low (-0.31+/-0.98). The Z scores for BMD had improved to lie within the normal range at predominantly cortical sites (33% radius, neck of femur and hip trochanter) but had worsened at predominantly trabecular sites (ultradistal radius and lumbar spine), where values lay below those of the reference group (P<0.05). Similarly, although volumetric BMAD Z scores at the 33% radius had normalized, BMAD Z scores at the lumbar spine remained below the reference population at follow-up (-0.67+/-1.12, P<0.001). Our results demonstrate persisting height reduction, overweight and osteopenia at the ultradistal radius and lumbar spine in young milk avoiders over 2 years of follow-up.

Biomechanical analysis of arm fracture in obese boys.

OBJECTIVE: To determine the role of the biomechanical factors of force of impact, bone strength, fall height and surface stiffness on the risk of forearm fracture in obese children compared to non-obese children. METHODOLOGY: Anthropometric and dual-energy X-ray absorptiometry bone density data from 50 boys (25 obese pair-matched with 25 non-obese subjects) aged 4-17 years were entered into a rheological-stochastic simulation model of arm impact. RESULTS: Obese children were shown to be at 1.7 times greater risk of fracture compared to non-obese children. Lower fall heights and softer impact surfaces were found not to reduce the relative risk of fracture between obese and non-obese children. CONCLUSIONS: Environmental modifications are unlikely to lower the risk of arm fracture in obese children to the same levels experienced by non-obese children. The best option available for obese children to reduce fracture risk is to take steps to attain a healthy bodyweight.

Identifying adolescents with high percentage body fat: a comparison of BMI cutoffs using age and stage of pubertal development compared with BMI cutoffs using age alone.

OBJECTIVE: To ascertain whether body mass index (BMI) cutoffs calculated according to age and pubertal stage are superior to BMI cutoffs calculated on the basis of age alone at correctly identifying children and adolescents with high levels of adiposity. DESIGN: Cross-sectional study. SETTING: Dunedin, a university city in New Zealand. SUBJECTS AND MEASUREMENTS: In total, 368 healthy Caucasian children and adolescents (179 males, 189 females) aged 8.5-15.5 y had their percentage body fat measured by dual-energy X-ray absorptiometry (DXA). High adiposity was defined as > or =25% body fat in males and > or =35% body fat in females. The sensitivity, specificity and areas under the receiver operating characteristic curves of two Z-score distributions of BMI were calculated for each gender. RESULTS: Forty-nine males (27.3%) and 43 females (22.8%) had high DXA-measured percentage body fat. In all, 86% of males and females with high adiposity were correctly identified by BMI cutoffs calculated according to age alone, with 89% of males and 97% of females with low adiposity being correctly classified. Similar results were observed when BMI cutoffs utilising both age and stage of pubertal development were used; 90% of males and 88% of females with high adiposity and 92% of both males and females with low adiposity were correctly classified according to BMI. CONCLUSIONS: Categorisation of BMI according to both age and pubertal stage of development does not produce cutoffs that are superior to BMI cutoffs calculated on the basis of age alone at identifying children with high DXA-measured adiposity. SPONSORSHIP: University of Otago and the Health Research Council, New Zealand.

Body composition of 4- and 5-year-old New Zealand girls: a DXA study of initial adiposity and subsequent 4-year fat change.

BACKGROUND: Dual-energy X-ray information (DXA) quantitating body fat mass and percentage fat in healthy children of preschool age is scarce. OBJECTIVE: To study the initial variability in body composition and subsequent longitudinal changes in absolute fat mass (kg) and relative adiposity (fat percentage) in a sample of contemporary young New Zealand girls. DESIGN: Cross-sectional study with a longitudinal component. SETTING: University research unit. SUBJECTS: A total of 89 Caucasian girls aged 4-5 y were recruited by advertisement at baseline and 4-y changes in body composition were evaluated in 23 of these girls. METHODS: Total body composition was measured by DXA, height and weight by anthropometry. RESULTS: Baseline values for fat mass varied more than values for lean mass or bone mass. Girls from the upper third of our fat percentage distribution (% fat >19.2%) had more than twice the fat mass (5.34 vs 2.31 kg, P<0.001) of those from the lowest third (% fat &<15.4%). The percentage gain in fat mass over 4 y (124 (95% CI 90-163) also exceeded the percentage gain of lean mass (55 (95% CI 51-59). In data adjusted for age and height, 63.5% of the variance in percentage body fat at time 2 was explained by fat mass at time one. CONCLUSIONS: In girls, the trajectory of fat gain appears to be established at a young age. Our results support the view that body fatness tracks strongly before puberty. Since preventing the accumulation of excessive fat is preferable to reduction of existing excessive fat stores, it is important to put in place strategies to limit excessive fat gain early in life.

Dynamic and static tests of balance and postural sway in boys: effects of previous wrist bone fractures and high adiposity.

Ninety-three males aged 10-21 years undertook the Bruininks-Oseretsky balance test and two computerized posturography tests to evaluate the effects of (a) previous forearm fracture and (b) high body weight on balance and postural sway. Body composition was measured by dual energy X-ray absorptiometry. Fracture history did not affect balance measures. However, Bruininks-Oseretsky balance scores were negatively correlated with body weight, body mass index, percentage fat and total fat mass. Overweight subjects (n=25) had lower scores (P<0.05) than boys of healthy weight (n=47), supporting the view that overweight adolescents have poorer balance than those of healthy weight.

How many children remain fracture-free during growth? a longitudinal study of children and adolescents participating in the Dunedin Multidisciplinary Health and Development Study.

While much is known regarding the incidence and pattern of fractures during growth, information is sparse as to how many children fracture repeatedly and how many remain fracture-free during growth. The Dunedin Multidisciplinary Health and Development Study, a birth cohort, whose members were questioned regularly throughout growth (at ages 5, 7, 9, 11, 13, 15 and 18 years) concerning injuries including fractures, has provided a unique opportunity to answer these questions. Life-table analysis showed that approximately half the children remained fracture-free throughout growth [girls 60.1%, (95% CI 54.7-65.0) and boys 49.3% (95% CI 44.0-54.4)]. Data on fracture history, for participants seen at every phase, was available for 601 members through to the age of 18 years (61.1% of the cohort seen at age 5 years). Two hundred and ninety-one of these 601 participants reported 498 fractures, with 172 sustaining a single fracture, and 119 more than one fracture (15.8% girls and 23.4% boys). The most common site of fracture was the wrist/forearm (24.1% of all fractures). We conclude that although bone fractures are a common adverse event in childhood, half of all children remain fracture-free throughout growth.

Spinal overload: a concern for obese children and adolescents?

Heavy children require stronger bones than leaner children. The present cross-sectional observational study was undertaken to examine the magnitude of compensatory increases in the spinal bone mineral content (BMC) and area shown by overweight and obese children and adolescents. Vertebral area and BMC of lumbar vertebrae L2-L4 were measured by dual-energy X-ray absorptiometry in 202 boys and 160 girls aged 3-19 years. Subjects were categorized as of normal weight, overweight or obese using international cutoffs for body mass index. Compared with children of healthy weight our overweight and obese children had lower vertebral BMC for their bone area, body height, body weight and pubertal development: ratios and 95% CI for overweight and obese groups were 0.92 (95% CI 0.87-0.97) and 0.88 (95% CI 0.80-0.96) for girls and 0.96 (95% CI 0.91-1.02, NS) and 0.87 (95% CI 0.78-0.96) for boys, respectively. Spinal area was low in overweight and obese girls compared with girls of healthy weight but overweight and obese boys had enlarged their vertebral area appropriately for their increased body size. We conclude that during growth overweight and obese children do not increase their spinal BMC to fully compensate for their excessive weight. Limiting excessive adiposity in childhood and adolescence should help to avoid excessive loading and stresses on the lumbar spine.

Intensive exercise may preserve bone mass of the upper limbs in spinal cord injured males but does not retard demineralisation of the lower body.

STUDY DESIGN: Cross-sectional study comparing a group of active spinal cord injured (SCI) males carefully matched for age, height, and weight with active able-bodied male controls. OBJECTIVES: To compare bone mass of the total body, upper and lower limbs, hip, and spine regions in active SCI and able-bodied individuals. SETTING: Outpatient study undertaken in two centres in New Zealand. METHODS: Dual energy X-ray absorptiometry (DEXA) scanning was used to determine bone mass. Questionnaires were used to ascertain total time spent in weekly physical activity for each individual. The criterion for entry into the study was regular participation in physical activity of more than 60 min per week, over and above that required for rehabilitation. RESULTS: Seventeen SCI and their able-bodied controls met our required activity criterion. Bone mineral density (BMD) values of the total body and hip regions were significantly lower in the SCI group than in their controls (P=0.0001). Leg BMD and bone mineral content (BMC) were also significantly lower in the SCI group (P=0.0001). By contrast, lumbar spine BMD and arm BMD and BMC did not differ between the SCI and control groups. Arm BMD and BMC were greater (not significant) than the reference norms (LUNAR database) for both groups. CONCLUSION: Intensive exercise regimens may contribute to preservation of arm bone mass in SCI males, but does not prevent demineralisation in the lower body.

Bone mineral density and body composition in boys with distal forearm fractures: a dual-energy x-ray absorptiometry study.

OBJECTIVE: To determine whether boys with distal forearm fractures differ from fracture-free control subjects in bone mineral density (BMD) or body composition. STUDY DESIGN: A case-control study of 100 patients with fractures (aged 3 to 19 years) and l00 age-matched fracture-free control subjects was conducted. Weight, height, and body mass index were measured anthropometrically. BMD values and body composition were determined by dual-energy x-ray absorptiometry. RESULTS: More patients than control subjects (36 vs l4) were overweight (body mass index >85th percentile for age, P <.001). Patients had lower areal (aBMD) and volumetric (BMAD) bone mineral density values and lower bone mineral content but more fat and less lean tissue than fracture-free control subjects. The ratios (95% CIs) for all case patients/control subjects in age and weight-adjusted data were ultradistal radius aBMD 0.94 (0.91-0.97); 33% radius aBMD 0.96 (0.93-0.98) and BMAD 0.95 (0.91-0.99); spinal L2-4 BMD 0.92 (0.89-0.95) and BMAD 0.92 (0.89-0.94); femoral neck aBMD 0.95 (0.92-0.98) and BMAD 0.95 (0.91-0.98); total body aBMD 0.97 (0.96-0.99), fat mass 1.14 (1.04-1.24), lean mass 0.96 (0.93-0.99), and total body bone mineral content 0.94 (0.91-0.97). CONCLUSIONS: Our results support the view that low BMC, aBMD, and BMAD values and high adiposity are associated with increased risk of distal forearm fracture in boys. This is a concern, given the increasing levels of obesity in children today.

The effects of sequential combined oral 17beta-estradiol norethisterone acetate on insulin sensitivity and body composition in healthy postmenopausal women: a randomized single blind placebo-controlled study.

OBJECTIVE: The androgenic effect of progestogen, necessary in early postmenopausal hormone replacement therapy (HRT), may adversely affect insulin sensitivity as well as body fat distribution and thereby increase the cardiovascular risk profile. The impact of HRT with sequential combined oral 17beta-estradiol and norethisterone acetate on insulin sensitivity and body composition in early menopause has not been studied. DESIGN: A randomized single blind placebo-controlled 6-month study of sequential combined 17beta-estradiol norethisterone acetate on insulin sensitivity and body composition was carried out. Thirty fit healthy postmenopausal women were enrolled and completed this 6-month study. Body composition was measured by dual-energy x-ray absorptiometry scanning, and insulin sensitivity was measured using the euglycemic hyperinsulinemic clamp. Studies were undertaken at baseline and after 6 months of therapy. The studies were performed during the estrogen-only phase of therapy. RESULTS: All women demonstrated a degree of decreased insulin sensitivity that was not modified by 6 months of hormone replacement therapy. Body composition remained unchanged over 6 months. There was no alteration in total body fat or the distribution of body fat. The percentage of central abdominal fat (android) was not altered. CONCLUSION: Six months of HRT with sequential combined oral 17beta-estradiol norethisterone acetate does not have an adverse effect on insulin sensitivity and does not promote an increase in weight or the more android distribution of body fat, which could contribute to the increased cardiovascular risk profile that is evident in postmenopausal women.