Impact of body mass index on the relationship between muscle quality and physical function in older women.

OBJECTIVES: To investigate the impact of body mass index (BMI) (normal weight, overweight, obese) on the relationship between muscle quality (MQ) and physical function in community-dwelling older women. DESIGN: Cross-sectional study. SETTING: University research laboratory. PARTICIPANTS: Community-dwelling older women (n = 94, 73.6 ± 5.4 y) stratified by BMI (normal weight: 20.0-24.9 kg/m2; overweight: 25.0-29.9 kg/m2; obese: ≥ 30.0 kg/m2). MEASUREMENTS: Body mass index using height and weight, leg extension power via the Nottingham power rig, body composition using dual-energy X-ray absorptiometry, and physical function (6-minute walk, 8-foot up-and-go, 30-second chair stand). Muscle quality was defined as leg power (watts) normalized for lower-body mineral-free lean mass (kg). RESULTS: Following adjustments for covariates, muscle quality was significantly higher in women of normal BMI compared to overweight (10.0 ± 0.4 vs. 8.7 ± 0.4 watts/kg, p = 0.03). Muscle quality was a significant predictor of performance on the 6-minute walk and 8-foot up-and-go in normal and overweight women (all p < 0.05) and performance on the 30-second chair stand in normal and obese women (both p < 0.05). Body mass index did not significantly impact the association between MQ and physical function (all p > 0.05). CONCLUSIONS: Muscle quality varies by BMI, yet the relationship to physical function is not significantly different across BMI groups. The results imply that interventions that increase MQ in older women may improve physical function, regardless of BMI.

Diet components associated with perceived fatigue in breast cancer survivors.

Little is known about the contribution of diet components independent of body composition to persistent fatigue in breast cancer survivors. Therefore, our study aim was to determine the associations among dietary intake and fatigue in relation to and independent of adiposity and physical activity (PA) in breast cancer survivors. Baseline data from 42 breast cancer survivors enrolled in a randomised exercise trial were analysed: fatigue (Functional Assessment of Cancer Therapy for fatigue), diet components (3-day diet record), body mass index, per cent body fat (dual-energy X-ray absorptiometry) and PA (accelerometer). The mean age was 54 ± 9 years with an average body mass index of 30.5 ± 8.1 kg/m(2). Fatigue was positively associated with % of kcal/day fat intake (r = 0.31, P < 0.05) and inversely related to fibre g/day (r = 0.38, P < 0.05) and carbohydrate g/day intake (r = 0.31, P < 0.05). Mean fatigue was greater for participants eating <25 g/day of fibre compared with >25 g/day of fibre (15.7 ± 10.8 versus 6.4 ± 3.7, P < 0.005). No significant associations were noted between fatigue and PA or body composition. Diets high in fibre and low in fat are associated with reduced fatigue in breast cancer survivors. The difference in fatigue for low- versus high-fibre diets exceeded the minimal clinically important difference of three units. Prospective studies evaluating the effect of changing diet on fatigue in breast cancer survivors are warranted.

The DeepTree Exhibit: Visualizing the Tree of Life to Facilitate Informal Learning.

In this paper, we present the DeepTree exhibit, a multi-user, multi-touch interactive visualization of the Tree of Life. We developed DeepTree to facilitate collaborative learning of evolutionary concepts. We will describe an iterative process in which a team of computer scientists, learning scientists, biologists, and museum curators worked together throughout design, development, and evaluation. We present the importance of designing the interactions and the visualization hand-in-hand in order to facilitate active learning. The outcome of this process is a fractal-based tree layout that reduces visual complexity while being able to capture all life on earth; a custom rendering and navigation engine that prioritizes visual appeal and smooth fly-through; and a multi-user interface that encourages collaborative exploration while offering guided discovery. We present an evaluation showing that the large dataset encouraged free exploration, triggers emotional responses, and facilitates visitor engagement and informal learning.

A technique to assess body composition and sarcopenia using DXA: application for an obese population.

The objective of this study was to explore the accuracy of summing multiple dual-energy X-ray absorptiometry (DXA) scans to estimate whole-body soft tissue measures and the sarcopenic index in female subjects for application to an obese population. Forty-five women who fit within the DXA scanning region (M+/-s.d.; BMI=24.5+/-4.6 kg/m(2)) were scanned four times (one normal whole body (WB) scan, one head/trunk/leg scan allowing trunk delineation (TRK-H-L), one scan with body shifted right (LA) and one left (RA) to allow arm delineation). Fat mass (FM) and appendicular lean mass were determined from the WB scan (aLM(WB)), with the latter determined by summing arm and leg mineral-free lean mass (MFLM). Strong agreement and no differences (M+/-s.d.(DIFF)) were found between FM(WB) and FM(SUM) (-0.12+/-0.38 kg, P=0.37; r=0.999, P<0.001); MFLM(WB) and MFLM(SUM) (0.02+/-0.36 kg, P=0.80; r=0.998, P<0.001); and aLM(WB) and aLM(SUM) (0.12+/-0.32 kg, P=0.63; r=0.994, P<0.001). Summing DXA scans is a valid method for determining the risk for sarcopenic obesity and may aid research regarding obesity and risk for disability.

Reduction in trunk fat predicts cardiovascular exercise training-related reductions in C-reactive protein.

C-reactive protein (CRP) is an independent risk factor for cardiovascular disease. We sought to determine (1) if 10 months of cardiovascular exercise training (Cardio) reduces CRP in a group of older adults, (2) if such a reduction is related to improvements in trunk fat, fitness, and/or psychosocial variables, and (3) if the effect of Cardio on CRP differs between men and women. Community-dwelling residents (n=127; 60-83 yrs) were randomized to a Flex group (n=61) where they participated in 2-75 min supervised sessions per wk during which they performed non-cardiovascular flexibility and balance exercises or a Cardio group (n=66) where they participated in three supervised sessions per wk during which they performed cardiovascular exercises for approximately 45-60 min at 60-70% maximal oxygen uptake. The main outcome measures were serum CRP, cardiovascular fitness, total and central adiposity, and self-reported psychosocial function. Cardio experienced a reduction in CRP (-0.5mg/L), as well as improvements in fitness (+7%) and total (-1.5%) and central (i.e., trunk) (-2.5%) adiposity. These relationships were not modified by sex. Regression analyses indicated that only the reduction in trunk fat was significantly related to the reduction in CRP. Ten months of cardiovascular exercise training reduced CRP in previously sedentary older adults and this effect was partially mediated by a reduction in trunk fat.

Body composition assessment in athletes with spinal cord injury: comparison of field methods with dual-energy X-ray absorptiometry.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To compare relative body fatness (%Fat) estimates from field methods (skinfold thickness measurement (SKF) and bioelectrical impedance analysis (BIA)) with measures by dual-energy X-ray absorptiometry (DXA). SETTING: University of Illinois, Urbana-Champaign, IL, USA. METHODS: Field methods used both three- and seven-site SKF prediction equations and BIA generalized, spinal cord injury (SCI)-specific and athlete-specific equations. DXA was used as the reference method. College-aged varsity athletes with SCI (women=8, men=8; time since injury 16.2+/-5.7 years; injury level range T5-L5) were recruited. RESULTS: Mean BMI was 20.8+/-2.6 and 22.5+/-2.1 kg m(-2), and mean DXA %Fat was 31.9+/-3.8 and 20.6+/-8.4%, for women and men, respectively. All field methods under-predicted the %Fat when compared with DXA (ranges in mean differences: SKF women 2.9-8.2%, SKF men 6.9-12.4%; BIA women 0.5-3.9%, BIA men 0.3-7.0%). None of the field methods accurately predicted the %Fat compared with DXA (total error (TE): SKF women 7.4-12.1%, SKF men 8.4-15.2%; BIA women 5.1-9.3%, BIA men 6.7-10.7%). Of the SKF and BIA prediction equations, Evans et al.'s three-site SKF (r=0.95, P<0.001, standard error of the estimate (SEE)=2.8 %Fat) prediction equation provided the best fit for this population. CONCLUSION: Further studies with larger samples are necessary to develop appropriate prediction equations for field methods in the athletic SCI population.

Location of body fat and body size impacts DXA soft tissue measures: a simulation study.

OBJECTIVE: The aim of this study was to determine the ability of dual X-ray absorptiometry (DXA) to detect exogenous fat in men and women simulating typical sex-specific weight changes. SUBJECTS: A diverse sample including 29 elderly (52-83 years) and 61 young (18-40 years) individuals (45 women, 45 men) of varying body mass index (BMI; M+/-s.d.: 26.1+/-4.9 kg/m2, range=16.4-39 kg/m2). METHODS: Whole body (WB) DXA scans (Hologic QDR 4500A) were completed with Scan 1 performed as a normal baseline scan, Scan 2 with 1 kg packet of lard placed on each thigh and Scan 3 with two 1 kg lard packets placed on the abdomen (men) or chest and abdomen (women). RESULTS: Measurement error of fat mass (FM) was more pronounced in the trunk as lard packets were detected with 59% accuracy (error=0.82+/-0.42 kg, P<0.001), whereas 94% of thigh lard (error=0.11+/-0.45 kg, P<0.001) was determined to be FM, while the remainder in both conditions was determined to be mineral free lean mass. Initial FM (r=0.37, P<0.001) for thigh loading and trunk bone mineral content (r=0.30, P<0.01) for trunk-loaded conditions had the most impact on measurement error of WB FM. CONCLUSIONS: Regional differences impact measurement error of simulated changes in FM with greater measurement error in the trunk compared to the thigh region and initial FM and higher levels of bone mineral content in the trunk region impacting error.

The association between regional body composition and metabolic outcomes in athletes with spinal cord injury.

STUDY DESIGN: Cross-sectional study comparing athletes with spinal cord injury (SCI) and age and body mass index matched able-bodied controls (AB). OBJECTIVE: To examine the impact of exercise training on the relation between whole body, regional and intermuscular adipose tissue (IMAT) and glucose tolerance, insulin action and lipid profile. SETTING: University Research Laboratory, USA. METHODS: Fourteen college-aged athletes with SCI (seven men; duration of injury 16.5+/-5.7 years, level of injury T5-L5) and 17 sedentary AB (eight men) were assessed for body composition via dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging. Insulin sensitivity index (ISI) was determined via 2-h oral glucose challenge; standard lipid profile was determined from fasting blood samples. RESULTS: Although ISI was 30% higher in SCI, there were no significant differences between groups in glucose and insulin responses or in lipid measures. Adjusting for absolute and relative thigh IMAT area, fasting insulin (13.8+/-5.3 microIU, 16.3+/-5.6 microIU; P<0.05; SCI vs AB respectively) and ISI (4.0+/-1.4, 3.1+/-1.3; P<0.05) were significantly better among SCI athletes compared to AB. Measures of adiposity did not correlate with glucose response or most lipid measures. Within SCI and AB, respectively, ISI correlated strongly (all P<0.05) with absolute (r = -0.70, -0.54) and relative IMAT (r = -0.54, -0.50), than with trunk (r = -0.62, -0.64) and whole body fat mass (r = -0.61, -0.64). CONCLUSION: Habitual physical activity can maintain insulin sensitivity in SCI compared to sedentary AB controls. Total body fat mass, central adiposity and thigh IMAT appear to impact risk for metabolic disease in SCI individuals with IMAT playing a larger role in SCI than AB.

Change in atypical maternal behavior predicts change in attachment disorganization from 12 to 24 months in a high-risk sample.

This longitudinal study examined links between disorganization and atypical maternal behavior at 12 and 24 months in 71 adolescent mother-child dyads. Organized attachment and maternal not disrupted behavior were more stable than disorganization and disrupted behavior, respectively. At both ages, disorganization and maternal disrupted behavior were significantly correlated. Change in atypical maternal behavior predicted change in disorganization across time. The results provide substantial support for extant theories linking anomalous maternal behavior to the development of disorganized attachment. The Interesting-but-Scary paradigm, introduced in this study, promises to be a useful tool for assessing attachment and maternal behavior in toddlerhood.

Gender differences in QTc interval in young, trained individuals with lower spinal cord injury.

STUDY DESIGN: Cross-sectional comparison. OBJECTIVE: To examine gender differences in rate-corrected QT interval (QTc), an index of ventricular depolarization/repolarization, in young, trained men and women with lower spinal cord injury (SCI) and able-bodied (AB) controls. SETTING: University of Illinois at Urbana-Champaign, Exercise and Cardiovascular Research Lab, USA. METHODS: Subjects consisted of 16 athletes with SCI (eight men and eight women) and 16 age-matched AB active controls (eight men and eight women). QT interval dynamics was derived from ECG recordings and rate corrected using the Bazett formula. RESULTS: Men with SCI had QTc similar to that of AB men (369.3+/-7.5 versus 357.9+/-3.0 ms, P>0.05). Women with SCI had QTc similar to that of AB women (400.0+/-4.6 versus 385.2+/-6.5 ms, P>0.05). AB women had longer QTc interval than AB men, and SCI women had longer QTc than SCI men (P<0.05). CONCLUSIONS: Gender differences in ventricular depolarization/repolarization are present in trained individuals with SCI. Thus, similar to their AB gender-matched peers, women with SCI have longer QTc intervals and may be at greater risk for the development of untoward cardiac arrhythmias than men with SCI.

Use of packaged entrees as part of a weight-loss diet in overweight men: an 8-week randomized clinical trial.

AIM: This study assessed the efficacy of a weight-loss diet by using packaged portion-controlled entrees vs. a self-selected diet based on the United States Department of Agriculture Food Guide Pyramid (FGP). METHODS: Sixty healthy overweight men (body mass index (BMI) 26-42 kg/m2; aged 24-60 years) were randomized into two groups for an 8-week intervention. Group E consumed two portion-controlled entrees daily, plus recommended servings from the FGP. Group P consumed a self-selected diet consisting of a recommended number of servings from the FGP. Diets were designed to be isocaloric (1700 kcal) and identical in macronutrient composition (55% carbohydrate, 25% protein and 20% fat). Participants were instructed to make no changes in physical activity levels. Each group was blinded to the protocol of the other group, and received separate diet instructions, but no behavioural or diet counselling. Outcomes included weight, BMI, body composition by dual energy X-ray absorptiometry, waist and hip circumference, blood pressure (BP), fasting blood lipids, glucose, insulin and C-reactive protein. RESULTS: Fifty-one men completed the study. The portion-control group E (n = 25) experienced greater decreases in weight (-7.4 +/- 3.1 vs. -5.1 +/- 4.0 kg), BMI (-2.4 +/- 1.0 vs. -1.6 +/- 1.3 kg/m2), fat mass (-3.6 +/- 1.8 vs. -2.5 +/- 1.8 kg), waist circumference (-6.6 +/- 3.3 vs. -4.3 +/- 2.9 cm) and diastolic BP (-6.0 +/- 7.2 vs. + 0.2 +/- 10.1 mmHg) than group P (n = 26) (p < 0.05). Consumption of a packaged entree diet resulted in greater losses of weight and fat mass, and reduced BP. CONCLUSIONS: Use of packaged entrees as part of a weight-loss diet is an effective means of achieving portion control and enhancing losses of weight and fat mass in overweight men.

Is the current BMI obesity classification appropriate for black and white postmenopausal women?

OBJECTIVE: To evaluate the relation between body fatness (%Fat) and body mass index (BMI) and to evaluate the validity of the BMI standards for obesity established by the NIH in older black and white postmenopausal women. RESEARCH METHODS: Height, weight, BMI, and %Fat, assessed by DXA, were determined for 296 healthy, independently living women ranging in age from 50 to 80 years (M+/-s.d.; 64.4+/-7.8 years). RESULTS: Per NIH guidelines, 32% were classified as obese (> or = 30 kg/m2, mean BMI = 28.1+/-5.5 kg/m2). In contrast, using the %Fat criterion of 38% advocated by Lohman to define obesity, 47% of our sample was obese (mean %Fat=37.3+/-6.2%). A moderately high curvilinear relation existed between BMI and %Fat (R = 0.82, SEE = 3.57 %Fat, P<0.05). Race added meaningfully to the prediction of %Fat (P<0.05) such that for the same BMI, black women will have 1% lower body fatness than white women. Based on a %Fat > or = 38 as the criterion for obesity, receiver operating characteristic (ROC) analysis, performed separately by race, indicated that the currently accepted BMI cutpoint for obesity produced low sensitivity (69% and 61% for black and white women, respectively). Alternatively, BMI values > or = 28.4 kg/m2 for black women and > or = 26.9 kg/m2 for white women to define obesity maximized classification accuracy. CONCLUSION: We conclude that current BMI categories may not be appropriate for identifying obesity among postmenopausal women. Furthermore, the relation between BMI and %Fat is different in black compared to white women but remains constant from the sixth through the eighth decade of life.

'Disappearing diabetes'--resolution of apparent Type 1 diabetes in a patient with AIDS and cytomegalovirus (CMV) infection.

A 30-year-old African female with established acquired immunodeficiency syndrome (AIDS) and no history of diabetes, presented in severe diabetic ketoacidosis (DKA). Blood pH was 6.96, serum bicarbonate 5 mmol/l, plasma glucose (PG) 33.0 mmol/l, and urine heavily positive for ketones. She responded to standard treatment and was established on twice-daily subcutaneous insulin. Four months later her insulin was stopped because of hypoglycaemic attacks on small doses. A glucose tolerance test (GTT) at 6 months postdiagnosis was normal (fasting PG 4.4 mmol/l and 2 h PG 7.5 mmol/l), and at 12 months random PG was 4.1 mmol/l and HbA1c 4.3%. The onset of her apparent Type 1 diabetes coincided with an HIV-associated cytomegalovirus (CMV) infection, and a reversible 'CMV insulitis' may be an explanation. Alternatively, the patient may have had what has recently been described as 'atypical diabetes' in African or Afro-Caribbean diabetic patients. Here resolution of diabetes may occur after presentation, though complete return to normoglycaemia after true DKA is very unusual.

An epizootic of highly virulent feline calicivirus disease in a hospital setting in New England.

This article reports an outbreak of 24 cases of an unusually virulent feline calicivirus (FCV) infection in a small animal hospital. The circumstances and disease signs were very similar to those recently described in an outbreak of FCV hemorrhagic disease in Northern California (Vet. Microbiol. 73 (2000) 281). The virus entered the facility through shelter cats showing upper respiratory signs. Affected cats manifested high fever, anorexia, labored respirations, oral ulceration, facial and limb edema, icterus, and pancreatitis. The infection spread rapidly among the patients by contaminated animal caretakers and hospital equipment. One case of fomite transmission from an employee to a housecat was documented. Prior vaccination, even with multiple doses of FCV-F9-based live calicivirus vaccine, was not protective. Affected cats often required extensive supportive care for 7-10 days, and the overall mortality from death and euthanasia was 32%. The strain of FCV responsible for this outbreak was genetically and serologically distinct from the FCV strain responsible for a similar epizootic and the FCV-F9 strain contained in most vaccines. Outbreaks of this type are being reported with increasing frequency, and are often associated with the practice of treating sick shelter cats in private practices. Similar to the present epizootic, outbreaks of FCV hemorrhagic disease have been self-limiting, but require prompt application of strict quarantine, isolation, personnel sanitation, and disinfection procedures.

Contributions of total and regional fat mass to risk for cardiovascular disease in older women.

The aim of this study was to determine whether trunk fat mass, measured by dual-energy X-ray absorptiometry (DEXA), is predictive of insulin resistance and dyslipidemia, independently of arm and leg fat mass, in postmenopausal women. Total and regional body composition was measured by DEXA in 166 healthy, postmenopausal women (66 +/- 4 yr). Four primary markers of insulin resistance and dyslipidemia were assessed: 1) area under the curve for the insulin (INS(AUC)) response to an oral glucose tolerance test (OGTT), 2) product of the OGTT glucose and insulin areas (INS(AUC)xGLU(AUC)), 3) serum triglycerides (TG), and 4) high-density lipoprotein (HDL)-cholesterol. Trunk fat mass was the strongest independent predictor of each of the primary dependent variables. In multivariate regression models, trunk fat mass was associated with unfavorable levels of INS(AUC), INS(AUC)xGLU(AUC), TG, and HDL-C, whereas leg fat mass was favorably associated with each of these variables. Thus trunk fat is a strong independent predictor of insulin resistance and dyslipidemia in postmenopausal women, whereas leg fat appears to confer protective effects against metabolic dysfunction.

Relation of bone mineral density and content to mineral content and density of the fat-free mass.

Differences in the mineral fraction of the fat-free mass (M(FFM)) and in the density of the FFM (D(FFM)) are often inferred from measures of bone mineral content (BMC) or bone mineral density (BMD). We studied the relation of BMC and BMD to the M(FFM) and D(FFM) in a heterogeneous sample of 216 young men (n = 115) and women (n = 101), which included whites (n = 155) and blacks (n = 61) and collegiate athletes ( n = 132) and nonathletes (n = 84). Whole body BMC and BMD were determined by dual-energy X-ray absorptiometry (DXA; Hologic QDR-1000W, enhanced whole body analysis software, version 5.71). FFM was estimated using a four-component model from measures of body density by hydrostatic weighing, body water by deuterium dilution, and bone mineral by DXA. There was no significant relation of BMD to M(FFM) (r = 0.01) or D(FFM) (r = -0.06) or of BMC to M(FFM) (r = -0.11) and a significant, weak negative relation of BMC to D(FFM) (r = -0.14, P = 0.04) in all subjects. Significant low to moderate relationships of BMD or BMC to M(FFM) or D(FFM) were found within some gender-race-athletic status subgroups or when the effects of gender, race, and athletic status were held constant using multiple regression, but BMD and BMC explained only 10-17% of the variance in M(FFM) and 0-2% of the variance in D(FFM) in addition to that explained by the demographic variables. We conclude that there is not a significant positive relation of BMD and BMC to M(FFM) or D(FFM) in young adults and that BMC and BMD should not be used to infer differences in M(FFM) or D(FFM).

Waist circumference vs body mass index for prediction of disease risk in postmenopausal women.

OBJECTIVE: To test the sensitivity of waist circumference (central adiposity) as an index of disease risk in postmenopausal women. DESIGN: Retrospective analysis of postmenopausal women tested at Washington University School of Medicine. SUBJECTS: A total of 323 healthy postmenopausal (66+/-5 y; mean+/-s.d.) women not using any hormone replacement. MEASUREMENTS: Body composition, hyperinsulinemia (insulin area), triglycerides and HDL-cholesterol. RESULTS: Excess waist size had a stronger association with hyperinsulinemia and hypertriglyceridemia than body mass index (BMI; kg/m(2)) in otherwise healthy, postmenopausal women. After adjusting for BMI, a strong relation existed between waist circumference and insulin area, HDL-cholesterol and triglycerides (P<0.01). Conversely, after adjusting for waist circumference, no relation was apparent between BMI and the dependent variables of interest. The strength of the association between waist circumference and disease risk became most apparent when analyses were restricted to normal-weight women (BMI 24--28 kg/m(2)). When BMI was held constant, hyperinsulinemia and triglyceridemia increased dose-dependently with changes in waist size. CONCLUSION: Waist circumference, an easily obtained index of central adiposity, is a more sensitive measure of relative disease risk than is BMI in middle-aged and older women, particularly in normal-weight individuals.

Use of air displacement plethysmography for estimating body fat in a four-component model.

PURPOSE: To compare measurements of body density (D(b)) obtained from air displacement plethysmography (AP) and hydrostatic weighing (HW) and to determine the accuracy of substituting D(b) via AP (D(b)-AP) for D(b) via HW (D(b)-HW) in estimating body fatness (%Fat(4C)) and the composition and density of the fat-free mass (Dffm) from a four-component model (fat, mineral, water, and protein). METHODS: D(b) was measured in 50 young adults using AP and HW. Total body water via deuterium dilution, bone mineral content via dual-energy x-ray absorptiometry, and D(b) were used to estimate %Fat(4C). RESULTS: D(b)-AP and D(b)-HW were highly correlated (r = 0.89, SEE = 0.008 g x mL(-1)), but D(b)-AP (1.065 +/- 0.003 g x mL(-1)) was significantly higher (P < 0.05) than D(b)-HW (1.058 +/- 0.003 g x mL(-1)), resulting in a mean difference of 2.8%fat. Differences between %Fat(4C-AP) (17.8 +/- 1.2%) and %Fat(4C-HW) (19.3 +/- 1.2%) were significant (P < 0.05), but the SD of the differences (2.3%) was low. When D(b)-AP was used in a four-component model in place of D(b)-HW, the calculated Dffm was significantly higher (1.109 +/- 0.002 vs 1.105 +/- 0.002 g x mL(-1)) based on a higher (P < 0.05) protein fraction (22.0 +/- 0.4% vs 20.6 +/- 0.4%) and lower (P < 0.05) water (71.1 +/- 0.4% vs 72.4 +/- 0.4%) and mineral fractions (7.0 +/- 0.1% vs 7.1 +/- 0.1%). CONCLUSIONS: AP yields a higher D(b) than HW and may not be a valid method for measuring D(b) or estimating %fat using densitometry. However, due to relatively small bias and low individual error, D(b)-AP is an acceptable substitute for D(b)-HW when estimating %fat with a four-component model in young adults.

Effects of HRT and exercise training on insulin action, glucose tolerance, and body composition in older women.

The independent and combined effects of exercise training and hormone replacement therapy (HRT) on body composition, fat distribution, glucose tolerance, and insulin action were studied in postmenopausal women, aged 68 +/- 5 yr, assigned to control (n = 19), exercise (n = 18), HRT (n = 15), and exercise + HRT (n = 16) groups. The exercise consisted of 2 mo of flexibility exercises followed by 9 mo of endurance exercise. HRT was conjugated estrogens 0.625 mg/day and trimonthly medroxyprogesterone acetate 5 mg/day for 13 days. Total and regional body composition were measured by dual-energy X-ray absorptiometry. Serum glucose and insulin responses were measured during a 2-h oral glucose tolerance test. There were significant main effects of exercise on reductions in total and regional (trunk, arms, legs) fat mass, increase in leg fat-free mass, and improvements in glucose tolerance and insulin action. There were significant main effects of HRT on the reduction of total fat mass (HRT, -3.0 +/- 4.0 kg; no HRT, -1.3 +/- 2.6 kg), with a strong trend for reductions in trunk and leg fat mass (both P = 0.07). There was also a significant improvement in insulin action in response to HRT. These results suggest that there are independent and additive effects of exercise training and HRT on the reduction in fat mass and improvement in insulin action in postmenopausal women; the effect of HRT on insulin action may be mediated, in part, through changes in central adiposity.

Congenital tuberculosis presenting as sepsis syndrome: case report and review of the literature.

We report an infant with congenital tuberculosis who presented with fulminant septic shock, disseminated intravascular coagulation and respiratory failure. Aggressive resuscitation and supportive care and prompt initiation of antituberculosis medications led to resolution of the shock state. We reviewed six other cases with a similar presentation. Congenital tuberculosis should be in the differential of the infant presenting acutely with sepsis syndrome.