Plasma leptin is directly related to body adiposity in subjects with spinal cord injury

We addressed the relationship between plasma leptin and body mass index in 48 able-bodied male controls and 34 male subjects with spinal cord injury, as well as the association between plasma leptin with body fat by dual energy x-ray absorptiometry in those with spinal cord injury. In subjects with spinal cord injury, the effect of an oral glucose tolerance test and the relationship of the serum lipid profile with plasma leptin levels were determined. Body mass index was not significantly different between the spinal cord injury and control groups. Plasma leptin was significantly higher in the group with spinal cord injury than in the control group (12.7 +/- 1.7 vs. 7.6 +/- 0.9 ng/ml, p < 0.005). A linear relationship was found between plasma leptin and body mass index in both groups separately (spinal cord injury: r = 0.59, p < 0.0002; control: r = 0.67, p < 0.0001). In those with SCI, a polynomial relationship was evident between plasma leptin and percent fat (r = 0.82, p < 0.0001). After an oral glucose load, plasma insulin levels and serum glucose concentrations were not related to plasma leptin levels. Serum triglycerides were found to be weakly correlated with plasma leptin levels (r = 0.35, p < 0.05). The higher plasma leptin levels in the group with spinal cord injury compared with the control group was probably due to a relatively increased percentage of adiposity in those with spinal cord injury.     

Distribution and latency of muscle responses to transcranial magnetic stimulation of motor cortex after spinal cord injury in humans

Noninvasive transcranial magnetic stimulation (TMS) of the motor cortex was used to evoke electromyographic (EMG) responses in persons with spinal cord injury (n = 97) and able-bodied subjects (n = 20, for comparative data). Our goal was to evaluate, for different levels and severity of spinal cord injury, potential differences in the distribution and latency of motor responses in a large sample of muscles affected by the injury. The spinal cord injury (SCI) population was divided into subgroups based upon injury location (cervical, thoracic, and thoracolumbar) and clinical status (motor-complete versus motor-incomplete). Cortical stimuli were delivered while subjects attempted to contract individual muscles, in order to both maximize the probability of a response to TMS and minimize the response latency. Subjects with motor-incomplete injuries to the cervical or thoracic spinal cord were more likely to demonstrate volitional and TMS-evoked contractions in muscles controlling their foot and ankle (i.e., distal lower limb muscles) compared to muscles of the thigh (i.e., proximal lower limb muscles). When TMS did evoke responses in muscles innervated at levels caudal to the spinal cord lesion, response latencies of muscles in the lower limbs were delayed equally for persons with injury to the cervical or thoracic spinal cord, suggesting normal central motor conduction velocity in motor axons caudal to the lesion. In fact, motor response distribution and latencies were essentially indistinguishable for injuries to the cervical or thoracic (at or rostral to T10) levels of the spine. In contrast, motor-incomplete SCI subjects with injuries at the thoracolumbar level showed a higher probability of preserved volitional movements and TMS-evoked contractions in proximal muscles of the lower limb, and absent responses in distal muscles. When responses to TMS were seen in this group, the latencies were not significantly longer than those of able-bodied (AB) subjects, strongly suggestive of "root sparing" as a basis for motor function in subjects with injury at or caudal to the T11 vertebral body. Both the distribution and latency of TMS-evoked responses are consistent with highly focal lesions to the spinal cord in the subjects examined. The pattern of preserved responsiveness predominating in the distal leg muscles is consistent with a greater role of corticospinal tract innervation of these muscles compared to more proximal muscles of the thigh and hip.     

Actions of interleukin-4 on prostaglandin biosynthesis by human amnion cells

Acute spinal cord injury (SCI) is associated with a marked propensity to thromboembolism and a variety of coagulation abnormalities. However, data on blood coagulation profiles in patients with uncomplicated long-standing SCI are limited. These data were studied here. Eight men with uncomplicated chronic SCI and nine able-bodied normal men were studied. Plasma activities and/or antigen concentrations of high molecular weight kininogen (HMWK) and of factors XII, XI, IX, VIII, VII, X, V, II and XIII as well as von Willebrand factor (vWF), fibrinogen and fibronectin were measured by appropriate functional and or immunological assays. The SCI group exhibited normal values for factors XII, IX, VIII, vWF, VII, X and V as well as HMWK, vWF and fibronectin concentration. However, they showed slight reductions in plasma factor XI activity, factor XIII antigen concentration and modest increases in fibrinogen and factor II concentrations. No correlation was found between the parameters studied and either the duration or the level of injury. In conclusion, in contrast to acute SCI, the coagulation profile in uncomplicated chronic SCI is noted to be largely normal with only a few minor alterations of questionable clinical significance.     

Prevalence of Posttraumatic Stress Disorder in Persons With Spinal Cord Injuries: The Mediating Effect of Social Support.

Objectives: To evaluate the prevalence of posttraumatic stress disorder (PTSD) and to identify risk factors of PTSD in persons with spinal cord injury (SCI). Main Outcome Measures: PTSD and social support were assessed by using the Harvard Trauma Questionnaire (R. F. Mollica et al., 1992) and the Crisis Support Scale (S. Joseph, W. Yule, R. Williams, & B. Andrews, 1993). Participants: One hundred sixty-eight persons with SCI, who were an average of 14 years after injury, filled in the questionnaire. Results: The prevalence of PTSD was 7.1%. Risk factors for PTSD included complete injury, being single, and low level of social support. Conclusions: The prevalence of PTSD after SCI is similar to that in the general population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of marital life in Korean spinal cord injured patients

The purposes of this study were to assess the quality of marital life and to investigate the most serious problem in the marital relationships of Korean spinal cord injured patients. 30 spinal cord injured (SCI) couples (SCI husbands and their non-disabled wives) who were married prior to injury and 30 able-bodied (AB) couples participated in a questionnaire study. The quality of marital life was measured with three parameters: marital stability, marital adjustment, and marital satisfaction. The results were as follows: (1) The marriage of chronic SCI couples was not noticeably unstable when compared with that of AB couples; (2) There was no significant difference in dyadic adjustment and marital satisfaction between SCI couples and AB couples; (3) There was no significant difference in marital stability, marital adjustment, and marital satisfaction between SCI husbands and their wives; (4) SCI couples had more cohesive marital relationships and SCI husbands expressed less affection to their wives than AB husbands and (5) Sex was the most serious problem in marriages of SCI couples. In conclusion: (1) the quality of marital life in chronic SCI couples is not highly different from that of AB couples; (2) There is no significant difference in the quality of marital life between chronic SCI husbands and their non-disabled wives; and (3) It is considered necessary that rehabilitation program for SCI patients should include information on the altered physiology of sexual function of SCI patients and subsequent mutual adaptation to changed sexual function.     

Role of group I metabotropic glutamate receptors in traumatic spinal cord white matter injury

Metabotropic glutamate receptors (mGluRs) participate in glutamate neural transmission, but their role in the pathophysiology of spinal cord injury (SCI) has not been explored. Accordingly, we examined the role of group I mGluRs, which are linked to phospholipase C, in mediating SCI using an in vitro model. A dorsal column segment was isolated from the spinal cord of adult rats, maintained in vitro, and injured by compression for 15 sec with a clip having a 2 g closing force. Under control conditions after SCI, the compound action potential (CAP) amplitude was reduced to 69.1 +/- 5.4% of baseline. Blockade of group I mGluR receptors with MCPG, 4CPG, or AIDA resulted in improved recovery of CAP amplitude (82.2 +/- 2.0%, 86.2 +/- 3.9%, and 86.0 +/- 2.5% of baseline, respectively). The group I/II agonist trans-ACPD and selective group I agonist DHPG exacerbated the posttraumatic reduction of CAP amplitude. The phospholipase C inhibitor U-73122 improved recovery of CAP amplitude after traumatic spinal cord axonal injury. Western blotting and immunocytochemistry demonstrated the presence of mGluR1alpha-immunopositive astrocytes and the absence of mGluR5 in spinal cord white matter. These studies are consistent with the hypothesis that activation of group I mGluR receptors after SCI exacerbates posttraumatic axonal injury through a phospholipase C dependent mechanism. The presence of mGluR1alpha labeling on astrocytes suggests a role for these cells in the pathophysiology of SCI. Additional studies in vivo, are required to further clarify the role of mGluRs in acute traumatic SCI.     

Exercise as stigma management for individuals with onset-controllable and onset-uncontrollable spinal cord injury.

Studies have suggested that individuals with physical disabilities are often stigmatized and are perceived to possess less favorable physical and psychological characteristics than individuals without disability. Purpose: To investigate whether able-bodied adults' perceptions of people with different causes of spinal cord injury (SCI) are influenced by physical activity status information. Method and Participants: Each participant (N = 198) read all five vignettes describing individuals with SCI who had varying levels of physical activity participation and cause of injury information (e.g., onset-uncontrollable [hit by impaired driver] and onset-controllable [caused by impaired driving]). After reading each vignette, participants completed a 12-item Warmth and Competence Questionnaire to evaluate each target. One-way repeated measures multivariate analyses of variance were conducted to examine the within-subjects differences. Results: Physically active individuals with onset-uncontrollable SCI were rated most favorably on warmth and competence. Physically active individuals with onset-controllable SCI also were rated more favorably on warmth and competence than physically inactive targets with onset-controllable SCI. Conclusion: A physically active lifestyle may be beneficial in managing the stigma experienced by individuals with both onset-controllable and onset-uncontrollable SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Size at birth and hypertension in longitudinally followed 50-70-year-old men

The aim of the present study was to compare bone mineral density (BMD in g/cm2) in the lumbar spine and three hip regions of male spinal cord injured subjects at various times post injury to age-matched able-bodied controls and to correlate their BMDs to their age and level of their spinal cord lesion. Patients and controls were stratified into three 20 years age groups (20-39, 40-59, and 60+ years of age). BMD measurements were obtained using dual energy X-ray absorptiometry (DEXA, Lunar Model DPX). BMD levels taken within the first year of injury were not significantly lower than the age-matched able-bodies controls. The 20-39 year old patients injured longer than 1 year had significantly lower (P < or = 0.01) BMDs in their femoral region than both their age matched controls and the 20-39 year old acutely injured (injured for less than 1 year) patients. Although femoral BMDs of both paraplegic and quadriplegic patients 40-59 and 60+ years of age decreased over time, none showed significant bone loss in this regions until 10 years after their injury. These results indicate that spinal cord injury associated bone loss occurs most dramatically in the femoral region of young men. These results also indicate that initial bone mass loss does not occur prior to 1 year post-injury to the extent that it is detectable by densitometry, or at least it did not occur in our patients.     

Spinal Cord Injury Pain: Impact, Classification, Treatment Trends, and Implications From Translational Research.

Pain following spinal cord injury (SCI) has been recognized as a significant problem in the literature for over half a century. Prevalence estimates have varied widely, with most reports suggesting this to be an extremely common condition (60%-90%). Severe pain is reported by perhaps 25%, but for these persons, pain is literally the "insult added to injury." Effective treatments with a substantial body of empirical support did not exist until recently, and research progress has been compromised by lack of a standardized method for classifying and assessing pain. Encouraging developments for both assessment and treatment have occurred and are reviewed. There have been parallel developments in research using animal models of SCI pain that argue for exploration of translational work from animals to humans. Areas of research in which psychologists have been active and/or could become active are reviewed, both in clinical and translational research arenas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Osteoporosis after spinal cord injury

Immobilisation secondary to spinal cord injury (SCI) is associated with marked and rapid atrophy of trabecular bone. The purpose of this study was to evaluate bone mineral density (BMD) in both the upper and lower extremities following SCI sustained for various lengths of time and to correlate the BMD to the level of the lesion, time from injury, spasticity and serum calcium, phosphorus and alkaline phosphatase (ALP) levels. A study was undertaken in 41 SCI patients with a mean age of 35.8 +/- 12.7 years. A significant difference in BMD between upper and lower extremities of the paraplegics were found. BMD of upper and lower extremities were similar in tetraplegies. The BMD values were significantly different when the upper extremity scores of paraplegics and tetraplegics were compared but BMD scores of the lower extremities were similar in the two groups. The decrease in BMD was less in the spastic patients when compared to the flaccid group. There was a positive correlation between time from injury and the degree of BMD deficit in the paralysed areas. In the whole group of patients a significant positive correlation was found between the duration of SCI and serum ALP levels.     

A study of patients who leave without notice in an A & E department

Neuronal degradation accompanied with axonal degeneration has been known to occur in spinal motor neurons after an upper level of spinal cord lesion. In the present study, the functional integrity of neuromuscular transmission was assessed by utilizing a sensitive electrodiagnostic method comprising of stimulated single-fiber electromyography (SFEMG), along with axonal microstimulation, in paralytic muscles of patients with spinal cord injury (SCI). Neuromuscular jitter was measured in anterior tibial muscles for 30 patients with SCI and also for 12 normal controls. Mean jitter of 37.4 +/- 14.7 (mean +/- SD) micros, as obtained in SCI patients, was found to be significantly greater than the results of 20.1 +/- 8.4 micros in normal controls (P < 0.01). Jitter measurement was not significantly different in varied functional scales of SCI. A positive correlation was noted between the increased jitter and the disease duration from the onset of cord lesion till the time of stimulated SFEMG test (r = 0.68; P < 0.01). The present abnormal finding of neuromuscular jitter provides an electrophysiologic evidence for axonal degeneration and suggests that transsynaptic degeneration of motor neuron may occur below the level of cord lesion in SCI patients. Furthermore, the neuronal degradation in SCI was positively correlated with the course duration of the disease.     

Psychological problems of spinal cord injury patients: Emotional distress as a function of time and locus of control.

A scale assessing psychological problems was developed and administered to 136 male VA hospital spinal cord injury (SCI) patients (under 30 yrs of age). Results suggest that reaction to SCI was dominated by emotional distress and was best predicted by external locus of control and by recent injury. The scale was correlated with self-reports of anxiety, adjustment, affiliation, and sociability in a college population. Results do not support a simple stage theory of reaction to SCI but are consistent with other studies of coping patterns in SCI patients. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body fat estimation in late pregnancy and early postpartum: comparison of two-, three-, and four-component models

Accurate methods for determining body fat mass during reproduction are necessary to evaluate energy balance. However, determination of fat mass is complicated during pregnancy by the accretion of water, which invalidates assumptions underlying standard two-compartment models. The extent to which the variability in body water during pregnancy invalidates use of pregnancy-corrected two-compartment models for determination of fat mass in individual women is unknown. Moreover, it is unclear whether body water returns to nonpregnant values by 2 wk postpartum, which is frequently used as the baseline in studies of postpartum women. The present study uses a four-component model as a criterion for evaluating two- and three-component models. Fifty-six healthy, normotensive women between the ages of 19 and 35 y were studied at 36 +/- 1 wk gestation and 15 +/- 2 d postpartum. Total body water (TBW), total body potassium (TBK), body density, and bone mineral content were measured by deuterium dilution, whole-body potassium counting, hydrodensitometry, and dual-energy X-ray absorptiometry (postpartum only), respectively. At 2 wk postpartum, hydration and density of fat-free mass (FFM) had not returned to nonpregnant values, and differed between lactating and nonlactating women (P < 0.05). Accordingly, standard TBW and body density estimates of fat mass differed from four-component estimates at both time points (P < 0.005). Moreover, our data indicate that even when pregnancy-specific values for hydration or density of FFM are used in TBW and body density models, individual fat mass estimates may differ by > 3 kg from the four-component value. Fat mass by TBK may differ by > 10 kg from fat mass by the four-component model during pregnancy, and by 6 kg postpartum. Use of standard two-compartment models to estimate fat mass results in significant error both during pregnancy and at 2 wk postpartum. Pregnancy-corrected two-compartment models produce reliable mean fat mass estimates during pregnancy, but individual fat mass estimates may vary widely from four-component values.     

Evaluation of modified multicompartment models to calculate body composition in healthy males

Body volume was measured by underwater weighing (UWW) or with a skinfold caliper; bone mineral by dual energy X-ray absorptiometry (DXA); and body water by bioelectrical impedance analysis (BIA) in 22 healthy males. The percentage of water and bone mineral in fat-free mass had a significant effect on the calculated amount of fat using a two-compartment model. A three-compartment model based on field-adapted methods (skinfold thickness + BIA) to calculate body fat, correlated significantly with a more complex four-compartment model (UWW + BIA + DXA) (r = 0.95, p < 0.001). The advantages of three- and four-compartment equations are that they reduce the number of assumptions.     

Factors affecting employment following spinal cord injury: A qualitative study.

Examined factors that differentiated persons with spinal cord injury (SCI) who returned to work from those who did not. Ss were 6 employed persons with SCI matched with 6 unemployed persons with SCI on the basis of education, race, age, gender, time since injury, and level of function. Semistructured interviews 1 to 2 hrs in length were completed and transcribed. The responses of the employed were compared with those of the unemployed using grounded theory. The theory is inductively derived from the qualitative data. Psychological and environmental factors were the most salient factors affecting employment in this matched sample. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation. Conclusions: The development of increased optimism may promote employment for persons with SCI. Employment barriers and the perception of these barriers as insurmountable need to be decreased. Policies that promote return to work with former employers are likely to improve employment rates for persons with SCI A more intensive job exploration process using job shadowing of peers and positive peer models may also improve employment after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients

The aim of this paper is to review the incidence and characteristics found in traumatic spinal cord injury (SCI) occurring in patients with long-standing ankylosing spondylitis (AS). The incidence of patients with traumatic SCI admitted to our unit from January 1984 to February 1996 was 2% (15 out of 893). They were all men with a mean age of 56 years. Most frequently the etiology of the lesion was a motor vehicle accident and the injury was mainly due to a hyperextension mechanism. Acute spinal fracture occurred in 13 patients, all involving the cervical region. No fracture was observed in two patients with thoracic neurological level. Three patients presented with an interval free period of neurological symptoms in whom a spinal epidural hematoma was visualized with magnetic resonance imaging. On admission eight patients were diagnosed as having complete SCI and the other seven an incomplete SCI. In the acute phase, respiratory complications were most frequent, causing six patients to die. Treatment was conservative in 14 patients. Multidisciplinary management of these patients should be implemented in an institution equipped with both a Spinal Injury Unit and an Intensive Care Unit.     

Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma

The aim of this study was to assess and compare spinal cord injured (SCI) and traumatic brain injured (TBI) persons and people from the general population concerning partner relationships, functioning, mood and global quality of life. One hundred and sixty seven SCI persons, 92 TBI persons and 264 controls participated in the study. The median age was: SCI persons 33 years (range 19 to 79 years), TBI persons 40 years (range 20 to 70 years), and controls 31 years (range 19 to 79 years). Age at injury ranged among SCI persons from 14 to 76 years (Md 28 years), and among TBI persons from 16 to 56 years (Md 32 years). Half of the SCI group (51%), 58% of the TBI group and 59% of the controls had a stable partner relationship at the time of the investigation. Many of these SCI and TBI relationships (38% and 55% respectively) were established after injury. Both SCI and TBI persons showed significantly more depressive feelings compared with the controls. Perceived quality of life (global QL rating) was significantly lower in the SCI group compared with the controls, whereas the ratings of TBI persons and controls did not differ significantly. SCI and TBI persons did not differ significantly in level of education, perceived quality of life or distress. In all three groups, global quality-of-life ratings were significantly lower among single persons compared to those with a partner relationship. It was concluded that both SCI and TBI appear to affect overall quality of life and mental well-being negatively. The number of partner relationships contracted after injury among both SCI and TBI persons indicates, however, that the injury is not a major barrier to establishing close partner relationships. Being in good spirits, that is, lack of depressive feelings has a profound impact on the perception of a high quality of life in all three groups. For the SCI and TBI persons, a high level of physical and social independence were further positive determinants of a perceived high quality of life.     

Human lumbosacral spinal cord interprets loading during stepping

Studies suggest that the human lumbosacral spinal cord can generate steplike oscillating electromyographic (EMG) patterns, but it remains unclear to what degree these efferent patterns depend on the phasic peripheral sensory information associated with bilateral limb movements and loading. We examined the role of sensory information related to lower-extremity weight bearing in modulating the efferent motor patterns of spinal-cord-injured (SCI) subjects during manually assisted stepping on a treadmill. Four nonambulatory subjects, each with a chronic thoracic spinal cord injury, and two nondisabled subjects were studied. The level of loading, EMG patterns, and kinematics of the lower limbs were studied during manually assisted or unassisted stepping on a treadmill with body weight support. The relationships among lumbosacral motor pool activity [soleus (SOL), medial gastrocnemius (MG), and tibialis anterior (TA)], limb load, muscle-tendon length, and velocity of muscle-tendon length change were examined. The EMG mean amplitude of the SOL, MG, and TA was directly related to the peak load per step on the lower limb during locomotion. The effects on the EMG amplitude were qualitatively similar in subjects with normal, partial, or no detectable supraspinal input. Responses were most consistent in the SOL and MG at load levels of < 50% of a subject's body weight. The modulation of the EMG amplitude from the SOL and MG, both across steps and within a step, was more closely associated with limb peak load than muscle-tendon stretch or the velocity of muscle-tendon stretch. Thus stretch reflexes were not the sole source of the phasic EMG activity in flexors and extensors during manually assisted stepping in SCI subjects. The EMG amplitude within a step was highly dependent on the phase of the step cycle regardless of level of load. These data suggest that level of loading on the lower limbs provides cues that enable the human lumbosacral spinal cord to modulate efferent output in a manner that may facilitate the generation of stepping. These data provide a rationale for gait rehabilitation strategies that utilize the level of load-bearing stepping to enhance the locomotor capability of SCI subjects.     

Alteration of thromboxane A2/prostacyclin and their effect on spinal cord blood flow in experimental spinal cord injury in rats

In order to document the contribution of Thromboxane (TXA2) and Prostacyclin (PGI2) to the secondary damage following spinal cord injury (SCI) and their effects on spinal cord blood flow (SCBF), the alteration of SCBF, TXB2 and 6-keto-PGF1 alpha concentration in injury site (T13-L1) and adjacent cords (upper: T12, under: L2) were studied using a rat SCI model induced by Allen's weight drop method (50g-cm). The result showed that after SCI the SCBF in injury site significantly reduced during 1-2 hrs and reduced further during 4-8 hrs. The SCBF in adjacent cords also decreased during 4-8 hrs. TXB2 levels significantly increased at 1 hr and reached peak value at 4 hrs. The 6-keto-PGF1 alpha concentration also significantly increased at 1 hr and maintained that level for 24 hrs. The TXB2/6-keto-PGF1 alpha ratio was significantly elevated at 1 hr and reached its peak at 4 hrs after SCI, then gradually decreased to the preinjury level during 8-24 hrs. The negative correlation of SCBF with TXB2 concentration and TXB2/6-keto-PGF1 alpha ratio were appeared. The experimental results indicated that the imbalance of TXB2/6-keto-PGF1 alpha could be the main cause of microcirculatory disturbance and secondary damage in SCI.     

Preliminary evidence that DEXA provides an accurate assessment of body composition

It was previously found that dual-energy X-ray absorptiometry (DEXA) underestimated central body fat. The purposes of this study were to determine whether an updated version (enhanced version 5.64) of the analysis program corrected this problem (experiment 1) and to compare body composition assessed by DEXA and hydrodensitometry (HD) in women (n = 225) and men (n = 110) across a 21- to 81-yr age range (experiment 2). For experiment 1, 10 subjects underwent DEXA procedures in a control condition and with packets of lard positioned over either the thighs or the truncal region. DEXA accurately quantified the additional mass as approximately 96% fat, regardless of position. For experiment 2, DEXA yielded higher (P < 0.001) estimates of fatness than did HD (32.1 +/- 12.0 vs. 31.2 +/- 10.1%). The mean difference between the two methods was similar in young, middle-aged, and older subjects, but was different in men (HD-DEXA, 1.6 +/- 3.4% of body wt) than in women (-2.1 +/- 3.8% of body wt). Correcting the density of fat-free mass for variance in the bone mineral fraction of fat-free mass reduced the difference between the methods in men from 1.6 +/- 3.4 to -0.7 +/- 2.9% but widened it in women from -2.1 +/- 3.8 to -3.5 +/- 3.4%. A second correction procedure that adjusted for variance in water, protein, and mineral fractions of fat-free mass eliminated the differences in estimates of fat content by DEXA and HD in both men (21.1 +/- 9.3 vs. 20.6 +/- 8.4%, respectively) and women (37.5 +/- 9.3 vs. 36.8 +/- 8.0%, respectively). These results provide encouraging, but not definitive, evidence that the assessment of body composition by DEXA is accurate under the specified conditions.