Objective Nutritional status is assessed by measuring BMI or percent body fat (%fat). BMI can misclassify persons who carry more weight as fat-free mass and %fat can be misleading in cases of malnutrition or in disease states characterized by wasting of lean tissue. The fat-free mass index (FFMI) is proposed to assess body composition in individuals who have a similar body composition but differ in height allowing identification of those suffering from malnutrition, wasting or those that possess a relatively high muscle mass. The purpose was to determine whether the FFMI differs in a group of racially/ethnically diverse adults. Design Cross-sectional. Subjects Subjects were a multi-ethnic sample (Caucasian, CA; African American, AA; Hispanic, HIS and Asian, AS) of 1339 healthy males (n = 480) and females (n = 859) ranging in age from 18–110 years. Total body fat, total fat-free mass and bone mineral density were estimated using dual energy X-ray absorptiometry. Results FFMI differed among the four ethnic groups (P ≤ 0.05) for both genders. A curvilinear relationship was found between age and FFMI for both genders although the coefficients in the quadratic model differed between genders (P ≤ 0.001) indicating the rate of change in FFMI differed between genders. The estimated turning point where FFMI started to decline was in the mid 20s for male and mid 40s for female participants. An age × gender interaction was found such that the rate of decline was greater in male than female participants (P ≤ 0.001). For both genders, FFMI was greatest in AA and the least in AS (P ≤ 0.001). There was no significant interaction between race and age or age2 (P = 0.06). However, male participants consistently had a greater FFMI than female participants (P ≤ 0.001). Conclusions These findings have clinical implications for identifying individuals who may not be recognized as being malnourished based on their BMI or %fat but whose fat-free mass corrected for height is relatively low.

Purpose Despite their widespread use in research and fitness settings, Durnin and Womersley’s (DW) 1974 prediction equations using skinfold thickness to estimate body fat percent by hydrodensitometry have not been systematically evaluated in racial or ethnic groups using body fat percent measured by dual-energy x-ray absorptiometry (%BFDXA) as the standard. Methods This cross-sectional, population-based study examined whether the DW skinfold equations predict %BFDXA in a large, multiracial sample. Four skinfold measures (biceps, triceps, subscapular, and suprailiac), other clinical anthropometrics, and %BFDXA were obtained from 1675 healthy adults, age 18–110 yr, who were classified into four racial or ethnic categories: Caucasian, African American, Hispanic, or Asian. Predicted body fat percent using DW equations was compared with %BFDXA and evaluated within race/ethnicity- and sex-specific groups. Results Mean body fat percent predicted by DW equations was significantly different from %BFDXA in four of eight race/ethnicity- and sex-specific groups, particularly in Asian women and African American men (3.3 and 2.4 percentage point overestimates, respectively, P < 0.0001). New linear regression equations were developed estimating %BFDXA specific to each race/ethnicity and sex group, using the original DW skinfold sites. Body weight, height, and waist circumference independently predicted fat percent and were also included in the new equations. Conclusions The 1974 DW equations did not predict %BFDXA uniformly in all races or ethnicities. Using %BFDXA as the criterion measure, the original DW skinfold equations have been updated specific to sex and race/ethnicity while maintaining the DW options for a minimalistic model using fewer predictors.

ObjectiveGlial fibrillary acidic protein antibody (GFAP) is a newly recognized biomarker for an immunotherapy responsive autoimmune meningo-encephalomyelitis with a wide variety of clinical presentations. We report the second GFAP antibody positive case in a young man who died despite appropriate and aggressive immunomodulatory treatment.Background29 year old previously healthy male with childhood immune disorder presented with 3 week history of acute progressive worsening headaches, bloody emesis, nausea, blurry vision and generalized weakness. Exam was significant for downbeating nystagmus, limb ataxia and tremor and later progressing into inattention, confusion, urinary retention, asymmetric pupils, hyprreflexia and lack of motor or sensory response. Lumbar puncture revealed lymphocytic pleocytosis with elevated protein and opening pressure of 36 cm H20. MRI demonstrated areas of restricted diffusions symmetrically involving white matter of the corpus callosum, middle cerebellar peduncle, cerebellar white matter bilaterally as well as within the pons centrally. Patient was started on intravenous immunogammaglobulin (IVIG) and pulse corticosteroids along with broad spectrum antimicrobial therapy. After an initial apparent response to treatment, repeat head CT showed Diffuse Sulci effacement. Shortly after, He rapidly decompensated with clinical findings indicating brainstem herniation, cardiac arrest and brain death was diagnosed. CSF studies subsequently were reported as positive for GFAP antibodies. An autopsy reported the cause of death as cerebellar tonsillar herniation secondary to diffuse cerebral edema. all sections showed perivascular inflammation and gliosis.Design/MethodsNA.ResultsNA.ConclusionsThis reported case of anti-GFAP meningo-encephalomyelitis is unusual for the rapid onset of cerebral edema and rapid progression to herniation and brain death occurring only 4 weeks after symptom onset. While this may be a rare complication of Anti GFAP encephalitis, clinicians should be vigilant for acutely increased intracranial pressure in patients with clinical findings of encephalitis in general.