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Fabbri E, An Y, Zoli M, Simonsick EM, Guralnik JM, Bandinelli S, Boyd CM, Ferrucci L. Aging and the burden of multimorbidity: associations with inflammatory and anabolic hormonal biomarkers. J Gerontol A Biol Sci Med Sci 2014; 70:63-70. [PMID: 25104822 DOI: 10.1093/gerona/glu127] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity increases with aging, but risk factors beyond age are unknown. OBJECTIVE To investigate the association of inflammatory and anabolic hormonal biomarkers with presence and prospective development of multimorbidity. METHODS Nine-year longitudinal study of 1018 participants aged 60 years or older (InCHIANTI Study). Multimorbidity was evaluated at baseline and follow-up visits as number of diagnosed diseases from a predefined list of 15 candidate chronic conditions, defined according to standard clinical criteria. Linear mixed models were used to test cross-sectional and longitudinal associations between candidate biomarkers and multimorbidity. RESULTS At baseline, multimorbidity was significantly higher in older participants (p < .001) and higher IL-6, IL-1ra, TNF-α receptor II (TNFAR2), and lower dehydroepiandrosterone sulfate were associated with higher number of diseases, independent of age, sex, body mass index, and education. The rate of longitudinal increase in number of chronic diseases was significantly steeper in participants who were older at baseline (p < .001). In addition, higher baseline IL-6 and steeper increase of IL-6 levels were significantly and independently associated with a steeper increase in multimorbidity over time (p < .001 and p = .003, respectively). Sensitivity analyses, performed using 15 different models obtained by removing each of 15 conditions included in the original list of candidate diseases, confirmed that results were not driven by any specific condition. CONCLUSIONS Accumulation of chronic diseases accelerates at older ages and in persons with higher baseline levels and steeper increase over time of IL-6. High IL-6 and increase in IL-6 may serve as early warning sign to better target interventions aimed at reducing the burden of multimorbidity.
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Affiliation(s)
- Elisa Fabbri
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland. Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Yang An
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, Division of Gerontology, University of Maryland School of Medicine, Baltimore
| | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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52
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Afilalo J. Androgen Deficiency as a Biological Determinant of Frailty: Hope or Hype? J Am Geriatr Soc 2014; 62:1174-8. [DOI: 10.1111/jgs.12835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan Afilalo
- Divisions of Cardiology and Clinical Epidemiology; Department of Medicine; Jewish General Hospital; McGill University; Montreal Quebec Canada
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53
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Yeap BB, Flicker L. Hormones and Cardiovascular Disease in Older Men. J Am Med Dir Assoc 2014; 15:326-33. [DOI: 10.1016/j.jamda.2013.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 12/29/2022]
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54
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Leitner MK, Kautzky-Willer A. [Gender-specific differences in age-associated endocrinology]. Z Gerontol Geriatr 2014; 46:505-10. [PMID: 23780632 DOI: 10.1007/s00391-013-0512-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The endocrine system is intimately involved in modulating lifespan and quality of life. Facing an ever increasing proportion of aged people in the western society, there is great interest in understanding the complex interrelations between increasing age and hormonal regulation. Age-associated endocrinological changes comprise the decline of basal hormonal levels, pulsatile hormone distribution, and activity of hormonal axis, which result in changes in body composition. Men and women experience different age-associated alterations of the hormonal system. Aging per se is a risk factor for diseases like diabetes mellitus type 2, thyroid disorders, osteoporosis, frailty, and sarcopenia. Gender-specific differences with respect to symptoms, interactions, diagnosis, and therapy must be taken into consideration. Current data do not allow a general recommendation for hormonal substitution, neither for women nor for men. New research approaches following a multifactorial pathway are required to elucidate the complexity of age-associated endocrinological changes and to develop gender-specific therapies for endocrinological diseases.
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Affiliation(s)
- M K Leitner
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Gender Medicine Unit, Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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55
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Magnani JW, Moser CB, Murabito JM, Sullivan LM, Wang N, Ellinor PT, Vasan RS, Benjamin EJ, Coviello AD. Association of sex hormones, aging, and atrial fibrillation in men: the Framingham Heart Study. Circ Arrhythm Electrophysiol 2014; 7:307-12. [PMID: 24610804 DOI: 10.1161/circep.113.001322] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endogenous sex hormones have been related to cardiovascular outcomes and mortality. We hypothesized that sex hormones are related to atrial fibrillation (AF) in a community-based cohort of middle-aged to older men. METHODS AND RESULTS We examined testosterone, estradiol, and dehydroepiandrosterone sulfate in relation to incident AF in men participating in the Framingham Heart Study. We assessed the 10-year risk of AF in multivariable-adjusted hazard models. The cohort consisted of 1251 men (age, 68.0±8.2 years), of whom 275 developed incident AF. We identified a significant interaction between age and testosterone and, therefore, stratified men into age 55 to 69 years (n=786), 70 to 79 years (n=351), and ≥80 years (n=114). In men aged 55 to 69 years, each 1 SD decrease in testosterone was associated with hazard ratio (HR) 1.30 (95% confidence interval [CI], 1.07-1.59) for incident AF. The association between testosterone and 10-year incident AF in men 70 to 79 years did not reach statistical significance. In men≥80 years, a 1 SD decrease in testosterone was associated with HR 3.53 (95% CI, 1.96-6.37) for AF risk. Estradiol was associated with incident AF (HR, 1.12; 95% CI, 1.01-1.26). Dehydroepiandrosterone sulfate had a borderline association with risk of AF that was not statistically significant (HR, 1.12; 95% CI, 0.99-1.28). CONCLUSIONS Testosterone and estradiol are associated with incident AF in a cohort of older men. Testosterone deficiency in men≥80 years is strongly associated with AF risk. The clinical and electrophysiological mechanisms underlying the associations between sex hormones and AF in older men merit continued investigation.
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Affiliation(s)
- Jared W Magnani
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Boston, MA
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56
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Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng CW, Madia F, Fontana L, Mirisola MG, Guevara-Aguirre J, Wan J, Passarino G, Kennedy BK, Wei M, Cohen P, Crimmins EM, Longo VD. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab 2014; 19:407-17. [PMID: 24606898 PMCID: PMC3988204 DOI: 10.1016/j.cmet.2014.02.006] [Citation(s) in RCA: 584] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/24/2014] [Accepted: 02/10/2014] [Indexed: 01/08/2023]
Abstract
Mice and humans with growth hormone receptor/IGF-1 deficiencies display major reductions in age-related diseases. Because protein restriction reduces GHR-IGF-1 activity, we examined links between protein intake and mortality. Respondents aged 50-65 reporting high protein intake had a 75% increase in overall mortality and a 4-fold increase in cancer death risk during the following 18 years. These associations were either abolished or attenuated if the proteins were plant derived. Conversely, high protein intake was associated with reduced cancer and overall mortality in respondents over 65, but a 5-fold increase in diabetes mortality across all ages. Mouse studies confirmed the effect of high protein intake and GHR-IGF-1 signaling on the incidence and progression of breast and melanoma tumors, but also the detrimental effects of a low protein diet in the very old. These results suggest that low protein intake during middle age followed by moderate to high protein consumption in old adults may optimize healthspan and longevity.
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Affiliation(s)
- Morgan E Levine
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA
| | - Jorge A Suarez
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Sebastian Brandhorst
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Priya Balasubramanian
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Chia-Wei Cheng
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Federica Madia
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; EURL ECVAM, Institute for Health & Consumer Protection, European Commission Joint Research Centre, Ispra (VA) 21027, Italy
| | - Luigi Fontana
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Clinical and Experimental Sciences, Brescia University School of Medicine, Brescia 25123, Italy; CEINGE Biotecnologie Avanzate, Napoli 80145, Italy
| | - Mario G Mirisola
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA; Dipartimento di Biopatologia e Metodologie Biomediche, Universita' di Palermo, Palermo 90127, Italy
| | | | - Junxiang Wan
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Giuseppe Passarino
- Department of Biology, Ecology and Earth Science, University of Calabria, Rende 87036, Italy
| | | | - Min Wei
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Pinchas Cohen
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA
| | - Valter D Longo
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90033, USA; Longevity Institute, University of Southern California, Los Angeles, CA 90033, USA.
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Cooper LA, Page ST. Androgens and prostate disease. Asian J Androl 2014; 16:248-55. [PMID: 24407178 PMCID: PMC3955334 DOI: 10.4103/1008-682x.122361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/04/2022] Open
Abstract
A growing body of literature has established the anabolic benefi ts of testosterone (T) therapy in hypogonadal men. However, there remains a paucity of data regarding the risks of exogenous androgen use in older men and the potential for adverse effects on the prostate gland. Whether T therapy in older, hypogonadal men might worsen lower urinary tract symptoms or exacerbate, unmask, or even incite prostate cancer development has tempered enthusiasm for T therapy, while known prostatic disease has served as a relative contraindication to T therapy. Androgens are necessary for the development and maintenance of the prostate gland. However, epidemiologic studies do not consistently fi nd a positive relationship between endogenous serum androgen concentrations and the risk of prostate disease. Recent data demonstrate that 5α-reductase inhibitors decrease the risk of low-grade prostate cancer, suggesting that modifying androgen metabolism may have beneficial effects on prostate health, yet similar reductions in high-grade disease have not been observed, thereby questioning the true clinical benefits of these agents for chemoprevention. Knowing how to best investigate the relationship between androgens and the development of prostate disease given the lack of large, randomized trials is difficult. Accumulating data challenges the assumption that alterations in serum androgens have parallel effects within the prostate hormonal environment or change androgen-regulated processes within the gland. Long-term intervention studies are needed to truly ascertain the effects of androgen manipulation on prostate tissue and disease risk. However, available data do not support the notion that restoring serum androgens to normal physiologic ranges drives prostate disease.
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Affiliation(s)
- Lori A Cooper
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington, Seattle, USA
| | - Stephanie T Page
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington, Seattle, USA
- University of Washington and Harborview Medical Center, Seattle, Washington, USA
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58
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Francomano D, Lenzi A, Aversa A. Effects of five-year treatment with testosterone undecanoate on metabolic and hormonal parameters in ageing men with metabolic syndrome. Int J Endocrinol 2014; 2014:527470. [PMID: 24688542 PMCID: PMC3945028 DOI: 10.1155/2014/527470] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/05/2013] [Indexed: 01/10/2023] Open
Abstract
Metabolic and hormonal modifications after long-term testosterone (T) treatment have never been investigated. 20 hypogonadal men (mean T = 241 ng/dL-8.3 nmol/L) with metabolic syndrome (MS, mean age 58) were treated with T-undecanoate injections every 12 weeks for 60 months. 20 matched subjects in whom T was unaccepted or contraindicated served as controls. Primary endpoints were variations from baseline of metabolic and hormonal parameters. In T-group, significant reductions in waist circumference (-9.6 ± 3.8 cm, P < 0.0001), body weight (-15 ± 2.8 Kg, P < 0.0001), and glycosylated hemoglobin (-1.6 ± 0.5%, P < 0.0001) occurred, along with improvements in insulin sensitivity (HOMA-I; -2.8 ± 0.6, P < 0.0001), lipid profile (total/HDL-cholesterol ratio -2.9 ± 1.5, P < 0.0001), systolic and diastolic blood pressure (-23 ± 10 and -16 ± 8 mm Hg, P < 0.0001, resp.), and neck and lumbar T-scores (+0.5 ± 0.15 gr/cm(2), P < 0.0001; +0.7 ± 0.8, P < 0.0001, resp.). Also, serum vitamin D (+14.0 ± 1.3 ng/mL, P < 0.01), TSH (- 0.9 ± 0.3 mUI/mL, P < 0.01), GH (0.74 ± 0.2 ng/mL, P < 0.0001), and IGF1 (105 ± 11 ng/mL, P < 0.01) levels changed in T-group but not in controls. Normalization of T levels in men with MS improved obesity, glycemic control, blood pressure, lipid profile, and bone mineral density compared with controls. Amelioration in hormonal parameters, that is, vitamin D, growth hormone, and thyrotropin plasma levels, were reported.
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Affiliation(s)
- Davide Francomano
- Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonio Aversa
- Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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59
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Sanders JL, Ding V, Arnold AM, Kaplan RC, Cappola AR, Kizer JR, Boudreau RM, Cushman M, Newman AB. Do changes in circulating biomarkers track with each other and with functional changes in older adults? J Gerontol A Biol Sci Med Sci 2014; 69:174-81. [PMID: 23811185 PMCID: PMC4038245 DOI: 10.1093/gerona/glt088] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/24/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unclear if changes in proposed circulating biomarkers of aging are strongly correlated to each other or functional change. We tested if biomarker changes track with each other and with functional measures over 9 years in older adults. METHODS Dehydroepiandrosterone sulfate (DHEAS), adiponectin, insulin-like growth factor 1 (IGF-1), IGF binding proteins 1 (IGFBP-1) and 3 (IGFBP-3), interleukin-6 (IL-6), cholesterol, and function (gait speed, grip strength, Modified Mini Mental Status Exam [3MSE] and Digit Symbol Substitution Test [DSST] scores) were measured in 1996-1997 and 2005-2006 in the Cardiovascular Health Study All Stars study (N = 901, mean [standard deviation, SD] age 85.3 [3.6] years in 2005-2006). Adjusted Pearson correlations illustrated if biomarkers tracked together. Multivariable linear regression demonstrated if biomarker changes tracked with functional changes. RESULTS Correlations among biomarker changes were mostly <0.2. In models with each biomarker entered separately, a 1-SD increase biomarker change was associated with change in function as follows: grip strength (DHEAS β = 0.61kg, p = .001; IL-6 β = -0.46kg, p = .012; cholesterol men β = 0.79kg, p = .016); gait speed (DHEAS β = 0.02 meters per second, p = .039; IL-6 β = -0.018 meters per second, p = .049); and DSST score (DHEAS women β = 1.46, p = .004; IL-6 β = -0.83, p = .027). When biomarkers were entered in the same model, significant associations remaining were as follows: grip strength (DHEAS β = 0.54kg, p = .005; IL-6 β = -0.43kg, p = .022); 3MSE score (IGF-1 β = 0.96, p = .04; IGFBP-3 β = -1.07, p = .024); and DSST score (DHEAS women β = 1.27, p = .012; IL-6 β = -0.80, p = .04). CONCLUSION Changes in biomarkers were poorly correlated, supporting a model of stochastic, independent change across systems. DHEAS and IL-6 tracked most closely with function, illustrating that changes in inflammation and sex steroids may play dominant roles in changes of these functional outcomes.
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Affiliation(s)
- Jason L Sanders
- Bellefield Professional Building 4th Floor, 130 North Bellefield Avenue, Pittsburgh, PA 15213.
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60
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Hackett G, Cole N, Bhartia M, Kennedy D, Raju J, Wilkinson P, Saghir A. The response to testosterone undecanoate in men with type 2 diabetes is dependent on achieving threshold serum levels (the BLAST study). Int J Clin Pract 2014; 68:203-15. [PMID: 24355040 DOI: 10.1111/ijcp.12235] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The association between testosterone deficiency and insulin resistance in men with type 2 diabetes is well established. Current Endocrine Society and European Association of Urology guidelines recommend the measurement of testosterone levels in all men with type 2 diabetes and in men suffering from erectile dysfunction. It is recognised that a range of physical symptoms appear as the testosterone level falls but few studies have addressed the threshold at which symptoms improve with physiological replacement. We report the first double-blind placebo-controlled study conducted exclusively in a male type 2 diabetes population to assess the metabolic changes with testosterone replacement. METHODS The type 2 diabetes registers of seven general practices were screened to establish the prevalence of low testosterone and the associations with diabetes control. Of 550 eligible patients approached, 488 men (mean age 62.6) consented to take part in screening with a morning testosterone level, assessed between 8 and 11 am. This identified 211 patients for a double-blind placebo-controlled study of long acting testosterone undecanoate (TU) 1000 mg lasting 30 weeks followed by 52 weeks of open label use. The population was divided into a SEVERE group with either total testosterone (TT) of 8 nmol/l or less or free testosterone (FT) 180 pmol/l or less or a MILD group with TT 8.1-12 nmol/l or FT 181-250 pmol/l. RESULTS Men in the SEVERE group increased mean through TT from 7.73 nmol/l at baseline to 9.93 at 30 weeks and the MILD group from 10.47 to 11.94. The SEVERE group showed marked improvement in sexual function, but no significant improvement in metabolic parameters. The MILD group showed no improvement in sexual function, but significant improvement in weight, body mass index, waist circumference and Hospital Anxiety and Depression Scale. Improvement was seen in all parameters during 52 weeks open label treatment where trough TT levels approached 15 nmol/l. Baseline prostate-specific antigen (PSA) was lower in the SEVERE group and increased with TU for 30 weeks and then stabilised. There was no increase in PSA with treatment in the MILD group. CONCLUSIONS Testosterone undecanoate significantly improves sexual parameters and Ageing Male Symptom Score, but not metabolic factors at 30 weeks in men with SEVERE testosterone deficiency syndrome (TDS). In men with MILD TDS, significant improvements in metabolic but not sexual parameters were seen, suggesting that there are threshold levels for response to testosterone replacement therapy and that trials of therapy need to achieve sustained therapeutic levels to be effective. PSA showed minor rises, but only for 30 weeks in the SEVERE group.
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Affiliation(s)
- G Hackett
- Good Hope Hospital, Sutton Coldfield, UK
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Hackett G, Kirby M, Sinclair AJ. Testosterone deficiency, cardiac health, and older men. Int J Endocrinol 2014; 2014:143763. [PMID: 24812558 PMCID: PMC4000629 DOI: 10.1155/2014/143763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/12/2014] [Accepted: 02/05/2014] [Indexed: 12/26/2022] Open
Abstract
Low levels of testosterone are manifested by erectile dysfunction, reduced sexual desire, and loss of morning erections with increasing numbers of men are being diagnosed and require treatment. The prevalence rates of testosterone deficiency vary according to different studies but may be as high as 40% in populations of patients with type 2 diabetes. There is increasing evidence that testosterone deficiency is associated with increased cardiovascular and all-cause mortality. Screening for low testosterone is recommended in a number of high risk groups including those with type 2 diabetes and metabolic syndrome. There are recent data to suggest that testosterone replacement therapy may reduce cardiovascular mortality as well as improving multiple surrogate markers for cardiovascular events. Specific clinical trials of testosterone replacement therapy are needed in selected populations but in the meantime we must treat patients based on the best current evidence.
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Affiliation(s)
- G. Hackett
- Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
- IDOP, University of Bedfordshire, Putteridge Bury Campus, Luton, Bedfordshire LU2 8LE, UK
| | - M. Kirby
- IDOP, University of Bedfordshire, Putteridge Bury Campus, Luton, Bedfordshire LU2 8LE, UK
- The Prostate Centre, 32 Wimpole Street, London W1G 8GT, UK
| | - A. J. Sinclair
- IDOP, University of Bedfordshire, Putteridge Bury Campus, Luton, Bedfordshire LU2 8LE, UK
- The Luton & Dunstable Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK
- *A. J. Sinclair:
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Vasunilashorn S, Cohen AA. Stress responsive biochemical anabolic/catabolic ratio and telomere length in older adults. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2014; 60:174-184. [PMID: 25343365 PMCID: PMC4347836 DOI: 10.1080/19485565.2014.950722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
It has been hypothesized that chronic psychological stress is associated with shorter telomere length; however, the mechanisms that link stress and telomere length are not well understood. To examine the interplay between biochemical factors related to stress arousal and cellular aging, we investigate the association between anabolic/catabolic (A/C) imbalance and leukocyte telomere length (LTL) in the Social Environment and Biomarkers of Aging Study (SEBAS), conducted in Taiwan (N = 925). SEBAS participants aged 54 and older (mean age 68.3) with values for two anabolic hormones (serum dehydroepiandrosterone sulfate [DHEAS] and insulin growth factor [IGF]-1), four catabolic hormones (cortisol, epinephrine, norepinephrine, and interleukin-6 [IL-6]), and LTL were examined. We found that high IL-6 was associated with short LTL (≤ 0.88 T/S ratio; odds ratio [OR] 1.41, 95% confidence interval [CI] = 1.04-1.92). Neither DHEAS/cortisol nor IGF-1/cortisol ratio was associated with telomere length; however, a high A/C imbalance summary score was associated with greater odds of having a short LTL relative to long LTL (OR 1.19, 95% CI = 1.05-1.35). These results indicate that our A/C imbalance score, defined by several anabolic and catabolic biochemical factors, may be one mechanism through which psychological stress is associated with short LTL and possibly cellular senescence.
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Maggio M, De Vita F, Lauretani F, Nouvenne A, Meschi T, Ticinesi A, Dominguez LJ, Barbagallo M, Dall'Aglio E, Ceda GP. The Interplay between Magnesium and Testosterone in Modulating Physical Function in Men. Int J Endocrinol 2014; 2014:525249. [PMID: 24723948 PMCID: PMC3958794 DOI: 10.1155/2014/525249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 02/01/2023] Open
Abstract
The role of nutritional status as key factor of successful aging is very well recognized. Among the different mechanisms by which nutrients may exert their beneficial effects is the modulation of the hormonal anabolic milieu, which is significantly reduced with aging. Undernutrition and anabolic hormonal deficiency frequently coexist in older individuals determining an increased risk of mobility impairment and other adverse outcomes. Mineral assessment has received attention as an important determinant of physical performance. In particular, there is evidence that magnesium exerts a positive influence on anabolic hormonal status, including Testosterone, in men. In this review we summarize data from observational and intervention studies about the role of magnesium in Testosterone bioactivity and the potential underlying mechanisms of this relationship in male subjects. If larger studies will confirm these pivotal data, the combination of hormonal and mineral replacements might be adopted to prevent or delay the onset of disability in the elderly.
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Affiliation(s)
- Marcello Maggio
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
- *Marcello Maggio:
| | - Francesca De Vita
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Fulvio Lauretani
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Antonio Nouvenne
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Tiziana Meschi
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Andrea Ticinesi
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Ligia J. Dominguez
- Department of Internal Medicine and Medical Specialties (DIMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
| | - Mario Barbagallo
- Department of Internal Medicine and Medical Specialties (DIMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
| | - Elisabetta Dall'Aglio
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Gian Paolo Ceda
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
- Geriatric Rehabilitation Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
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Chrysohoou C, Stefanadis C. Longevity and diet. Myth or pragmatism? Maturitas 2013; 76:303-7. [PMID: 24210636 DOI: 10.1016/j.maturitas.2013.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 09/29/2013] [Accepted: 09/30/2013] [Indexed: 12/26/2022]
Abstract
Longevity is a very complex phenomenon, because many environmental, behavioral, socio-demographic and dietary factors influence the physiological pathways of aging and life-expectancy. Nutrition has been recognized to have an important impact on overall mortality and morbidity; and its role in extending life expectancy has been the object of extensive scientific research. This paper reviews the pathophysiological mechanisms that potentially link aging with diet and the scientific evidence supporting the anti-aging effect of the traditional Mediterranean diet, as well as of some specific foods. The diet and several of its components have additionally been shown to have beneficial effects on the co-morbidities typical of elderly populations. Furthermore, the epigenetic effects of diet on the aging process - through calorie restriction and the consumption of foods like red wine, orange juice, probiotics and prebiotics - have attracted scientific interest. Some, such as dark chocolate, red wine, nuts, beans, avocados are being promoted as anti-aging foods, due to their anti-oxidative and anti-inflammatory properties. Finally, an important moderator in the relationship between diet, longevity and human health remains the socio-economic status of individual, as a healthy diet, due to its higher cost, is closely related to higher financial and educational status.
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Affiliation(s)
- Christina Chrysohoou
- First Cardiology Clinic, Hippokration Hospital, School of Medicine, University of Athens, Greece.
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Maggio M, De Vita F, Lauretani F, Buttò V, Bondi G, Cattabiani C, Nouvenne A, Meschi T, Dall’Aglio E, Ceda GP. IGF-1, the cross road of the nutritional, inflammatory and hormonal pathways to frailty. Nutrients 2013; 5:4184-205. [PMID: 24152751 PMCID: PMC3820068 DOI: 10.3390/nu5104184] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 12/11/2022] Open
Abstract
The decline in functional capacity is a heterogeneous phenomenon in the elderly. An accelerated ageing determines a frail status. It results in an increased vulnerability to stressors for decreased physiological reserves. The early identification of a frail status is essential for preventing loss of functional capacity, and its clinical consequences. Frailty and mobility limitation result from an interplay of different pathways including multiple anabolic deficiency, inflammation, oxidative stress, and a poor nutritional status. However, the age-related decline in insulin-like growth factor 1 (IGF-1) bioactivity deserves special attention as it could represent the ideal crossroad of endocrine, inflammatory, and nutritional pathways to frailty. Several minerals, namely magnesium, selenium, and zinc, appear to be important determinants of IGF-1 bioactivity. This review aims to provide an overview of the potential usefulness of nutrients modulating IGF-1 as potential therapeutic targets in the prevention of mobility limitation occurring in frail older subjects.
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Affiliation(s)
- Marcello Maggio
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (F.V.); (F.L.); (A.N.); (G.P.C.)
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (V.B.); (G.B.); (T.M.); (E.D.A.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +0039-0521-703-916; Fax: +0039-0521-987-562
| | - Francesca De Vita
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (F.V.); (F.L.); (A.N.); (G.P.C.)
| | - Fulvio Lauretani
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (F.V.); (F.L.); (A.N.); (G.P.C.)
| | - Valeria Buttò
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (V.B.); (G.B.); (T.M.); (E.D.A.)
| | - Giuliana Bondi
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (V.B.); (G.B.); (T.M.); (E.D.A.)
| | - Chiara Cattabiani
- Azienda USL Piacenza, Via Taverna, 49, Piacenza (PC) 23121, Italy; E-Mail:
| | - Antonio Nouvenne
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (F.V.); (F.L.); (A.N.); (G.P.C.)
| | - Tiziana Meschi
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (V.B.); (G.B.); (T.M.); (E.D.A.)
| | - Elisabetta Dall’Aglio
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (V.B.); (G.B.); (T.M.); (E.D.A.)
| | - Gian Paolo Ceda
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (F.V.); (F.L.); (A.N.); (G.P.C.)
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, Parma (PR) 43126, Italy; E-Mails: (V.B.); (G.B.); (T.M.); (E.D.A.)
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Volpato S, Bianchi L, Cherubini A, Landi F, Maggio M, Savino E, Bandinelli S, Ceda GP, Guralnik JM, Zuliani G, Ferrucci L. Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm. J Gerontol A Biol Sci Med Sci 2013; 69:438-46. [PMID: 24085400 DOI: 10.1093/gerona/glt149] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Muscle impairment is a common condition in older people and a powerful risk factor for disability and mortality. The aim of this study was to apply the European Working Group on Sarcopenia in Older People criteria to estimate the prevalence and investigate the clinical correlates of sarcopenia, in a sample of Italian community-dwelling older people. METHODS Cross-sectional analysis of 730 participants (74% aged 65 years and older) enrolled in the InCHIANTI study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria using bioimpedance analysis for muscle mass assessment. Logistic regression analysis was used to identify the factors independently associated with sarcopenia. RESULTS Sarcopenia defined by the European Working Group on Sarcopenia in Older People criteria increased steeply with age (p < .001), with 31.6% of women and 17.4% of men aged 80 years or older being affected by this condition. Higher education (odds ratio: 0.85; 95% CI: 0.74-0.98), lower insulin-like growth factor I (lowest vs highest tertile, odds ratio: 3.89; 95% CI: 1.03-14.1), and low bioavailable testosterone (odds ratio: 2.67; 95% CI: 1.31-5.44) were independently associated with the likelihood of being sarcopenic. Nutritional intake, physical activity, and level of comorbidity were not associated with sarcopenia. CONCLUSIONS Sarcopenia identified by the European Working Group on Sarcopenia in Older People criteria is a relatively common condition in Italian octogenarians, and its prevalence increases with aging. Correlates of sarcopenia identified in this study might suggest new approaches for prevention and treatment of sarcopenia.
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Affiliation(s)
- Stefano Volpato
- Department of Medical Science, University of Ferrara, Via Savonarola, 9, Ferrara I-44100, Italy.
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Kalicińska E, Wojtas K, Majda J, Doehner W, von Haehling S, Banasiak W, Ponikowska B, Borodulin-Nadzieja L, Anker SD, Ponikowski P, Jankowska EA. Anabolic deficiencies in men with systolic heart failure: do co-morbidities and therapies really contribute significantly? Aging Male 2013; 16:123-31. [PMID: 23803163 DOI: 10.3109/13685538.2013.807427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Deficiencies of anabolic hormones are common in men with heart failure (HF). It remains unclear whether the deranged metabolism of these hormones is the pathophysiological element of HF itself or is the consequence of co-morbidities or/and treatment in HF. METHODS We examined 382 men with systolic HF. Serum hormones (i.e. total testosterone [TT], DHEAS, IGF-1) were assessed using immunoassays, serum free testosterone (eFT) - using the Vermeulen equation. RESULTS Prevalence of TT and eFT deficiencies was similar in men with HF aged < versus ≥60 years (23% and 32% for TT and eFT deficiencies). Deficiencies in DHEAS and IGF-1 were more common in younger (63% and 92%) than older patients (48% and 73%). In men <60 years, TT deficiency was accompanied by the therapy with digoxin, eFT deficiency - the therapy with digoxin and the presence of diabetes, DHEAS deficiency - the therapy with loop diuretic (all p < 0.05). In men ≥60 years, TT deficiency - the therapy with loop diuretic, DHEAS deficiency - the therapy with spironolactone and digoxin, and hsCRP, IGF-1 deficiency - the high hsCRP (all p < 0.05). CONCLUSIONS Deficiencies in anabolic hormones are common in younger and older men with HF. Some therapies (but not major co-morbidities) may contribute to anabolic deficiencies.
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68
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Bello AK, Stenvinkel P, Lin M, Hemmelgarn B, Thadhani R, Klarenbach S, Chan C, Zimmerman D, Cembrowski G, Strippoli G, Carrero JJ, Tonelli M. Serum testosterone levels and clinical outcomes in male hemodialysis patients. Am J Kidney Dis 2013; 63:268-75. [PMID: 23896484 DOI: 10.1053/j.ajkd.2013.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 06/13/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies linking low serum testosterone concentration to adverse clinical outcomes in hemodialysis patients have been relatively small. We investigated the role of testosterone in adverse outcomes and quality of life in an incident cohort of male Canadian hemodialysis patients. STUDY DESIGN A prospectively designed multicenter observational study using data from the Canadian Kidney Disease Cohort Study (CKDCS). SETTING & PARTICIPANTS Male patients initiating hemodialysis therapy since February 14, 2005, in 3 Canadian centers serving ethnically diverse populations were studied (N = 623). PREDICTOR Serum testosterone levels using the International Society of Andrology, International Society for the Study of the Aging Male, and European Association of Urology cutoffs (low, <231 ng/dL; borderline, 231-346 ng/dL; normal, >346 ng/dL). OUTCOMES All-cause mortality, fatal and nonfatal cardiovascular (CV) events, and Health Utility Index (HUI)-assessed health-related quality of life. MEASUREMENTS Participants completed a structured interview on demographics and medical history and an HUI questionnaire (version 3). Routine laboratory test results captured into the study database, and serum testosterone measured within 3 months after initiation of the baseline hemodialysis session. RESULTS During a median follow-up of 20 (range, 1-81) months, 166 (27%) died and 98 (20%) had a CV event. Mean serum testosterone level was 234.1 ± 146.1 (SD) ng/dL. Higher serum testosterone levels were associated with significantly decreased unadjusted risk of death (HR per 10-ng/dL increase, 0.58; 95% CI, 0.37-0.90). There was a statistically significant trend for higher all-cause mortality with low serum testosterone levels in adjusted analyses (P < 0.001). Higher levels of log-transformed testosterone were associated with significantly higher HUI scores (P for trend <0.001), and low levels of serum testosterone were associated significantly with lower HUI scores (P for trend <0.001). Although there was a significant trend in the unadjusted risk of CV events among participants with low serum testosterone levels (P < 0.001), the risk was no longer significant after adjustment for age. There was no significant interaction with age and serum testosterone level tested as continuous variables (P = 0.07). LIMITATIONS A short follow-up period and serum testosterone measured on a single occasion. CONCLUSIONS Low serum testosterone concentration may be a modifiable risk factor for adverse outcomes and poor quality of life in male hemodialysis patients. This hypothesis should be tested in randomized controlled trials.
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Affiliation(s)
| | | | - Meng Lin
- University of Alberta, Edmonton, Alberta, Canada
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Go SW, Cha YH, Lee JA, Park HS. Association between Sarcopenia, Bone Density, and Health-Related Quality of Life in Korean Men. Korean J Fam Med 2013; 34:281-8. [PMID: 23904958 PMCID: PMC3726796 DOI: 10.4082/kjfm.2013.34.4.281] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 06/18/2013] [Indexed: 12/23/2022] Open
Abstract
Background Sarcopenia is the loss of muscle mass leading to decreased muscle strength, physical disability, and increased mortality. The genesis of both sarcopenia and osteoporosis is multifactorial, and several factors that play a role in osteoporosis are thought to contribute to sarcopenia. This study evaluated the association between sarcopenia and bone density and health-related quality of life in Korean men. Methods We used the data of 1,397 men over 50 years of age from the 2009 Korean National Health and Nutrition Examination Survey. Sarcopenia was defined as the appendicular skeletal muscle mass divided by height2 (kg/m2) < 2 standard deviations below the sex-specific mean for young adults. Health-related quality of life was measured by the EuroQol-5 dimension (EQ-5D) instrument. Logistic regression analysis was performed to evaluate the relationship between sarcopenia, bone density, and health-related quality of life. Results The T-score of the lumbar spine, total femur, and femur neck in bone mineral density in subjects with sarcopenia were lower than those in subjects without sarcopenia. The score of the EQ-5D index was significantly lower and the rate of having problems with individual components of health-related quality of life was higher in the sarcopenic group. After adjustment for age and body mass index, the odds ratios (ORs) (95% confidence interval [CI]) for sarcopenia were 2.06 (1.07-3.96) in osteopenic subjects and 3.49 (1.52-8.02) in osteoporotic subjects, respectively. After adjustment, the total score of the EQ-5D index was significantly lower in the sarcopenic subjects. The ORs (95% CI) for having problems of mobility and usual activity of the EQ-5D descriptive system were 1.70 (1.02-2.84) and 1.90 (1.09-3.31), respectively. Conclusion Sarcopenia was associated with decreased bone mineral density in Korean men. In addition, sarcopenia was related to poor quality of life, especially with regard to mobility and usual activity. Greater attention to and evaluation for sarcopenia are needed in subjects showing low bone mineral density to prevent and manage poor quality of life.
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Affiliation(s)
- Seon Won Go
- Department of Family Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Maggio M, Cattabiani C, Lauretani F, Bandinelli S, De Vita F, Dall'Aglio E, Corsonello A, Lattanzio F, Paolisso G, Ferrucci L, Ceda GP. Insulin-like growth factor-1 bioactivity plays a prosurvival role in older participants. J Gerontol A Biol Sci Med Sci 2013; 68:1342-50. [PMID: 23671288 DOI: 10.1093/gerona/glt045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to address the intriguing issue of the role of the insulin-like growth factor (IGF)-1 system in longevity looking at the role of different components of IGF system. Vital status was ascertained in 1,197 men and women aged greater than or equal to 65 years from the InCHIANTI study. Hormonal levels were categorized into quartiles, and ratio of IGF-1 to IGF-binding protein (IGFBP)-1 was calculated. The relationship between hormones and mortality was tested by Cox proportional hazard models adjusted for age, sex, and confounders. During the 8-year follow-up period, 240 died and 957 survived. Lowest quartiles of IGF-1 and IGFBP-1 were considered as reference. Compared with the lowest quartiles, IGF-1 in upper quartiles was a negative predictor of mortality independent of age and sex (p = .01) but not independent of IGFBP-1 and other confounders. IGFBP-1 in second-third quartiles was negatively associated and that in the fourth quartiles was positively associated with risk of death. IGF-1/IGFBP-1 ratio in the lowest quartiles was a strong positive predictor of mortality, in age- and sex-adjusted model (p = .005), and independent of additional confounders (p = .037). High IGFBP-1 and low IGF-1/IGFBP-1 ratio are associated with all-cause mortality in older population.
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Affiliation(s)
- Marcello Maggio
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, 43100 Parma, Italy.
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The mitochondria-targeted antioxidant SkQ1 but not N-acetylcysteine reverses aging-related biomarkers in rats. Aging (Albany NY) 2013; 4:686-94. [PMID: 23104863 PMCID: PMC3517939 DOI: 10.18632/aging.100493] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although antioxidants have been repeatedly tested in animal models and clinical studies, there is no evidence that antioxidants reduce already developed age-related decline. Recently we demonstrated that mitochondria-targeted antioxidant 10-(6'-plastoquinonyl) decyltriphenylphosphonium (SkQ1) delayed some manifestations of aging. Here we compared effects of SkQ1 and N-acetyl-L-cysteine (NAC) on age-dependent decline in blood levels of leukocytes, growth hormone (GH), insulin-like growth factor-1 (IGF-1), testosterone, dehydroepiandrosterone (DHEA) in Wistar and senescence-accelerated OXYS rats. When started late in life, supplementation with SkQ1 not only prevented age-related decline but also significantly reversed it. With NAC, all the observed effects were of the lower magnitude compared with SkQ1 (in spite of that dose of NAC was 16000 times higher). We suggest that supplementation with low doses of SkQ1 is a promising intervention to achieve a healthy ageing.
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Puttabyatappa Y, Stallone JN, Ergul A, El-Remessy AB, Kumar S, Black S, Johnson M, Owen MP, White RE. Peroxynitrite mediates testosterone-induced vasodilation of microvascular resistance vessels. J Pharmacol Exp Ther 2013; 345:7-14. [PMID: 23318471 PMCID: PMC3608447 DOI: 10.1124/jpet.112.201947] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/13/2012] [Indexed: 01/01/2023] Open
Abstract
Our knowledge of how androgens influence the cardiovascular system is far from complete, and this lack of understanding is especially true of how androgens affect resistance vessels. Our aim was to identify the signaling mechanisms stimulated by testosterone (TES) in microvascular arteries and to understand how these mechanisms mediate TES-induced vasodilation. Mesenteric microvessels were isolated from male Sprague-Dawley rats. Tension studies demonstrated a rapid, concentration-dependent, vasodilatory response to TES that did not involve protein synthesis or aromatization to 17β-estradiol. Dichlorofluorescein fluorescence and nitrotyrosine immunoblot experiments indicated that TES stimulated peroxynitrite formation in microvessels, and functional studies demonstrated that TES-induced vasodilation was inhibited by scavenging peroxynitrite. As predicted, TES enhanced the production of both peroxynitrite precursors (i.e., superoxide and nitic oxide), and xanthine oxidase was identified as the likely source of TES-stimulated superoxide production. Functional and biochemical studies indicated that TES signaling involved activity of the phosphoinositide 3 (PI3) kinase-protein kinase B (Akt) cascade initiated by activation of the androgen receptor and culminated in enhanced production of cGMP and microvascular vasodilation. These findings, derived from a variety of analytical and functional approaches, provide evidence for a novel nongenomic signaling mechanism for androgen action in the microvasculature: TES-stimulated vasodilation mediated primarily by peroxynitrite formed from xanthine oxidase-generated superoxide and NO. This response was associated with activation of the PI3 kinase-Akt signaling cascade initiated by activation of the androgen receptor. We propose this mechanism could account for TES-stimulated cGMP production in microvessels and, ultimately, vasodilation.
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Affiliation(s)
- Yashoda Puttabyatappa
- Department of Pharmacology & Toxicology, Georgia Health Sciences University, Augusta, Georgia, USA
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Abstract
PURPOSE OF REVIEW Sarcopenia is a geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Sarcopenia is a multifactorial process involving the decline of androgens, including dehydroepiandrosterone sulphate (DHEAS) and testosterone. The aim of this review is to highlight the effects of DHEAS and testosterone treatment to counteract sarcopenia, especially in older men. RECENT FINDINGS DHEAS and, more importantly, testosterone treatment are associated with increased muscle mass, whereas the effects on muscle function and physical performance are less clear. The results of recent randomized placebo controlled trials with DHEAS in older men and women and testosterone in men with mobility limitation are discussed. The novel current and future scenarios to attenuate the detrimental effects and to optimize the efficacy of sex hormone treatment are also addressed. SUMMARY DHEAS and testosterone are important options in the armamentarium of sarcopenia treatment in older men. Future studies are needed to address new approaches by using selective compounds, targeting the correct form and dosage, tailoring the correct patient to treat, and taking into account the multifactorial origin and the new definition of sarcopenia.
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Affiliation(s)
- Marcello Maggio
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, Parma, Italy.
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Svensson J, Carlzon D, Petzold M, Karlsson MK, Ljunggren Ö, Tivesten A, Mellström D, Ohlsson C. Both low and high serum IGF-I levels associate with cancer mortality in older men. J Clin Endocrinol Metab 2012; 97:4623-30. [PMID: 23015658 DOI: 10.1210/jc.2012-2329] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although recent population-based studies suggest a U-shaped relationship between serum IGF-I concentration and all-cause mortality, the distribution of death causes underlying this association remains unclear. We hypothesized that high IGF-I levels associate with increased cancer mortality, whereas low IGF-I levels associate with increased cardiovascular disease (CVD) mortality. METHODS Serum IGF-I levels were measured in 2901 elderly men (mean age 75.4, range 69-81 yr) included in the prospective population-based Osteoporotic Fractures in Men Study (Sweden) study. Mortality data were obtained from central registers with no loss of follow-up. The statistical analyses included Cox proportional hazards regressions with or without a spline approach. RESULTS During the follow-up (mean 6.0 yr), 586 of the participants died (cancer deaths, n = 211; CVD deaths, n = 214). As expected, our data revealed a U-shaped association between serum IGF-I levels and all-cause mortality. Low as well as high serum IGF-I (quintile 1 or 5 vs. quintiles 2-4) associated with increased cancer mortality [hazard ratio (HR) = 1.86, 95% confidence interval (CI) = 1.34-2.58; and HR = 1.90, 95% CI = 1.37-2.65, respectively]. Only low serum IGF-I associated with increased CVD mortality (quintile 1 vs. quintiles 2-4, HR = 1.48, 95% CI = 1.08-2.04). These associations remained after adjustment for multiple covariates and exclusion of men who died during the first 2 yr of follow-up. CONCLUSIONS Our findings demonstrate that both low and high serum IGF-I levels are risk markers for increased cancer mortality in older men. Moreover, low IGF-I levels associate with increased CVD mortality.
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Affiliation(s)
- Johan Svensson
- Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden.
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Yeap BB, Araujo AB, Wittert GA. Do low testosterone levels contribute to ill-health during male ageing? Crit Rev Clin Lab Sci 2012; 49:168-82. [PMID: 23094995 DOI: 10.3109/10408363.2012.725461] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Testosterone regulates male sexual development and body composition. In adult men, testosterone levels exhibit a gradual decline with increasing age. Whether it is age per se or health and behaviour related factors that are responsible for this decline, and the implications thereof for subsequent health remain controversial. Observational studies report associations of lower testosterone levels with poorer health outcomes in ageing men, including frailty, reduced sexual activity, insulin resistance and cardiovascular events and mortality. However, outcome data from randomised clinical trials of testosterone are limited, and are lacking for major endpoints such as cardiovascular events. The risks and benefits of testosterone intervention in older men require further clarification. This article will review the role of testosterone in men, discuss epidemiological and interventional data illuminating its potential role to preserve health during male ageing, consider the limitations of the evidence base and implications for clinical practice, and explore future directions for research in this topical area.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.
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Florvaag A, Oberle V, Fritzenwanger M, Kretschmar D, Betge S, Goebel B, Barz D, Ferrari M, Figulla HR, Franz M, Jung C. Testosterone deficiency in male heart failure patients and its effect on endothelial progenitor cells. Aging Male 2012; 15:180-6. [PMID: 22776027 DOI: 10.3109/13685538.2012.702361] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Endothelial progenitor cells (EPCs) are thought to contribute to reendothelialization and neoangiogenesis. Since it is known that EPCs express a testosterone receptor, we wanted to assess the prevalence of testosterone deficiency in patients with CHF and its impact on circulating EPCs. METHODS 137 male patients with chronic heart failure (CHF) were included (age 61 ± 13 years; BMI 29 ± 5 kg/m(2); New York Heart Association classification (NYHA) I: n = 47, NYHA II: n = 51, NYHA III: n = 39). Numbers of different populations of circulating EPCs were quantified using flow cytometry. Levels of free testosterone and EPC-regulating cytokines were determined using ELISA. RESULTS The prevalence of testosterone deficiency in our University CHF clinic was 39%. However, there was no difference between patients with and without testosterone deficiency regarding their levels of EPCs. Testosterone levels were inversely correlated with age (R(2) = -0.32, p = 0.001) and NYHA status (R(2) = 0.28, p = 0.001) and correlated with cardiorespiratory capacity (R(2) = 0.26, p = 0.03). CONCLUSION Testosterone deficiency is frequent in male patients with CHF but does not appear to impact the regenerative EPCs.
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Affiliation(s)
- Anna Florvaag
- First Department of Medicine, Division of Cardiology, Friedrich-Schiller-University, Jena, Germany
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77
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Maggio M, Nicolini F, Cattabiani C, Beghi C, Gherli T, Schwartz RS, Valenti G, Ceda GP. Effects of testosterone supplementation on clinical and rehabilitative outcomes in older men undergoing on-pump CABG. Contemp Clin Trials 2012; 33:730-8. [DOI: 10.1016/j.cct.2012.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 02/27/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
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78
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Abstract
Several large scale studies in recent years have demonstrated increased cardiovascular mortality in men with low testosterone, especially those with existing cardiovascular disease and type 2 diabetes. In some patients the baseline measurement was a single total testosterone level, in others the association was seen only with free or bioavailable testosterone. These differences are most likely related to different characteristics of the cohorts studied in terms of age, obesity and presence of metabolic syndrome. Other smaller studies show consistent benefit from testosterone replacement in terms of reduced insulin resistance, HbA1c, total, LDL-cholesterol, triglycerides and inflammatory markers for CHD. There is clear evidence for a reduction in visceral and lean fat mass, improvement in sexual function, mood and symptom scores. Whilst most of these benefits are modest, the combined effect on these surrogate markers for cardiovascular risk is considerable and the improvement in well-being is likely to be welcomed by patients. There is early evidence from non-randomised studies that physiological testosterone replacement is extremely safe and may reduce cardiovascular mortality. The fact that few patients in potentially risk groups are being screened and treated is probably because of the wide range of specialities involved and the reluctance of one discipline to embrace and manage testosterone deficiency.
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Affiliation(s)
- G Hackett
- Consultant Urologist, Heartlands Hospital, Birmingham, UK.
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79
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de Gonzalo-Calvo D, Fernández-García B, de Luxán-Delgado B, Rodríguez-González S, García-Macia M, Suárez FM, Solano JJ, Rodríguez-Colunga MJ, Coto-Montes A. Long-term training induces a healthy inflammatory and endocrine emergent biomarker profile in elderly men. AGE (DORDRECHT, NETHERLANDS) 2012; 34:761-771. [PMID: 21643762 PMCID: PMC3337937 DOI: 10.1007/s11357-011-9266-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 05/05/2011] [Indexed: 05/30/2023]
Abstract
The objective of the present study was to investigate the changes in a large panel of emergent geriatric biomarkers in long-term trained elderly men to analyze the effects of long-term exercise on an aged population. We collected blood samples from two groups of male volunteers older than 65 years who maintain a measure of functional independence: one group of sedentary subjects without a history of regular physical activity and the other of subjects who have sustained training, starting during adulthood (mean training time = 49 ± 8 years). We studied morbidity, polypharmacy, cellular and serological inflammatory parameters, and endocrine mediators. After adjusting for confounding factors, we observed reduced medication intake per subject and lower number of diseases per subject with statistical differences nearly significant in the long-term exercise group. We showed that long-term training was associated with lower levels of white blood cell counts, neutrophil counts, interleukin-6, interleukin-10, interleukin-1 receptor antagonist, and soluble TNF receptor-I. Furthermore, we noted an increase in the concentrations of insulin-like growth factor-1 and dehydroepiandrosterone in the long-term training group. We concluded that long-term exercise training from adulthood to old age is clearly associated with a healthy profile of emergent geriatric biomarkers. Long-term training could improve the inflammatory-endocrine imbalance associated with disease, frailty, functional decline, and mortality in elderly men. Our results point to the benefits of prolonged exercise from adulthood to old age.
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Affiliation(s)
- David de Gonzalo-Calvo
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
| | - Benjamín Fernández-García
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
| | - Beatriz de Luxán-Delgado
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
| | - Susana Rodríguez-González
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
| | - Marina García-Macia
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
| | | | | | - María Josefa Rodríguez-Colunga
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
| | - Ana Coto-Montes
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
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80
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Higashi Y, Sukhanov S, Anwar A, Shai SY, Delafontaine P. Aging, atherosclerosis, and IGF-1. J Gerontol A Biol Sci Med Sci 2012; 67:626-39. [PMID: 22491965 PMCID: PMC3348497 DOI: 10.1093/gerona/gls102] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/01/2012] [Indexed: 12/18/2022] Open
Abstract
Insulin-like growth factor 1 (IGF-1) is an endocrine and autocrine/paracrine growth factor that circulates at high levels in the plasma and is expressed in most cell types. IGF-1 has major effects on development, cell growth and differentiation, and tissue repair. Recent evidence indicates that IGF-1 reduces atherosclerosis burden and improves features of atherosclerotic plaque stability in animal models. Potential mechanisms for this atheroprotective effect include IGF-1-induced reduction in oxidative stress, cell apoptosis, proinflammatory signaling, and endothelial dysfunction. Aging is associated with increased vascular oxidative stress and vascular disease, suggesting that IGF-1 may exert salutary effects on vascular aging processes. In this review, we will provide a comprehensive update on IGF-1's ability to modulate vascular oxidative stress and to limit atherogenesis and the vascular complications of aging.
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Affiliation(s)
- Yusuke Higashi
- Tulane University Heart & Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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81
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Forti P, Maltoni B, Olivelli V, Pirazzoli GL, Ravaglia G, Zoli M. Serum dehydroepiandrosterone sulfate and adverse health outcomes in older men and women. Rejuvenation Res 2012; 15:349-58. [PMID: 22524205 DOI: 10.1089/rej.2011.1248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low serum dehydroepiandrosterone sulfate (DHEAS) is common in older persons with poor health. The geriatric syndrome of physical frailty is associated with a higher risk of developing fatal and nonfatal health outcomes. However, the association of DHEAS with frailty is uncertain. This study investigated the association of serum DHEAS with frailty and its related adverse outcomes in 416 men and 504 women aged ≥65 years from an Italian prospective population-based cohort study. At baseline, frailty status was defined according to the physical phenotype, and serum DHEAS was measured in a fasting venous blood sample. After 4 years, subjects were reassessed for incident frailty and occurrence of nonfatal frailty-related outcomes (hospital admission, nursing home placement, disability, falls, and fractures). All-cause mortality after 8 years was also recorded. Incident frailty was inversely associated with baseline log-transformed DHEAS in men (odds ratio [OR]=0.35, 95% confidence interval [CI] 0.14-0.88, p=0.026) but not in women. Independent of baseline frailty status, women in the lowest DHEAS quartile compared to the upper three quartiles had a higher risk of hospital admission (OR=0.44, 95% CI 0.21-0.91, p=0.027) and nursing home placement (OR=0.27, 95% CI 0.08-0.95, p=0.041). Baseline log-transformed serum DHEAS was also inversely associated with mortality risk, but limited to women with concurrent frailty (hazard ratio [HR]=0.27, 95% CI 0.11-0.68, p=0.005) or preexisting major diseases (HR=0.57, 95% CI 0.33-0.98, p=0.041). These findings suggest that DHEAS is associated with incident frailty in older men and with fatal and nonfatal frailty-related adverse outcomes in older women.
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Affiliation(s)
- Paola Forti
- Department of Internal Medicine, Aging, and Nephrology, University of Bologna, Bologna, Italy.
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82
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Abstract
Despite regional variations in the prevalence of coronary artery disease (CAD), men are consistently more at risk of developing and dying from CAD than women, and the gender-specific effects of sex hormones are implicated in this inequality. This 'Perspectives' article reviews the current evidence regarding the cardiovascular effects of testosterone in men including an examination of the age-related decline in testosterone, the relationship between testosterone levels and coronary disease, coronary risk factors and mortality. We also review the vaso-active effects of testosterone, and discuss how these have been used in men with heart failure and angina. We discuss the 'cause' versus 'effect' controversy, regarding low testosterone levels in men with coronary heart disease, as well as concerns over the use of testosterone replacement therapy in middle aged and elderly men. The article concludes with a discussion regarding the future direction for work in this interesting area, including the relative merits of screening for, and treating hypogonadism with testosterone replacement therapy in men with heart disease.
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83
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Horstman AM, Dillon EL, Urban RJ, Sheffield-Moore M. The role of androgens and estrogens on healthy aging and longevity. J Gerontol A Biol Sci Med Sci 2012; 67:1140-52. [PMID: 22451474 DOI: 10.1093/gerona/gls068] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aging is associated with a loss of sex hormone in both men (andropause) and women (menopause). In men, reductions in testosterone can trigger declines in muscle mass, bone mass, and in physical function. In women, the impact of the loss of sex hormones, such as estradiol, on bone is well elucidated, but evidence is limited on whether the loss of estradiol negatively affects muscle mass and physical function. However, deficiencies in multiple anabolic hormones have been shown to predict health status and longevity in older persons. Thus, consideration should be given as to whether targeted hormone replacement therapies may prove effective at treating clinical conditions, such as age-related sarcopenia, cancer cachexia, and/or acute or chronic illnesses. If initiated carefully in the appropriate clinical population, hormone replacement therapies in men and women may prevent and reverse muscle and bone loss and functional declines and perhaps promote healthy aging and longevity.
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Affiliation(s)
- Astrid M Horstman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1060, USA.
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84
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Surampudi PN, Wang C, Swerdloff R. Hypogonadism in the aging male diagnosis, potential benefits, and risks of testosterone replacement therapy. Int J Endocrinol 2012; 2012:625434. [PMID: 22505891 PMCID: PMC3312212 DOI: 10.1155/2012/625434] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/04/2011] [Accepted: 12/07/2011] [Indexed: 01/26/2023] Open
Abstract
Hypogonadism in older men is a syndrome characterized by low serum testosterone levels and clinical symptoms often seen in hypogonadal men of younger age. These symptoms include decreased libido, erectile dysfunction, decreased vitality, decreased muscle mass, increased adiposity, depressed mood, osteopenia, and osteoporosis. Hypogonadism is a common disorder in aging men with a significant percentage of men over 60 years of age having serum testosterone levels below the lower limits of young male adults. There are a variety of testosterone formulations available for treatment of hypogonadism. Data from many small studies indicate that testosterone therapy offers several potential benefits to older hypogonadal men. A large multicenter NIH supported double blind, placebo controlled study is ongoing, and this study should greatly enhance the information available on efficacy and side effects of treatment. While safety data is available across many age groups, there are still unresolved concerns associated with testosterone therapy. We have reviewed the diagnostic methods as well as benefits and risks of testosterone replacement therapy for hypogonadism in aging men.
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Affiliation(s)
- Prasanth N. Surampudi
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA 90509, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA 90509, USA
| | - Ronald Swerdloff
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA 90509, USA
- *Ronald Swerdloff:
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85
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Maggio M, Dall'Aglio E, Lauretani F, Cattabiani C, Ceresini G, Caffarra P, Valenti G, Volpi R, Vignali A, Schiavi G, Ceda GP. The hormonal pathway to cognitive impairment in older men. J Nutr Health Aging 2012; 16:40-54. [PMID: 22238001 DOI: 10.1007/s12603-012-0002-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In older men there is a multiple hormonal dysregulation with a relative prevalence of catabolic hormones such as thyroid hormones and cortisol and a decline in anabolic hormones such as dehydroepiandrosterone sulphate, testosterone and insulin like growth factor 1 levels. Many studies suggest that this catabolic milieu is an important predictor of frailty and mortality in older persons. There is a close relationship between frailty and cognitive impairment with studies suggesting that development of frailty is consequence of cognitive impairment and others pointing out that physical frailty is a determinant of cognitive decline. Decline in cognitive function, typically memory, is a major symptom of dementia. The "preclinical phase" of cognitive impairment occurs many years before the onset of dementia. The identification of relevant modifiable factors, including the hormonal dysregulation, may lead to therapeutic strategies for preventing the cognitive dysfunction. There are several mechanisms by which anabolic hormones play a role in neuroprotection and neuromodulation. These hormones facilitate recovery after brain injury and attenuate the neuronal loss. In contrast, elevated thyroid hormones may increase oxidative stress and apoptosis, leading to neuronal damage or death. In this mini review we will address the relationship between low levels of anabolic hormones, changes in thyroid hormones and cognitive function in older men. Then, giving the contradictory data of the literature and the multi-factorial origin of dementia, we will introduce the hypothesis of multiple hormonal derangement as a better determinant of cognitive decline in older men.
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Affiliation(s)
- M Maggio
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy.
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86
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Stanton A. Hormone Replacement in Men. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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87
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Cattabiani C, Basaria S, Ceda GP, Luci M, Vignali A, Lauretani F, Valenti G, Volpi R, Maggio M. Relationship between testosterone deficiency and cardiovascular risk and mortality in adult men. J Endocrinol Invest 2012; 35:104-20. [PMID: 22082684 DOI: 10.3275/8061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Classic male hypogonadism is associated with known adverse effects including decreased libido, erectile dysfunction, osteoporosis, and changes in body composition. Recently, we have come to appreciate that reduction in serum testosterone (T) levels resulting from aging or chronic disease or androgen deprivation therapy (ADT) have consequences similar to those seen in classic male hypogonadism which include increased fat mass, decreased lean body mass, decreased muscle strength, and sexual dysfunction. These data suggest that low T levels may represent a newly recognized cardiometabolic risk factor. Therefore, we carried out a careful review of the literature, focusing on major turning points of research and studies which gave more important and controversial contribution to the cardiovascular role of T. Observational studies and clinical trials investigating the relationship between T levels and cardiovascular disease and mortality were identified byMedline search. The results were synthesized, tabulated, and interpreted. The aim of this review is to discuss the association between low T levels and adverse metabolic profile such as insulin resistance, metabolic syndrome, and diabetes. We will also investigate the potential mechanisms by which male hypogonadism, especially age related or induced by ADT, may increase cardio-metabolic risk. Finally we will detail the emerging relationship between low T and mortality in men addressing also the reverse hypothesis that low T has a protective role by turning off T-dependent functions.
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Affiliation(s)
- C Cattabiani
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy
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88
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Friedrich N, Schneider HJ, Haring R, Nauck M, Völzke H, Kroemer HK, Dörr M, Klotsche J, Jung-Sievers C, Pittrow D, Lehnert H, März W, Pieper L, Wittchen HU, Wallaschofski H, Stalla GK. Improved prediction of all-cause mortality by a combination of serum total testosterone and insulin-like growth factor I in adult men. Steroids 2012; 77:52-8. [PMID: 22037276 DOI: 10.1016/j.steroids.2011.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lower levels of anabolic hormones in older age are well documented. Several studies suggested that low insulin-like growth factor I (IGF-I) or testosterone levels were related to increased mortality. The aim of the present study was to investigate the combined influence of low IGF-I and low testosterone on all-cause mortality in men. METHODS AND RESULTS From two German prospective cohort studies, the DETECT study and SHIP, 3942 men were available for analyses. During 21,838 person-years of follow-up, 8.4% (n=330) of men died. Cox model analyses with age as timescale and adjusted for potential confounders revealed that men with levels below the 10th percentile of at least one hormone [hazard ratio (HR) 1.38 (95% confidence-interval (CI) 1.06-1.78), p=0.02] and two hormones [HR 2.88 (95% CI 1.32-6.29), p<0.01] showed a higher risk of all-cause mortality compared to men with non-low hormones. The associations became non-significant by using the 20th percentile as cut-off showing that the specificity increased with lower cut-offs for decreased hormone levels. The inclusion of both IGF-I and total testosterone in a mortality prediction model with common risk factors resulted in a significant integrated discrimination improvement of 0.5% (95% CI 0.3-0.7%, p=0.03). CONCLUSIONS Our results prove that multiple anabolic deficiencies have a higher impact on mortality than a single anabolic deficiency and suggest that assessment of more than one anabolic hormone as a biomarker improve the prediction of all-cause mortality.
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Affiliation(s)
- Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
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89
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Albani D, Mazzuco S, Polito L, Batelli S, Biella G, Ongaro F, Gustafson DR, Antuono P, Gajo G, Durante E, Caberlotto L, Zanardo A, Siculi M, Gallucci M, Forloni G. Insulin-like growth factor 1 receptor polymorphism rs2229765 and circulating interleukin-6 level affect male longevity in a population-based prospective study (Treviso Longeva--TRELONG). Aging Male 2011; 14:257-64. [PMID: 22115178 DOI: 10.3109/13685538.2011.607521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Insulin-like growth factor 1 (IGF-1) signaling modulation has been associated with increased lifespan in model organisms, while high levels of circulating interleukin-6 (IL-6) are a marker of disability and mortality. In the prospective, population-based "Treviso Longeva"--TRELONG Study from Italy (n = 668, age range 70-105.5 years at baseline, followed for seven years) we investigated the effects of survival on the IGF-1 receptor (IGF-1R) gene polymorphism rs2229765, the IL-6 gene promoter polymorphism rs1800795, and plasma concentrations of IGF-1 and IL-6, alone or in combination. We found a sex-dependent effect for the IGF-1R rs2229765 polymorphism, as male carriers of the homozygous A/A genotype survived longer, while the IL-6 rs1800795 genotype did not influence overall or sex-specific longevity. Higher IL-6 levels were more detrimental for survival among males than females, while IGF-1 had no dose-response effect. These findings sustain the hypothesis that sex-specific longevity relies on detectable differences in genetic and biochemical parameters between males and females.
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Affiliation(s)
- Diego Albani
- Department of Neuroscience, "Mario Negri" Institute for Pharmacological Research, via La Masa, Milan, Italy.
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90
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O'Connell MDL, Ravindrarajah R, Tajar A, Wu FCW. Low testosterone in ageing men: a modifiable risk factor for frailty? Trends Endocrinol Metab 2011; 22:491-8. [PMID: 21978496 DOI: 10.1016/j.tem.2011.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/20/2011] [Accepted: 08/24/2011] [Indexed: 12/22/2022]
Abstract
There is substantial interest in the role of testosterone (T) in male ageing. Studies suggest that low T may be a risk factor for frailty, the vulnerable health status that occurs at advanced ages. However, T deficiency is relatively rare in ageing men and, importantly, is linked to modifiable risk factors including body weight and concurrent illnesses. These observations shift the focus away from hormone replacement and towards potential preventative strategies to help maintain T levels in ageing men. Furthermore, the effects of T on physical function remain inconsistent, and studies examining the safety of T treatment in ageing males raise concerns. Further research may usefully focus on novel pro-anabolic pharmaceutical agents, which together with other interventions will allow for optimal management of frailty.
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Affiliation(s)
- Matthew D L O'Connell
- Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester Royal Infirmary, Manchester M13 9WL, UK
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91
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Deenadayalu V, Puttabyatappa Y, Liu AT, Stallone JN, White RE. Testosterone-induced relaxation of coronary arteries: activation of BKCa channels via the cGMP-dependent protein kinase. Am J Physiol Heart Circ Physiol 2011; 302:H115-23. [PMID: 22081702 DOI: 10.1152/ajpheart.00046.2011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Androgens are reported to have both beneficial and detrimental effects on human cardiovascular health. The aim of this study was to characterize nongenomic signaling mechanisms in coronary artery smooth muscle (CASM) and define the ionic basis of testosterone (TES) action. TES-induced relaxation of endothelium-denuded porcine coronary arteries was nearly abolished by 20 nM iberiotoxin, a highly specific inhibitor of large-conductance, calcium-activated potassium (BK(Ca)) channels. Molecular patch-clamp studies confirmed that nanomolar concentrations of TES stimulated BK(Ca) channel activity by ∼100-fold and that inhibition of nitric oxide synthase (NOS) activity by N(G)-monomethyl-L-arginine nearly abolished this effect. Inhibition of nitric oxide (NO) synthesis or guanylyl cyclase activity also attenuated TES-induced coronary artery relaxation but did not alter relaxation due to 8-bromo-cGMP. Furthermore, we detected TES-stimulated NO production in porcine coronary arteries and in human CASM cells via stimulation of the type 1 neuronal NOS isoform. Inhibition of the cGMP-dependent protein kinase (PKG) attenuated TES-stimulated BK(Ca) channel activity, and direct assay determined that TES increased activity of PKG in a concentration-dependent fashion. Last, the stimulatory effect of TES on BK(Ca) channel activity was mimicked by addition of purified PKG to the cytoplasmic surface of a cell-free membrane patch from CASM myocytes (∼100-fold increase). These findings indicate that TES-induced relaxation of endothelium-denuded coronary arteries is mediated, at least in part, by enhanced NO production, leading to cGMP synthesis and PKG activation, which, in turn, opens BK(Ca) channels. These findings provide a molecular mechanism that could help explain why androgens have been reported to relax coronary arteries and relieve angina pectoris.
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Affiliation(s)
- Viju Deenadayalu
- Department of Physiology & Biophysics, Wright State University School of Medicine, Dayton, Ohio, USA
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92
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Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)—A Precursor Steroid or an Active Hormone in Human Physiology (CME). J Sex Med 2011; 8:2960-82; quiz 2983. [DOI: 10.1111/j.1743-6109.2011.02523.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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93
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Abstract
Androgen deficiency in aging men is common, and the potential sequelae are numerous. In addition to low libido, erectile dysfunction, decreased bone density, depressed mood, and decline in cognition, studies suggest strong correlations between low testosterone, obesity, and the metabolic syndrome. Because causation and its directionality remain uncertain, the functional and cardiovascular risks associated with androgen deficiency have led to intense investigation of testosterone replacement therapy in older men. Although promising, evidence for definitive benefit or detriment is not conclusive, and treatment of late-onset hypogonadism is complicated.
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Affiliation(s)
- Jeremy B Shelton
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA.
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94
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Moulana M, Lima R, Reckelhoff JF. Metabolic syndrome, androgens, and hypertension. Curr Hypertens Rep 2011; 13:158-62. [PMID: 21274756 DOI: 10.1007/s11906-011-0184-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Obesity is one of the constellation of factors that make up the definition of the metabolic syndrome. Metabolic syndrome is also associated with insulin resistance, dyslipidemia, hypertriglyceridemia, and type 2 diabetes mellitus. The presence of obesity and metabolic syndrome in men and women is also associated with increased risk of cardiovascular disease and hypertension. In men, obesity and metabolic syndrome are associated with reductions in testosterone levels. In women, obesity and metabolic syndrome are associated with increases in androgen levels. In men, reductions in androgen levels are associated with inflammation, and androgen supplements reduce inflammation. In women, increases in androgens are associated with increases in inflammatory cytokines, and reducing androgens reduces inflammation. This review discusses the possibility that the effects of androgens on metabolic syndrome and its sequelae may differ between males and females.
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Affiliation(s)
- Mohadetheh Moulana
- Women's Health Research Center, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216-4505, USA
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95
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Maggio M, Ceda GP, Lauretani F, Cattabiani C, Avantaggiato E, Morganti S, Ablondi F, Bandinelli S, Dominguez LJ, Barbagallo M, Paolisso G, Semba RD, Ferrucci L. Magnesium and anabolic hormones in older men. ACTA ACUST UNITED AC 2011; 34:e594-600. [PMID: 21675994 DOI: 10.1111/j.1365-2605.2011.01193.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Optimal nutritional and hormonal statuses are determinants of successful ageing. The age associated decline in anabolic hormones such as testosterone and insulin-like growth factor 1 (IGF-1) is a strong predictor of metabolic syndrome, diabetes and mortality in older men. Studies have shown that magnesium intake affects the secretion of total IGF-1 and increase testosterone bioactivity. This observation suggests that magnesium can be a modulator of the anabolic/catabolic equilibrium disrupted in the elderly people. However, the relationship between magnesium and anabolic hormones in men has not been investigated. We evaluated 399 ≥65-year-old men of CHIANTI in a study population representative of two municipalities of Tuscany (Italy) with complete data on testosterone, total IGF-1, sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS) and serum magnesium levels. Linear regression models were used to test the relationship between magnesium and testosterone and IGF-1. Mean age of the population was 74.18 ± 6.43 (years ± SD, age range 65.2-92.4). After adjusting for age, magnesium was positively associated with total testosterone (β ± SE, 34.9 ± 10.3; p = 0.001) and with total IGF-1 (β ± SE, 15.9 ± 4.8; p = 0.001). After further adjustment for body mass index (BMI), log (IL-6), log (DHEAS), log (SHBG), log (insulin), total IGF-1, grip strength, Parkinson's disease and chronic heart failure, the relationship between magnesium and total testosterone remained strong and highly significant (β ± SE, 48.72 ± 12.61; p = 0.001). In the multivariate analysis adjusted for age, BMI, log (IL-6), liver function, energy intake, log (insulin), log (DHEAS), selenium, magnesium levels were also still significantly associated with IGF-1 (β ± SE, 16.43 ± 4.90; p = 0.001) and remained significant after adjusting for total testosterone (β ± SE, 14.4 ± 4.9; p = 0.01). In a cohort of older men, magnesium levels are strongly and independently associated with the anabolic hormones testosterone and IGF-1.
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Affiliation(s)
- M Maggio
- Section of Geriatrics, Department of Internal Medicine and Biomedical Sciences, University of Parma, Parma, Italy.
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96
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Abstract
Cardiovascular disease remains the leading cause of death in most of the developed world despite advances in both prevention and treatment. At the same time, the incidence rates of cardiovascular disease differ greatly between the genders, with men more likely than women to manifest ischemic heart disease. This observation has prompted new research initiatives to explain the discrepancy in heart disease prevalence and incidence between the sexes. Whether androgens affect cardiovascular disease adversely remains a contentious issue, with some data pointing to a deleterious effect of androgens on lipid profiles, and other studies revealing androgens' possible benefits on cardiovascular function. This review will examine the relationship between the endogenous production of androgen as well as the exogenous replacement of testosterone in men and the possible links to cardiovascular disease. The role of testosterone in male cardiovascular health is not completely understood, and additional studies are needed to explain its effect on atherosclerosis and its complications.
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97
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Cummings-Vaughn LA, Malmstrom TK, Morley JE, Miller DK. Testosterone is not associated with mortality in older African-American males. Aging Male 2011; 14:132-40. [PMID: 20681930 PMCID: PMC4519078 DOI: 10.3109/13685538.2010.502269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION. Although testosterone and its association with disease progression and mortality is a widely studied topic, no studies have evaluated mortality risks related to testosterone levels in an older African-American population. The mechanisms for known racial differences in mortality risk for certain cancers and cardiovascular risk factors are largely unknown. Elucidating a mortality risk associated with testosterone levels may give insight into the elevated risk for certain diseases in African-Americans. METHODS AND RESULTS. Study data were derived from a cohort 622 African-Americans (age 80.05 ± 6.4, range 68-102) from Saint Louis, Missouri that includes 190 males (age 79.38 ± 6.2, range 70-102). The eligible sample for this report includes 56 of the 190 males (age 78.89 ± 6.9, range 70-102) who donated blood at baseline in 1992-1994 and subsequently tested for total testosterone and bioavailable testosterone. Covariates for adjusted analyses were lower body functional limitations, physician visits and comorbidities, also collected at baseline. Males' mean bioavailable testosterone levels (ng/dl) were 33.33 ± 24.4 (n above 70 ng/dl = 5) and mean total testosterone levels (ng/dl) were 246.63 ± 118.7 (n above 300 ng/dl = 20). Vital status was determined through 2002; 41 males (73%) were deceased and 15 were alive. Mortality did not differ among males with testosterone levels <300 versus 300+ (p = 0.42) or with bioavailable testosterone levels <70 versus > 70 (p = 0.34). Total testosterone levels did not predict mortality when adjusted for age (Adjusted Hazard Ratio [AHR] = 0.998; 95% confidence interval [CI] 0.995-1.001; p = 0.28) or adjusted for age and other covariates (AHR = 0.099; 95% CI 0.996, 1.002; p = 0.35). Bioavailable testosterone levels did not predict mortality when adjusted for age (AHR = 0.992; 95% CI .977-1.007; p = 0.30) or when adjusted for age and other covariates (AHR 0.991; 95% CI .976-1.006; p = 0.261). CONCLUSION. In older African-American males, total and bioavailable testosterone levels, with and without adjustment for covariates, are not independently associated with mortality risk.
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98
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Abstract
The endocrinology of the aging male is complex, with multiple hormones along the hypothalamic-pituitary-testicular (HPT) axis interacting with one another in feedback. As men age, there is a small and progressive (not precipitous, as in women) decline in several sex hormones, in particular testosterone and dehydroepiandrosterone, and related increases in luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin. The importance of these changes is wide-ranging because of the ubiquitous role of sex hormones in male physiology. This chapter discusses the endocrinology of the aging male. We provide an overview of the regulation of the HPT axis with an emphasis on the changes that occur with aging and the measurement of gonadal steroids, including hormone pulsatility, within-subject and circadian variations. The difficulties of assessing the symptoms of late-onset hypogonadism are highlighted. There is a comprehensive discussion of the epidemiology of sex hormone changes, including their age associations, prevalence of symptomatic hypogonadism, secular changes, risk factors, and the association of sex hormones with outcomes.
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Affiliation(s)
- Andre B. Araujo
- Director, Epidemiology, New England Research Institutes, Inc., 9 Galen Street, Watertown, MA 02472, Tel: 617.923.7747 x452, Fax: 617.673.9509,
| | - Gary A. Wittert
- Head, Discipline of Medicine, The University of Adelaide, Principal Research Scientist, New England Research Institutes, Inc., Phone: +61 882225502, Fax: +61 882233870,
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99
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Stenholm S, Metter EJ, Roth GS, Ingram DK, Mattison JA, Taub DD, Ferrucci L. Relationship between plasma ghrelin, insulin, leptin, interleukin 6, adiponectin, testosterone and longevity in the Baltimore Longitudinal Study of Aging. Aging Clin Exp Res 2011; 23:153-8. [PMID: 21743292 DOI: 10.1007/bf03351078] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Caloric restriction (CR) is the most robust and reproducible intervention for slowing aging, and maintaining health and vitality in animals. Previous studies found that CR is associated with changes in specific biomarkers in monkeys that were also associated with reduced risk of mortality in healthy men. In this study we examine the association between other potential biomarkers related to CR and extended lifespan in healthy humans. METHODS Based on the Baltimore Longitudinal Study of Aging, "long-lived" participants who survived to at least 90 years of age (n=41, cases) were compared with "short-lived" participants who died between 72-76 years of age (n=31, controls) in the nested case control study. Circulating levels of ghrelin, insulin, leptin, interleukin 6, adiponectin and testosterone were measured from samples collected between the ages 58 to 70 years. Baseline differences between groups were examined with t-test or Wilcoxon test, and mixed effects general linear model was used for a logistic model to differentiate the two groups with multiple measurements on some subjects. RESULTS At the time of biomarkers evaluation (58-70 yrs), none of the single biomarker levels was significantly different between the two groups. However, after combining information from multiple biomarkers by adding the z-transformed values, the global score differentiated the long- and short-lived participants (p=0.05). CONCLUSIONS In their sixties, long-lived and short-lived individuals do not differ in biomarkers that have been associated with CR in animals. However, difference between the groups was only obtained when multiple biomarker dysregulation was considered.
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Affiliation(s)
- Sari Stenholm
- National Institute on Aging, Clinical Research Branch, Longitudinal Studies Section, Baltimore, MD 21225, USA
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100
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Friedrich N, Schneider H, Dörr M, Nauck M, Völzke H, Klotsche J, Sievers C, Pittrow D, Böhler S, Lehnert H, Pieper L, Wittchen HU, Wallaschofski H, Stalla GK. All-cause mortality and serum insulin-like growth factor I in primary care patients. Growth Horm IGF Res 2011; 21:102-106. [PMID: 21435927 DOI: 10.1016/j.ghir.2011.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 12/14/2010] [Accepted: 02/27/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Previous population-based studies provided conflicting results regarding the association of total serum insulin-like growth factor I (IGF-I) and mortality. The aim of the present study was to assess the relation of IGF-I levels with all-cause mortality in a prospective study. DESIGN DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a large, multistage, and nationally representative study of primary care patients in Germany. The study population included 2463 men and 3603 women. Death rates were recorded by the respective primary care physician. Serum total IGF-I levels were determined by chemiluminescence immunoassays and categorized into three groups (low, moderate, and high) according to the sex- and age-specific 10th and 90th percentiles. RESULTS Adjusted analyses revealed that men with low [hazard ratio (HR) 1.70 (95% confidence interval [CI] 1.05-2.73), p=0.03] and high [HR 1.76 (95% CI 1.09-2.85), p=0.02] IGF-I levels had higher risk of all-cause mortality compared to men with moderate IGF-I levels. The specificity of low IGF-I and high IGF-I levels increased with lower and higher cut-offs, respectively. No such association became apparent in women. CONCLUSIONS The present study revealed a U-shaped relation between IGF-I and all-cause mortality in male primary care patients.
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Affiliation(s)
- N Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, Ernst Moritz Arndt University of Greifswald, Germany.
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