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Scacchi M, Danesi L, Cattaneo A, Sciortino G, Radin R, Ambrogio AG, Vitale G, D'Angelo E, Mirra N, Zanaboni L, Arvigo M, Boschetti M, Ferone D, Marzullo P, Baldini M, Cassinerio E, Cappellini MD, Persani L, Cavagnini F. Bone turnover and mineral density in adult thalassemic patients: relationships with growth hormone secretory status and circulating somatomedins. Endocrine 2016; 53:551-7. [PMID: 26825070 DOI: 10.1007/s12020-016-0865-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
Abstract
Previous evidence supports a role for growth hormone (GH)-insulin-like growth factor (IGF)-I deficiency in the pathophysiology of osteopenia/osteoporosis in adult thalassemia. Moreover, serum IGF-II has never been studied in this clinical condition. Thus, we elected to study the GH secretory status and the levels of circulating somatomedins, correlating these parameters with bone mineral density (BMD) and biochemical markers of bone turnover. A hundred and thirty-nine normal weight adult thalassemic patients (72 men and 67 women) were studied. Lumbar and femoral neck BMD were measured in 106/139 patients. Sixty-eight patients underwent growth hormone releasing hormone plus arginine testing. Measurement of baseline IGF-I and IGF-II was performed in all patients, while osteocalcin, C-terminal telopeptide of type I collagen (CTx), and urinary cross-linked N-telopeptides of type I collagen (NTx) were assayed in 95 of them. Femoral and lumbar osteoporosis/Z score below the expected range for age were documented in 61.3 and in 56.6 % of patients, respectively. Severe GH deficiency (GHD) was demonstrated in 27.9 % of cases, whereas IGF-I SDS was low in 86.3 %. No thalassemic patients displayed circulating levels of IGF-II below the reference range. GH peaks were positively correlated with femoral, but not lumbar, Z score. No correlations were found between GH peaks and osteocalcin, CTx and NTx. GH peaks were positively correlated with IGF-I values, which in their turn displayed a positive correlation with osteocalcin, CTx, and NTx. No correlations emerged between IGF-I values and either femoral or lumbar Z scores. No correlations were found between IGF-II and any of the following parameters: GH peaks, osteocalcin, CTx, NTx, femoral Z score, and lumbar Z score. Our study, besides providing for the first time evidence of a normal IGF-II production in thalassemia, contributes to a better understanding of the involvement of the somatotropin-somatomedin axis in the pathophysiology of bone demineralization in this disease. In particular, the contribution of GHD to femoral osteoporosis appears to be likely mediated by locally produced rather than circulating IGF-I.
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Affiliation(s)
- Massimo Scacchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Ospedale San Giuseppe IRCCS, Division of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano, Oggebbio-Piancavallo, Verbania, Italy.
| | - Leila Danesi
- Ospedale San Luca IRCCS, Division of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
| | - Agnese Cattaneo
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Sciortino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Raffaella Radin
- Ospedale San Luca IRCCS, Division of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
| | - Alberto Giacinto Ambrogio
- Ospedale San Luca IRCCS, Division of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Vitale
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ospedale San Luca IRCCS, Division of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
| | - Emanuela D'Angelo
- Second Pediatric Clinic, University of Milan, Fondazione Policlinico Mangiagalli Regina Elena, Milan, Italy
| | - Nadia Mirra
- Second Pediatric Clinic, University of Milan, Fondazione Policlinico Mangiagalli Regina Elena, Milan, Italy
| | - Laura Zanaboni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marica Arvigo
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Mara Boschetti
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Diego Ferone
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Paolo Marzullo
- Ospedale San Giuseppe IRCCS, Division of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano, Oggebbio-Piancavallo, Verbania, Italy
- Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Marina Baldini
- Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Cassinerio
- Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ospedale San Luca IRCCS, Division of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
| | - Francesco Cavagnini
- Laboratory of Neuroendocrine Research, Istituto Auxologico Italiano, Milan, Italy
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Best LG, García-Esquinas E, Yeh JL, Yeh F, Zhang Y, Lee ET, Howard BV, Farley JH, Welty TK, Rhoades DA, Rhoades ER, Umans JG, Navas-Acien A. Association of diabetes and cancer mortality in American Indians: the Strong Heart Study. Cancer Causes Control 2015; 26:1551-60. [PMID: 26250516 PMCID: PMC4596901 DOI: 10.1007/s10552-015-0648-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 07/29/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE The metabolic abnormalities that accompany diabetes mellitus are associated with an increased risk of many cancers. These associations, however, have not been well studied in American Indian populations, which experience a high prevalence of diabetes. The Strong Heart Study is a population-based, prospective cohort study with extensive characterization of diabetes status. METHODS Among a total cohort of 4,419 participants who were followed for up to 20 years, 430 cancer deaths were identified. RESULTS After adjusting for sex, age, education, smoking status, drinking status, and body mass index, participants with diabetes at baseline showed an increased risk of gastric (HR 4.09; 95% CI 1.42-11.79), hepatocellular (HR 2.94; 95% CI 1.17-7.40), and prostate cancer mortality (HR 3.10; 95% CI 1.22-7.94). Further adjustment for arsenic exposure showed a significantly increased risk of all-cause cancer mortality with diabetes (HR 1.27; 95% CI 1.03-1.58). Insulin resistance among participants without diabetes at baseline was associated with hepatocellular cancer mortality (HR 4.70; 95% CI 1.55-14.26). CONCLUSIONS Diabetes mellitus, and/or insulin resistance among those without diabetes, is a risk factor for gastric, hepatocellular, and prostate cancer in these American Indian communities, although relatively small sample size suggests cautious interpretation. Additional research is needed to evaluate the role of diabetes and obesity on cancer incidence in American Indian communities as well as the importance of diabetes prevention and control in reducing the burden of cancer incidence and mortality in the study population.
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Affiliation(s)
- Lyle G Best
- Epidemiology Department, Missouri Breaks Industries Research Inc., 118 S. Willow Str, Timber Lake, 57625, SD, USA.
- , 1935 118th Ave NW, Watford City, ND, 58854, USA.
| | - Esther García-Esquinas
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP, Madrid, Spain
| | - Jeun-Liang Yeh
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Fawn Yeh
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ying Zhang
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisa T Lee
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD, USA
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - John H Farley
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Thomas K Welty
- Epidemiology Department, Missouri Breaks Industries Research Inc., 118 S. Willow Str, Timber Lake, 57625, SD, USA
| | - Dorothy A Rhoades
- Stephenson Cancer Center and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Everett R Rhoades
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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