1
|
Liu F, Wu Y, Chen J, Zou T, Qin Y, Teng Z, Su Y, Wu R, Huang J. Risk factors for osteoporosis in chronic schizophrenia on long-term treatment with antipsychotics: a cross-sectional study. BMC Psychiatry 2023; 23:454. [PMID: 37344770 DOI: 10.1186/s12888-023-04951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Little is known about the laboratory variable risks with bone mineral density (BMD) in patients with schizophrenia. This study was designed to fully investigate the related risk factors for decreased BMD in schizophrenia, as well as evaluate the gender difference of BMD. METHOD The BMD of the forearm of 211 patients (males/females = 140/71) who met the diagnostic criteria for DSM-5 schizophrenia was measured by dual-energy X-ray absorptiometry. Basic demographic information, clinical assessments, and laboratory variables (regarding nutrition, hormones, metabolism, and inflammatory markers) were comprehensively collected. RESULTS Among 211 subjects, seventy-four (35%) patients had low BMD. Males had a significantly lower BMD T-score than females (P = 0.002). Multiple regression analyses showed that the independent risks with low BMD were lower folate, glycosylated hemoglobin levels, higher age, serum ferritin, and follicle-stimulating hormone (FSH) levels. In female patients, the BMD was mainly associated with age and serum hormones (FSH and testosterone), while the BMD of male patients was primarily related to age, microelements (serum ferritin and 25-OH-VD), and parathyroid hormone. CONCLUSION Our study found several meaningful correlations between osteoporosis and schizophrenia, especially regarding laboratory measures, which may provide new clues to identifying or preventing osteoporosis in clinical patients.
Collapse
Affiliation(s)
- Furu Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China
| | - Ying Wu
- Department of Intensive Care Unit, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China
| | - Tianxiang Zou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China
| | - Yue Qin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China
| | - Ziwei Teng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China
| | - Yuhan Su
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central, South University, 410011, Changsha, Hunan, China.
| |
Collapse
|
2
|
Elhadd T, Majzoub A, Wilson C, McCreight L, Mohamed MS, Green FC, Collier AJ. Hypergonadotropic hypogonadism and chromosomal aberrations: clinical heterogeneity and implications on the health of elderly men, case series. BMC Endocr Disord 2023; 23:110. [PMID: 37198592 DOI: 10.1186/s12902-023-01359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Hypogonadism in older men is often considered as late onset hypogonadism. However, this clinical condition results from primary testicular failure which could be of genetic origin with Klinefelter syndrome being the most common chromosomal abnormality associated with it. CASE PRESENTATION We report a heterogeneous group of cases who were diagnosed with hypergonadotropic hypogonadism in their adulthood and were found to have rare chromosomal aberrations. All were elderly men (in their 70 s and 80 s) for whom the diagnosis was made during the evaluation of incidental symptoms suggestive of endocrinopathy. The first had hyponatremia; the other two had gynaecomastia and features of hypogonadism noted during admission for various acute medical problems. With respect to their genetic results; the first had a male karyotype with balanced reciprocal translocation between the long arm of chromosome 4 and the short arm of chromosome 7. The second case had a male karotype with one normal X chromosome and an isochrome for the short arm of the Y chromosome. The third case was an XX male with unbalanced translocation between the X & Y chromosomes with retention of the SRY locus. CONCLUSION Hypergonadotrophic hypogonadism in the elderly, may be due to chromosomal aberrations, resulting in heterogeneous and diverse clinical phenotypes. Vigilance must be exercised when seeing cases with subtle clinical findings. This report suggests that in selected cases of adult hypergonadotropic hypogonadism, chromosomal analysis may be indicated.
Collapse
Affiliation(s)
- Tarik Elhadd
- Department of Medicine, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.
- Department of Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.
| | | | - Laura McCreight
- Department of Medicine, Ninewells Hospital & Medical School, Dundee, Scotland
| | - Muna S Mohamed
- Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland
| | - Fiona C Green
- Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland
| | | |
Collapse
|
3
|
García-Arnés JA, García-Casares N. Doping and sports endocrinology: growth hormone, IGF-1, insulin, and erythropoietin. Rev Clin Esp 2023; 223:181-187. [PMID: 36736729 DOI: 10.1016/j.rceng.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Among the substances prohibited by the World Anti-Doping Agency, "peptide hormones, growth factors, related substances, and mimetics" are classified as prohibited both in- and out-of-competition in section S2. This work reviews growth hormone and its releasing peptides, insulin-like growth factor 1 as the main growth factor, insulin, and erythropoietin and other agents that affect erythropoiesis. This review analyzes the prevalence of use among professional athletes and gym clients, the forms of use, dosing, ergogenic effects and effects on physical performance, as well as side effects and anti-doping detection methods.
Collapse
Affiliation(s)
- J A García-Arnés
- Departamento de Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain.
| | - N García-Casares
- Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
4
|
Fujimoto T, Manabe T, Yukimoto K, Tsuru Y, Kitagawa H, Okuyama K, Takesue S, Kai K, Noshiro H. Risk Factors for Postoperative Paralytic Ileus in Advanced-age Patients after Laparoscopic Colorectal Surgery: A Retrospective Study of 124 Consecutive Patients. J Anus Rectum Colon 2023; 7:30-37. [PMID: 36743464 PMCID: PMC9876602 DOI: 10.23922/jarc.2022-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/09/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives Postoperative paralytic ileus (POI) is one of the most common and troublesome complications following colorectal surgery. However, to date, the risk factors for POI remain unclear. This study aimed to identify the risk factors for POI following laparoscopic colorectal surgery in advanced-age patients. Methods The clinical data of 124 patients aged ≥75 years who underwent curative colorectal surgery from January 2018 to December 2020 were retrospectively reviewed. The relationship between POI and clinicopathological data including sarcopenia and visceral fat obesity was then assessed. Sarcopenia was defined as a low skeletal muscle mass index; visceral obesity, visceral fat with an area ≥100 cm2 on computed tomography at the level of the third lumbar vertebra; and sarcobesity, sarcopenia with visceral obesity. Results The rate of POI was 9% (12/124 patients), and all the affected patients improved with conservative treatment. In the univariate and multivariate analyses, sarcopenia and sarcobesity were significant predictive factors for POI. Conclusions Sarcopenia and sarcobesity may be risk factors for POI in patients aged ≥75 years after laparoscopic colorectal surgery.
Collapse
Affiliation(s)
- Takaaki Fujimoto
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Tatsuya Manabe
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Kumpei Yukimoto
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Yasuhiro Tsuru
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Hiroshi Kitagawa
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Keiichiro Okuyama
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Shin Takesue
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Keita Kai
- Department of Pathology, Saga University Hospital, Nabeshima, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| |
Collapse
|
5
|
García-Arnés J, García-Casares N. Endocrinología del dopaje y los deportes: hormona de crecimiento, IGF-1, insulina y eritropoyetina. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
6
|
Pataky MW, Young WF, Nair KS. Hormonal and Metabolic Changes of Aging and the Influence of Lifestyle Modifications. Mayo Clin Proc 2021; 96:788-814. [PMID: 33673927 PMCID: PMC8020896 DOI: 10.1016/j.mayocp.2020.07.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/01/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
Increased life expectancy combined with the aging baby boomer generation has resulted in an unprecedented global expansion of the elderly population. The growing population of older adults and increased rate of age-related chronic illness has caused a substantial socioeconomic burden. The gradual and progressive age-related decline in hormone production and action has a detrimental impact on human health by increasing risk for chronic disease and reducing life span. This article reviews the age-related decline in hormone production, as well as age-related biochemical and body composition changes that reduce the bioavailability and actions of some hormones. The impact of hormonal changes on various chronic conditions including frailty, diabetes, cardiovascular disease, and dementia are also discussed. Hormone replacement therapy has been attempted in many clinical trials to reverse and/or prevent the hormonal decline in aging to combat the progression of age-related diseases. Unfortunately, hormone replacement therapy is not a panacea, as it often results in various adverse events that outweigh its potential health benefits. Therefore, except in some specific individual cases, hormone replacement is not recommended. Rather, positive lifestyle modifications such as regular aerobic and resistance exercise programs and/or healthy calorically restricted diet can favorably affect endocrine and metabolic functions and act as countermeasures to various age-related diseases. We provide a critical review of the available data and offer recommendations that hopefully will form the groundwork for physicians/scientists to develop and optimize new endocrine-targeted therapies and lifestyle modifications that can better address age-related decline in heath.
Collapse
Affiliation(s)
- Mark W Pataky
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - K Sreekumaran Nair
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
| |
Collapse
|
7
|
Suter D, Sousa CV, Hill L, Scheer V, Nikolaidis PT, Knechtle B. Even Pacing Is Associated with Faster Finishing Times in Ultramarathon Distance Trail Running-The "Ultra-Trail du Mont Blanc" 2008-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197074. [PMID: 32992625 PMCID: PMC7578994 DOI: 10.3390/ijerph17197074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/08/2020] [Accepted: 09/24/2020] [Indexed: 12/28/2022]
Abstract
In recent years, there has been an increasing number of investigations analyzing the effects of sex, performance level, and age on pacing in various running disciplines. However, little is known about the impact of those factors on pacing strategies in ultramarathon trail running. This study investigated the effects of age, sex, and performance level on pacing in the UTMB® (Ultra-trail du Mont Blanc) and aimed to verify previous findings obtained in the research on other running disciplines and other ultramarathon races. Data from the UTMB® from 2008 to 2019 for 13,829 race results (12,681 men and 1148 women) were analyzed. A general linear model (two-way analysis of variance (ANOVA)) was applied to identify a sex, age group, and interaction effect in pace average and pace variation. A univariate model (one-way ANOVA) was used to identify a sex effect for age, pace average, and pace variation for the fastest men and women. In our study, pace average and a steadier pace were positively correlated. Even pacing throughout the UTMB® correlated with faster finishing times. The average pace depended significantly on sex and age group. When considering the top five athletes in each age group, sex and age group also had significant effects on pace variation. The fastest women were older than the fastest men, and the fastest men were faster than the fastest women. Women had a higher pace variation than men. In male competitors, younger age may be advantageous for a successful finish of the UTMB®. Faster male runners seemed to be younger in ultramarathon trail running with large changes in altitude when compared to other distances and terrains.
Collapse
Affiliation(s)
- Daniel Suter
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
| | - Caio Victor Sousa
- Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA;
| | - Lee Hill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Volker Scheer
- Ultra Sports Science Foundation, 109 Boulevard de l’Europe, 69310 Pierre-Bénite, France;
| | - Pantelis Theo Nikolaidis
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece;
- Exercise Physiology Laboratory, 18450 Nikaia, Greece
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
- Medbase St. Gallen, Am Vadianplatz, 9001 St. Gallen, Switzerland
- Correspondence: ; Tel.: +41-71-226-93-00
| |
Collapse
|
8
|
Age-related decrease in performance of male masters athletes in sprint, sprint–endurance, and endurance events. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00613-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Abstract
There is significant animal model data demonstrating a benefit of testosterone on both inflammatory and neuroprotective mechanisms relevant to multiple sclerosis (MS). Several studies have demonstrated lowered testosterone levels in up to 40% of men with MS. Lower testosterone levels were correlated with worsened scores of physical and cognitive disability. There is increasing data suggesting a role of testosterone in MS risk. A pilot study has demonstrated significant benefits of testosterone replacement therapy on cognitive, radiological, and immunological outcome measures in men with MS. Larger studies in other conditions have demonstrated concerns in terms of cardiovascular risk, which indicate the need for careful monitoring upon administration to MS patients. Further studies are needed to develop safer testosterone preparations, which preserve its multiple beneficial effects, as well as multicenter clinical trials to evaluate safety, dosing, and efficacy in larger populations of men with MS. Additionally, studies are needed to further explore the role of androgens as a risk factor for MS, particularly at key life transitions.
Collapse
Affiliation(s)
- Tanuja Chitnis
- Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
10
|
Sousa CV, da Silva Aguiar S, Rosemann T, Nikolaidis PT, Knechtle B. American Masters Road Running Records-The Performance Gap Between Female and Male Age Group Runners from 5 Km to 6 Days Running. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132310. [PMID: 31261850 PMCID: PMC6651451 DOI: 10.3390/ijerph16132310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
Recent studies investigating elite and master athletes in pool- and long-distance open-water swimming showed for elite swimmers that the fastest women were able to outperform the fastest men, and for master athletes that elderly women were able to achieve a similar performance to elderly men. The present study investigating age group records in runners from 5 km to 6 days aimed to test this hypothesis for master runners. Data from the American Master Road Running Records were analyzed, for 5 km, 8 km, 10 km, 10 miles, 20 km, half-marathon, 25 km, 30 km, marathon, 50 km, 50 miles, 100 km, 100 miles, 12 h, 24 h, 48 h and 144 h, for athletes in age groups ranging from 40 to 99 years old. The performance gap between men and women showed higher effects in events lengthening from 5 km to 10 miles (d = 0.617) and lower effects in events lengthening from 12 to 144 h (d = 0.304) running. Both other groups showed similar effects, being 20 km to the marathon (d = 0.607) and 50 km to 100 miles (d = 0.563). The performance gap between men and women showed higher effects in the age groups 85 years and above (d = 0.953) followed by 55 to 69 years (d = 0.633), and lower effects for the age groups 40 to 54 years (d = 0.558) and 70 to 84 years (d = 0.508). In summary, men are faster than women in American road running events, however, the sex gap decreases with increasing age but not with increasing event length.
Collapse
Affiliation(s)
- Caio Victor Sousa
- Graduate Program in Physical Education, Catholic University of Brasília, 71966-700 Brasília, DF, Brazil
- Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Samuel da Silva Aguiar
- Graduate Program in Physical Education, Catholic University of Brasília, 71966-700 Brasília, DF, Brazil
- Physical Education Department, University Center-UDF, 71966-700 Brasilia, DF, Brazil
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland.
| |
Collapse
|
11
|
Sadaie MR, Farhoudi M, Zamanlu M, Aghamohammadzadeh N, Amouzegar A, Rosenbaum RE, Thomas GA. What does the research say about androgen use and cerebrovascular events? Ther Adv Drug Saf 2018; 9:439-455. [PMID: 30364888 DOI: 10.1177/2042098618773318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
Many studies have investigated the benefits of androgen therapy and neurosteroids in aging men, while concerns remain about the potential associations of exogenous steroids and incidents of cerebrovascular events and ischemic stroke (IS). Testosterone is neuroprotective, neurotrophic and a potent stimulator of neuroplasticity. These benefits are mediated primarily through conversion of a small amount of testosterone to estradiol by the catalytic activity of estrogen synthetase (aromatase cytochrome P450 enzyme). New studies suggest that abnormal serum levels of the nonaromatized potent metabolite of testosterone, either high or low dihydrotestosterone (DHT), is a risk factor for stroke. Associations between pharmacologic androgen use and the incidence of IS are questionable, because a significant portion of testosterone is converted to DHT. There is also insufficient evidence to reject a causal relationship between the pro-testosterone adrenal androgens and incidence of IS. Moreover, vascular intima-media thickness, which is a predictor of stroke and myocardial symptoms, has correlations with sex hormones. Current diagnostic and treatment criteria for androgen therapy for cerebrovascular complications are unclear. Confounding variables, including genetic and metabolic alterations of the key enzymes of steroidogenesis, ought to be considered. Information extracted from pharmacogenetic testing may aid in expounding the protective-destructive properties of neurosteroids, as well as the prognosis of androgen therapy, in particular their cerebrovascular outcomes. This investigative review article addresses relevant findings of the clinical and experimental investigations of androgen therapy, emphasizes the significance of genetic testing of androgen responsiveness towards individualized therapy in post-IS injuries as well as identifying pertinent questions.
Collapse
Affiliation(s)
| | - Mehdi Farhoudi
- Neurosciences Research Center (NSRC), Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masumeh Zamanlu
- Neurosciences Research Center (NSRC), Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasser Aghamohammadzadeh
- Department of Endocrinology, Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gary A Thomas
- Penn State Hershey Neurology, Penn State University, PA, USA
| |
Collapse
|
12
|
Kougias DG, Das T, Perez AB, Pereira SL. A role for nutritional intervention in addressing the aging neuromuscular junction. Nutr Res 2018; 53:1-14. [PMID: 29804584 DOI: 10.1016/j.nutres.2018.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 12/20/2022]
Abstract
The purpose of this review is to discuss the structural and physiological changes that underlie age-related neuromuscular dysfunction and to summarize current evidence on the potential role of nutritional interventions on neuromuscular dysfunction-associated pathways. Age-related neuromuscular deficits are known to coincide with distinct changes in the central and peripheral nervous system, in the neuromuscular system, and systemically. Although many features contribute to the age-related decline in neuromuscular function, a comprehensive understanding of their integration and temporal relationship is needed. Nonetheless, many nutrients and ingredients show promise in modulating neuromuscular output by counteracting the age-related changes that coincide with neuromuscular dysfunction. In particular, dietary supplements, such as vitamin D, omega-3 fatty acids, β-hydroxy-β-methylbutyrate, creatine, and dietary phospholipids, demonstrate potential in ameliorating age-related neuromuscular dysfunction. However, current evidence seldom directly assesses neuromuscular outcomes and is not always in the context of aging. Additional clinical research studies are needed to confirm the benefits of dietary supplements on neuromuscular function, as well as to define the appropriate population, dosage, and duration for intervention.
Collapse
Affiliation(s)
- Daniel G Kougias
- Abbott Nutrition, Strategic Research, 3300 Stelzer Road, Columbus, OH, USA; Neuroscience Program, University of Illinois, Urbana-Champaign, IL, USA.
| | - Tapas Das
- Abbott Nutrition, Strategic Research, 3300 Stelzer Road, Columbus, OH, USA.
| | | | - Suzette L Pereira
- Abbott Nutrition, Strategic Research, 3300 Stelzer Road, Columbus, OH, USA.
| |
Collapse
|
13
|
Effects of Recombinant Human Growth Hormone for Osteoporosis: Systematic Review and Meta-Analysis. Can J Aging 2017; 36:41-54. [PMID: 28069090 DOI: 10.1017/s0714980816000696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Our objective was to evaluate the efficacy of recombinant human growth hormone (GH) on bone mineral density (BMD) in persons age 50 and older, with normal pituitary function, with or at risk for developing osteoporosis. We systematically reviewed randomized clinical trials (RCTs), searching six databases, and conducted meta-analyses to examine GH effects on BMD of the lumbar spine and femoral neck. Data for fracture incidence, bone metabolism biomarkers, and adverse events were also extracted and analysed. Thirteen RCTs met the eligibility criteria. Pooled effect sizes suggested no significant GH effect on BMD. Pooled effect sizes were largest, but nonsignificant, when compared to placebo. GH had a significant effect on several bone metabolism biomarkers. A significantly higher rate of adverse events was observed in the GH groups. Meta-analysis of RCTs suggests that GH treatment for persons with or at risk for developing osteoporosis results in very small, nonsignificant increases in BMD.
Collapse
|
14
|
Judge LW, Bellar DM, Hoover DL, Biggs D, Leitzelar BN, Craig BW. Effects of acute androstenedione supplementation on testosterone levels in older men. Aging Male 2016; 19:161-167. [PMID: 27558186 DOI: 10.3109/13685538.2016.1167180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of the study was to examine the effects of acute androstenedione supplementation on hormone levels in older men at rest and during exercise. Men (n = 11) between the ages of 58 and 69 were divided into an experimental (n = 6; 62.33 ± 2.57 y) and control (n = 5; 60.2 ± 1.02 y) groups. Each participant received an oral 300 mg dose of either androstenedione (experimental) or a cellulose placebo (control) for 7 d. Pre- and post-supplementation participants completed two separate, 20-min strength tasks consisting of leg extension and leg curls at different percentages of their 10-RM. Researchers collected blood samples pre-, during, and post-exercise. Blood samples were analyzed for testosterone, androstenedione, and estradiol levels. The researchers found a significant difference between pre- (4.36 ± 56 ng/mL) and post- (5.51 ± 0.35 ng/mL) testosterone levels, as well as pre- (0.88 ± 0.20) and post- (7.46 ± 1.25) androstenedione levels, but no significant differences between pre- and post-estradiol levels for either group. It appears that short-term androstenedione supplementation augmented acute testosterone responses to resistance exercise in older men. However, further study of this supplement is needed to determine any potential it may have in mitigating andropause.
Collapse
Affiliation(s)
- Lawrence W Judge
- a School of Kinesiology, Ball State University , Muncie , IN , USA
| | - David M Bellar
- b Department of Kinesiology , University of Louisiana Lafayette , Lafayette , LA , USA
| | - Donald L Hoover
- c Department of Physical Therapy , Western Kentucky University , Bowling Green , KY , USA , and
| | - Douglas Biggs
- d Human Performance Laboratory, Ball State University , Muncie , IN , USA
| | | | - Bruce W Craig
- d Human Performance Laboratory, Ball State University , Muncie , IN , USA
| |
Collapse
|
15
|
Bosy-Westphal A, Kahlhöfer J, Lagerpusch M, Skurk T, Müller MJ. Deep body composition phenotyping during weight cycling: relevance to metabolic efficiency and metabolic risk. Obes Rev 2015; 16 Suppl 1:36-44. [PMID: 25614202 DOI: 10.1111/obr.12254] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Weight cycling may lead to adverse effects on metabolic efficiency (i.e. adaptive thermogenesis or 'metabolic slowing') and metabolic risks (e.g. increased risk for insulin resistance and the metabolic syndrome). In order to investigate these topics, the partitioning of fat and lean mass (i.e. the change in the proportion of both compartments) needs to be extended to the organ and tissue level because metabolic risk differs between adipose tissue depots and lean mass is metabolically heterogeneous being composed of organs and tissues differing in metabolic rate. Contrary to data obtained with severe weight loss and regain in lean people, weight cycling most likely has no adverse effects on fat distribution and metabolic risk in obese patients. There is even evidence for an increased ability of fat storage in subcutaneous fat depots (at the trunk in men and at the limbs in women) with weight cycling that may provide a certain protection from ectopic lipid deposition and thus explain the preservation of a favourable metabolic profile despite weight regain. On the other hand, the mass-specific metabolic rate of lean mass may increase with weight gain and decrease with weight loss mainly because of an increase and respective decrease in the proportion (and/or activity) of metabolically active organ mass. Obese people could therefore have a higher slope of the regression line between resting energy expenditure (REE) and fat-free mass that leads to an overestimation of metabolic efficiency when applied to normalize REE data after weight loss. Furthermore, in addressing the impact of macronutrient composition of the diet on partitioning of lean and fat mass, and the old controversy about whether a calorie is a calorie, we discuss recent evidence in support of a low glycaemic weight maintenance diet in countering weight regain and challenge this concept for weight loss by proposing the opposite.
Collapse
Affiliation(s)
- A Bosy-Westphal
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Germany; Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts-Universität zu Kiel, Freising-Weihenstephan, Germany
| | | | | | | | | |
Collapse
|
16
|
Bove R, Musallam A, Healy BC, Raghavan K, Glanz BI, Bakshi R, Weiner H, De Jager PL, Miller KK, Chitnis T. Low testosterone is associated with disability in men with multiple sclerosis. Mult Scler 2014; 20:1584-92. [PMID: 24710799 DOI: 10.1177/1352458514527864] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gonadal steroids may modulate disease course in multiple sclerosis (MS). OBJECTIVE To assess the prevalence and clinical associations of hypogonadism in men with MS. METHODS Male patients, aged 18-65 years, with relapsing-remitting MS (RRMS) or clinically-isolated syndrome (CIS) and their first symptom < 10 years prior were selected from a longitudinal clinical study. We measured their hormones in stored morning blood samples, and collected their Expanded Disability Status Scale (EDSS) scores every 6 months and their Symbol Digit Modalities Test (SDMT) results annually. RESULTS Our analysis included 96 men with a mean age of 40 years, EDSS of 1.1 and disease duration of 4.6 years. Of these men, 39% were hypogonadal (total testosterone < 288 ng/dL); none showed compensatory elevations in luteinizing hormone. Their low testosterone levels and testosterone:estradiol ratios were negatively correlated with body mass index (BMI) and leptin, and showed no correlation with 25-hydroxy-vitamin D levels. In our primary cross-sectional analyses, there was a negative age-adjusted correlation between total testosterone and EDSS (p = 0.044). In the age-adjusted longitudinal analyses, higher baseline testosterone levels were associated with less decline in SDMT (p = 0.012). CONCLUSIONS Men with MS may experience hypogonadotropic hypogonadism. Low testosterone levels may be associated with worse clinical outcomes. A potential neuroprotective role for testosterone warrants further investigation.
Collapse
Affiliation(s)
- R Bove
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
| | - A Musallam
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USA
| | - B C Healy
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USAMassachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | | | - B I Glanz
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USA
| | - R Bakshi
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USA
| | - H Weiner
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
| | - P L De Jager
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
| | - K K Miller
- Harvard Medical School, Boston, MA, USANeuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - T Chitnis
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USAHarvard Medical School, Boston, MA, USACenter for Neurologic Diseases, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Antiangiogenic therapy effects on age-associated matrix metalloproteinase-9 (MMP-9) and insulin-like growth factor receptor-1 (IGFR-1) responses: a comparative study of prostate disorders in aged and TRAMP mice. Histochem Cell Biol 2014; 142:269-84. [PMID: 24562790 DOI: 10.1007/s00418-014-1193-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
Senescence is associated with hormonal imbalance and prostatic disorders. Angiogenesis is fundamental for the progression of malignant lesions and is a promising target for prostate cancer treatment. The aim was to characterize matrix metalloproteinase-9 (MMP-9) and insulin-like growth factor receptor-1 (IGFR-1) responses in the prostate during senescence and following antiangiogenic and/or androgen ablation therapies, comparing them to cancer progression features in TRAMP mice. Aged male mice (52-week-old FVB) were submitted to antiangiogenic treatments with SU5416 (6 mg/kg; i.p.) and/or TNP-470 (15 mg/kg; s.c). Finasteride (20 mg/kg; s.c.) was administered alone or associated to both inhibitors. Dorsolateral prostate was collected for light microscopy, and immunohistochemistry and Western blotting collected for MMP-9 and IGFR-1. Senescence led to inflammation and different proliferative lesions in the prostate, as well as to increased MMP-9 and IGFR-1, resembling TRAMP mice prostatic microenvironment. Antiangiogenic therapies promoted recovery and/or interruption of age-associated alterations, presenting differential effects on the molecules studied. SU5416 acted mainly on MMP-9, whereas TNP-470 showed its best influence on IGFR-1 levels. Finasteride administration, alone or in combination with antiangiogenic agents, also resulted in regression of inflammation and neoplastic lesions, besides having a negative modulatory effect on both MMP-9 and IGFR-1. We concluded that stimulated tissue remodeling and proliferative processes during senescence predisposed the prostate to malignant disorders. The combination of different agents was more effective to minimize prostatic imbalance during this period, probably due to the differential action of each drug on factors involved in cell proliferation and extracellular matrix remodeling, resulting in a broader spectrum of effects following the combined treatment.
Collapse
|
18
|
Abstract
The pituitary gland has a role in puberty, reproduction, stress-adaptive responses, sodium and water balance, uterine contractions, lactation, thyroid function, growth, body composition and skin pigmentation. Ageing is marked by initially subtle erosion of physiological signalling mechanisms, resulting in lower incremental secretory-burst amplitude, more disorderly patterns of pituitary hormone release and blunted 24 h rhythmic secretion. Almost all pituitary hormones are altered by ageing in humans, often in a manner dependent on sex, body composition, stress, comorbidity, intercurrent illness, medication use, physical frailty, caloric intake, immune status, level of exercise, and neurocognitive decline. The aim of this article is to critically discuss the mechanisms mediating clinical facets of changes in the hypothalamic-pituitary axis during ageing, and the extent to which confounding factors operate to obscure ageing-related effects.
Collapse
Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, MN 55905, USA.
| |
Collapse
|
19
|
Cook CJ, Beaven CM. Salivary testosterone is related to self-selected training load in elite female athletes. Physiol Behav 2013; 116-117:8-12. [PMID: 23531473 DOI: 10.1016/j.physbeh.2013.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 01/24/2013] [Accepted: 03/14/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Testosterone has been related to improved acute neuromuscular performance in athletic populations. It is our contention that testosterone may also contribute to improved volitional motivation and, when monitored longitudinally, may provide one proxy marker for readiness to perform. METHODS Twelve female netball players provided saliva samples prior to five standardized training sessions in which they completed a maximal-distance medicine ball throw, and then 3 sets of bench press and then back squat using a self-selected load perceived to equal a 3-repetition maximum load. Additional repetitions were encouraged when possible and total voluntary workload was calculated from the product of the load lifted and repetitions performed. RESULTS Relative salivary testosterone levels as a group were correlated with bench press (r=0.8399; p=0.0007) and squat (r=0.6703; p=0.0171) self-selected workload, as well as maximal medicine ball throw performance (r=0.7062; p=0.0103). CONCLUSIONS Individual salivary testosterone, when viewed relatively over time, demonstrated strong relationships with self-selected workloads during an in-season training period in female netball players. As such, daily variations in testosterone may provide information regarding voluntary training motivation and readiness to perform in elite athletic populations. Psychological and behavioral aspects of testosterone may have the potential to enhance training adaptation by complementing the known anabolic and permissive properties of testosterone.
Collapse
|
20
|
Ghrelin treatment of cachectic patients with chronic obstructive pulmonary disease: a multicenter, randomized, double-blind, placebo-controlled trial. PLoS One 2012; 7:e35708. [PMID: 22563468 PMCID: PMC3341383 DOI: 10.1371/journal.pone.0035708] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 03/20/2012] [Indexed: 11/21/2022] Open
Abstract
Background Pulmonary cachexia is common in advanced chronic obstructive pulmonary disease (COPD), culminating in exercise intolerance and a poor prognosis. Ghrelin is a novel growth hormone (GH)-releasing peptide with GH-independent effects. The efficacy and safety of adding ghrelin to pulmonary rehabilitation (PR) in cachectic COPD patients were investigated. Methodology/Principal Findings In a multicenter, randomized, double-blind, placebo-controlled trial, 33 cachectic COPD patients were randomly assigned PR with intravenous ghrelin (2 µg/kg) or placebo twice daily for 3 weeks in hospital. The primary outcomes were changes in 6-min walk distance (6-MWD) and the St. George Respiratory Questionnaire (SGRQ) score. Secondary outcomes included changes in the Medical Research Council (MRC) scale, and respiratory muscle strength. At pre-treatment, serum GH levels were increased from baseline levels by a single dose of ghrelin (mean change, +46.5 ng/ml; between-group p<0.0001), the effect of which continued during the 3-week treatment. In the ghrelin group, the mean change from pre-treatment in 6-MWD was improved at Week 3 (+40 m, within-group p = 0.033) and was maintained at Week 7 (+47 m, within-group p = 0.017), although the difference between ghrelin and placebo was not significant. At Week 7, the mean changes in SGRQ symptoms (between-group p = 0.026), in MRC (between-group p = 0.030), and in maximal expiratory pressure (MEP; between-group p = 0.015) were better in the ghrelin group than in the placebo group. Additionally, repeated-measures analysis of variance (ANOVA) indicated significant time course effects of ghrelin versus placebo in SGRQ symptoms (p = 0.049) and MEP (p = 0.021). Ghrelin treatment was well tolerated. Conclusions/Significance In cachectic COPD patients, with the safety profile, ghrelin administration provided improvements in symptoms and respiratory strength, despite the lack of a significant between-group difference in 6-MWD. Trial Registration UMIN Clinical Trial Registry C000000061
Collapse
|
21
|
Lovell DI, Cuneo R, Wallace J, McLellan C. The hormonal response of older men to sub-maximum aerobic exercise: the effect of training and detraining. Steroids 2012; 77:413-8. [PMID: 22248672 DOI: 10.1016/j.steroids.2011.12.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/19/2022]
Abstract
The hormonal response of 32 older men (70-80years) to a bout of sub-maximum aerobic exercise was examined before, after 16weeks of resistance or aerobic training and again after 4weeks of detraining. Blood samples were obtained at rest and immediately post sub-maximum exercise (30min @ 70% VO(2) max) to determine the concentrations of growth hormone (GH), insulin-like growth factor-1 (IGF-1), testosterone (Test), sex hormone-binding globulin (SHBG) and the calculation of free testosterone (FT). Both training groups had significant increases in leg strength and VO(2) max after 16weeks training but leg strength and VO(2) max returned to pre-training levels in the aerobic training and resistance training groups, respectively. During the 20week study there was no change in resting concentrations of any hormones among the three groups. There was no increase in GH, IGF-1 or SHBG immediately post sub-maximum exercise in any of the groups before training, after 16weeks training or after 4weeks detraining. Testosterone and FT increased immediately post sub-maximum exercise within all groups before training, after 16weeks training and after 4weeks detraining with the increase in Test and FT higher after 16weeks of resistance training compared to before training and after 4weeks detraining within the resistance training group. The increased responsiveness of Test and FT after 16weeks of resistance training was lost after 4weeks of detraining. Our results indicate that some physiological and hormonal adaptations gained after 16weeks training are lost after only 4weeks detraining.
Collapse
Affiliation(s)
- Dale I Lovell
- School of Health and Sport Sciences, Faculty of Science, Health & Education, University of the Sunshine Coast, Queensland 4556, Australia.
| | | | | | | |
Collapse
|
22
|
Quik E, Conemans E, Valk G, Kenemans J, Koppeschaar H, van Dam P. Cognitive performance in older males is associated with growth hormone secretion. Neurobiol Aging 2012; 33:582-7. [DOI: 10.1016/j.neurobiolaging.2010.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 03/05/2010] [Accepted: 03/28/2010] [Indexed: 11/25/2022]
|
23
|
Abstract
Pituitary somatotrophs secrete growth hormone (GH) into the bloodstream, to act as a hormone at receptor sites in most, if not all, tissues. These endocrine actions of circulating GH are abolished after pituitary ablation or hypophysectomy, indicating its pituitary source. GH gene expression is, however, not confined to the pituitary gland, as it occurs in neural, immune, reproductive, alimentary, and respiratory tissues and in the integumentary, muscular, skeletal, and cardiovascular systems, in which GH may act locally rather than as an endocrine. These actions are likely to be involved in the proliferation and differentiation of cells and tissues prior to the ontogeny of the pituitary gland. They are also likely to complement the endocrine actions of GH and are likely to maintain them after pituitary senescence and the somatopause. Autocrine or paracrine actions of GH are, however, sometimes mediated through different signaling mechanisms to those mediating its endocrine actions and these may promote oncogenesis. Extrapituitary GH may thus be of physiological and pathophysiological significance.
Collapse
Affiliation(s)
- S Harvey
- Department of Physiology, University of Alberta, 7-41 Medical Sciences Building, Edmonton, AB T6G 2H7, Canada,
| |
Collapse
|
24
|
Pühse G, Secker A, Kemper S, Hertle L, Kliesch S. Testosterone deficiency in testicular germ-cell cancer patients is not influenced by oncological treatment. ACTA ACUST UNITED AC 2010; 34:e351-7. [DOI: 10.1111/j.1365-2605.2010.01123.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Brown NA, Zenilman ME. The impact of frailty in the elderly on the outcome of surgery in the aged. Adv Surg 2010; 44:229-49. [PMID: 20919524 DOI: 10.1016/j.yasu.2010.05.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
As the population continues to age, we will continue to encounter issues involving aging and the elderly. Despite these issues, knowledge is expanding and evolving with new solutions to ongoing problems. Mechanistically, frailty at its root is a symptom of growing old, with cascades and circuitous feedback between organ systems at all levels. Clinically, frailty is as equally dynamic and its multifactorial nature represents a unique challenge to the surgical community and warrants the integration of geriatric assessment into clinical practice. Integration within clinical practice includes using an interdisciplinary approach, where surgeons work with anesthesiologists, geriatricians, nursing, rehabilitation, nutritionists, and other support staff to provide holistic assessment, efficient delivery, and higher quality of care. This in hand, recognition of frailty can occur in a timely fashion to initiate treatment, decreasing the risk of morbidity and mortality for improved surgical outcomes.
Collapse
Affiliation(s)
- Nefertiti A Brown
- Department of Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 40, Brooklyn, NY 11203, USA.
| | | |
Collapse
|
26
|
Decline of the Red Blood Cell Count in Patients Receiving Androgen Deprivation Therapy for Localized Prostate Cancer: Impact of ADT on Insulin-like Growth Factor-1 and Erythropoiesis. Urology 2010; 75:1441-5. [DOI: 10.1016/j.urology.2009.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 10/08/2009] [Accepted: 11/06/2009] [Indexed: 11/23/2022]
|
27
|
Abstract
Hypothalamic gonadotropin-releasing hormone (GnRH) stimulates secretion of pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which directly regulate ovarian function. Pituitary FSH can modulate osteoclast development, and thereby influence bone turnover. Pituitary oxytocin and prolactin effects on the skeleton are not merely limited to pregnancy and lactation; oxytocin stimulates osteoblastogenesis and bone formation, whereas prolactin exerts skeletal effects in an age-dependent manner. Cyclic levels of inhibins and estrogen suppress FSH and LH, respectively, and also suppress bone turnover via their suppressive effects on osteoblast and osteoclast differentiation. However, continuous exposure to inhibins or estrogen/androgens is anabolic for the skeleton in intact animals and protects against gonadectomy-induced bone loss. Alterations of one hormone in the hypothalamic-pituitary-gonadal (HPG) axis influence other bone-active hormones in the entire feedback loop in the axis. Thus, we propose that the action of the HPG axis should be extended to include its combined effects on the skeleton, thus creating the HPG skeletal (HPGS) axis.
Collapse
Affiliation(s)
- Kristy M Nicks
- Departments of Physiology and Biophysics and Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 505, Little Rock, AR, 72205, USA.
| | | | | |
Collapse
|
28
|
Abstract
Many theories aim at explaining the mechanisms of aging and death in humans. Decreased levels of androgens, growth hormone, and insulin-like growth factor accompany natural aging in men. Androgens influence the growth and maturation of men in various stages of their life. The action of androgens is performed by binding or not binding to androgen receptors. However, various actions of androgens were clarified after the discovery and genotyping of the androgen receptor. The influence of androgens on the lipid profile was reported by several researchers. This negative influence of androgens in men and the positive influence of estrogens in women are responsible for the higher impact of atherogenesis in men compared with women. In aging men, this negative influence of androgens on the lipid profile is more pronounced. This review considers the influence of age on lipid metabolism in men.
Collapse
|
29
|
Isahaya E, Hara N, Nishiyama T, Hoshii T, Takizawa I, Takahashi K. Bone metabolic disorder in patients with prostate cancer receiving androgen deprivation therapy (ADT): impact of ADT on the growth hormone/insulin-like growth factor-1/parathyroid hormone axis. Prostate 2010; 70:155-61. [PMID: 19760629 DOI: 10.1002/pros.21047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although androgen deprivation therapy (ADT) has been associated with bone loss in patients with prostate cancer, its mechanism remains unclear. The growth hormone (GH)/insulin-like growth factor-1 (IGF-1)/parathyroid hormone (PTH) axis plays a critical role in bone synthesis, but its activity during ADT is also unknown. METHODS Seventy-one patients with localized prostate cancer, who received ADT, were prospectively studied based on their bone mineral density (BMD) and blood and urine samples at the baseline and after ADT for 6 months. RESULTS The IGF-1 level was correlated with BMD before ADT (rs = 0.325, P = 0.007), but such a relationship disappeared after ADT (P = 0.565). Following ADT, the serum IGF-1 level increased compared with that at the baseline (22 +/- 6 nmol/L vs. 19 +/- 5 nmol/L, respectively, P < 0.001). The serum PTH level was reduced after ADT (41 +/- 33 ng/L) compared with the baseline (55 +/- 44 ng/L) (P < 0.001), but no change was observed in the serum GH level (P = 0.691). Bone resorption markers such as blood N-telopeptide (NTx), urinary NTx, calcium, and inorganic phosphorus levels increased after ADT (P < 0.001 in all). The ratio of the IGF-1 level after ADT/before ADT was associated with the ratio of the value after ADT/before ADT of alkaline phosphatase (rs = 0.266, P = 0.025) and calcium (rs = 0.242, P = 0.042). CONCLUSION Despite the unaffected GH and upregulated bone resorption, the serum IGF-1 level was elevated by ADT. The IGF-1 level was correlated with BMD before ADT, but the relationship was disrupted after ADT. IGF-1 or its receptor in the bone may be functionally inactivated during ADT.
Collapse
Affiliation(s)
- Etsuko Isahaya
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | | | | | | | | | | |
Collapse
|
30
|
Rhoden EL, Morgentaler A. Symptomatic Response Rates to Testosterone Therapy and the Likelihood of Completing 12 Months of Therapy in Clinical Practice. J Sex Med 2010; 7:277-83. [DOI: 10.1111/j.1743-6109.2009.01544.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Rosenzweig A, Mishra R. Evaluation and management of osteoporosis and fragility fractures in the elderly. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ahe.09.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Osteoporosis is characterized by low bone mass and microarchitectural deterioration that leads to increased bone fragility and fracture. The medical, psychosocial and economic burden that fragility fractures have on individuals and society is staggering. As the geriatric segment of the population continues to expand, so to will the magnitude of this epidemic. There are multiple mechanisms influencing bone quality and bone loss with age. Fragility fracture is a composite of multiple intrinsic and extrinsic factors related to the individual and their environment. Fall prevention remains the cornerstone of management in this problem. The FRAX® fracture risk assessment program, which estimates the 10-year probability of a major osteoporotic fracture, is an exciting new tool in assessing risk. Novel therapeutics, including zoledronic acid, strontium and teriparatide, are now available to complement proven osteoporosis treatments and more effectively decrease fracture risk in vulnerable individuals. Agents in Phase III trials, including denosumab and lasofoxifene, will probably increase the armamentarium of tools clinicians can use to combat the growing problem of osteoporosis and its complications.
Collapse
Affiliation(s)
- Andrew Rosenzweig
- Internal Medicine Resident, Department of Medicine, Abington Memorial Hospital, PA, USA
| | - Richa Mishra
- Muller Center for Senior Health, 1200 Old York Road, Elkins Building, Suite 2B, Abington, PA 19001, USA
| |
Collapse
|
32
|
Naghii MR, Mofid M. Elevation of biosynthesis of endogenous 17‐B oestradiol by boron supplementation: One possible role of dietary boron consumption in humans. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/13590840802150845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
33
|
Nakazato M, Koshinaka K, Toshinai K, Kodama T, Ashitani JI. [Possibility of clinical intervention by ghrelin to sarcopenia with aging]. Nihon Ronen Igakkai Zasshi 2009; 46:330-331. [PMID: 19713664 DOI: 10.3143/geriatrics.46.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
34
|
Abstract
Although male sex is a well-recognized risk factor for stroke, the role of androgens in cerebral ischemia remains unclear. Therefore, we evaluated effects of testosterone on infarct size in both young adult and middle-aged rats (Wistar, 3-month versus 14-month old) and mice (C57/BL6, 3-month versus 12-month old) subjected to middle cerebral artery occlusion. In young adult groups, castrates displayed less ischemic damage as compared with intact males and castrates with testosterone replacement (Cortex: 24% in castrates versus 42% in intact versus 40% with testosterone; Striatum: 45% versus 73% versus 70%) at 22 h reperfusion. Surprisingly, supplementing testosterone in middle-aged rats to the physiologic levels ordinarily seen in young males reduced infarction (Cortex: 2% with testosterone versus 31%; Striatum: 38% with testosterone versus 68%). Testosterone effects on infarct size were blocked by the androgen receptor (AR) antagonist flutamide and further confirmed in young versus middle-aged mice. Baseline cerebral aromatase mRNA levels and activity were not different between young and middle-aged rats. Aromatase activity increased in ischemic tissue, but only in young males. Lastly, stroke damage was not different in aging aromatase knockout mice versus wild-type controls. Our findings indicate that testosterone's effects in experimental stroke are age dependent, mediated via AR, but not cerebral aromatase.
Collapse
|
35
|
Arita K, Hirano H, Yunoue S, Fujio S, Tominaga A, Sakoguchi T, Sugiyama K, Kurisu K. Treatment of elderly acromegalics. Endocr J 2008; 55:895-903. [PMID: 18552460 DOI: 10.1507/endocrj.k08e-117] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We assessed the incidence of elderly patients in Japanese acromegalics and the characteristics of their clinical presentation. We also evaluated the safety and efficacy of transsphenoidal surgery (TSS) in this patient group. During the 28-year period from 1980 to 2007 we treated 290 patients with acromegaly at our hospitals. Of these, 9 (3.1%) were elderly, i.e. 70 years old or older. They comprised 0.7% of acromegalics treated during the first- and 4.5% of patients with acromegaly treated during the 2nd 14-year period. Before treatment, all manifested abnormal glucose tolerance; 6 had diabetes mellitus (DM), 6 presented with hypertension, and 2 had cardiovascular disease, malignant neoplasms, or hyperlipidemia. Of the 7 elderly acromegalics who underwent TSS none manifested surgical morbidity or new pituitary hormone deficiencies. Postoperatively, the nadir growth hormone (GH) level at the oral glucose tolerance test (OGTT) was under 1.0 ng/mL in 5 patients, insulin-like growth factor (IGF-1) levels normalized in 4. Glucose tolerance improved in all operated patients. Only 1 of 6 patients with preoperatively diagnosed DM continued to manifest DM post-treatment, anti-hypertensive drugs could be tapered in 3 of patients with preoperative hypertension. In conclusion, we found that there was a high incidence of abnormal glucose tolerance and hypertension in elderly acromegalics, that surgical treatment was effective and safe in this population, and that it was useful for the control of co-morbidities.
Collapse
Affiliation(s)
- Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Nandy PR, Singh DV, Madhusoodanan P, Sandhu AS. Male Andropause : A Myth or Reality. Med J Armed Forces India 2008; 64:244-9. [PMID: 27408157 PMCID: PMC4921612 DOI: 10.1016/s0377-1237(08)80105-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 07/09/2007] [Indexed: 10/18/2022] Open
Abstract
Male andropause, male climacteric or viropause is a condition in which men suffer from complex symptomatology due to low androgen level with aging. After the age of 40 years testosterone level starts declining and andropause corresponds to the age at which a pathogenic threshold is reached. This review summarizes the etiology, consequences, screening, diagnosis, monitoring of androgen deficiency in aging male (ADAM). The pros and cons of testosterone replacement therapy (TRT) in elderly male have been discussed. Currently oral, transdermal, transbuccal, intramuscular, and subcutaneous implants are available for clinical use. The choice is made by physicians based on therapeutic indication and patient preferences.
Collapse
Affiliation(s)
- PR Nandy
- Classified Specialist (Surgery & Urology), Command Hospital (Southern Command), Pune
| | - DV Singh
- Senior Advisor (Surgery & Urology), Base Hospital, Delhi Cantt
| | | | - AS Sandhu
- Senior Advisor (Surgery & Urology), Command Hospital (Southern Command), Pune
| |
Collapse
|
37
|
Ariyasu H, Iwakura H, Yamada G, Nakao K, Kangawa K, Akamizu T. Efficacy of ghrelin as a therapeutic approach for age-related physiological changes. Endocrinology 2008; 149:3722-8. [PMID: 18372331 DOI: 10.1210/en.2007-1650] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aging is associated with decreases in food intake and GH secretion, termed the anorexia of aging and somatopause, respectively. The mechanisms underlying these phenomena are not fully understood. Although many approaches have attempted to improve these age-related physiological changes, none have achieved satisfactory results. Ghrelin, a 28-amino-acid acylated peptide, was identified as an endogenous ligand for the GH secretagogue receptor. Ghrelin stimulates GH secretion and food intake in animals and humans. Previous studies have demonstrated that the mean plasma concentrations of ghrelin in normal-weight elderly people were lower than those in younger people. We hypothesized that ghrelin administration might improve the metabolic and physiological changes that accompany the anorexia of aging and somatopause. First, 75-wk-old mice fasted for 72 h, after which they resumed feeding with sc administration of ghrelin (360 microg/kg) twice daily for 4 d. Multiple administrations of ghrelin after a 72-h fast increased food intake and hastened body weight recovery with a high lean body mass ratio. Next, 50-wk-old mice were sc injected with rat ghrelin (40 microg/kg) twice weekly from 50-80 wk of age. Long-term administration of ghrelin kept aged mice with low body weight and low adiposity. These results suggest that ghrelin might be a novel approach for the therapy of age-related metabolic and physiological changes.
Collapse
Affiliation(s)
- Hiroyuki Ariyasu
- Ghrelin Research Project, Translational Research Center, Kyoto University Hospital, Kyoto, Japan.
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
Plastic repair of the trephination hole in the parietal bone with syngeneic cartilage was carried out in old rabbits. The ossification process eventuated in the formation of a callus by day 28 postoperation, while in control animals bone tissue defect still persisted during this period.
Collapse
|
39
|
Toshinai K, Mondal MS, Shimbara T, Yamaguchi H, Date Y, Kangawa K, Nakazato M. Ghrelin stimulates growth hormone secretion and food intake in aged rats. Mech Ageing Dev 2007; 128:182-6. [PMID: 17109935 DOI: 10.1016/j.mad.2006.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 09/21/2006] [Accepted: 10/03/2006] [Indexed: 10/23/2022]
Abstract
Age-related decreases in energy expenditure have been associated with the loss of skeletal muscle and decline of food intake, possibly through a mechanism involving changes of growth hormone (GH) secretion and feeding behavior. Age-related declines of growth hormone secretion and food intake have been termed the somatopause and anorexia of ageing, respectively. Ghrelin, a 28-amino-acid peptide, was isolated from human and rat stomachs as an endogenous ligand of growth hormone secretagogue receptor. Ghrelin stimulates growth hormone release and food intake when peripherally administered to rodents and humans. Here, we investigate the relationship between age-related decline of growth hormone secretion and/or food intake and ghrelin function. Ghrelin (10 nmol/kg body weight) was administered intravenously to male 3-, 12-, 24-and 27-month-old Long-Evans rats, after which growth hormone concentrations and 2 h food intake were measured. An intravenous administration of ghrelin to rats increased food intake in all generations. In addition, to orexigenic effect by ghrelin, intravenous administration of ghrelin elicited a marked increase in plasma GH levels, with the peak occurring 15 min after administration. These findings suggest that the aged rats maintain the reactivity to administered exogenous ghrelin.
Collapse
Affiliation(s)
- Koji Toshinai
- Department of Internal Medicine, Miyazaki Medical College, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | | | | | | | | | | | | |
Collapse
|
40
|
Vasta V, Shimizu-Albergine M, Beavo JA. Modulation of Leydig cell function by cyclic nucleotide phosphodiesterase 8A. Proc Natl Acad Sci U S A 2006; 103:19925-30. [PMID: 17172443 PMCID: PMC1750886 DOI: 10.1073/pnas.0609483103] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Indexed: 11/18/2022] Open
Abstract
Leydig cells produce testosterone in the testes under the pulsatile control of pituitary luteinizing hormone (LH). cAMP is the intracellular messenger for LH action on steroidogenesis, and pharmacological evidence indicates that the response to LH can be modulated by cyclic nucleotide phosphodiesterases (PDEs). However the types and roles of the PDEs present in Leydig cells have not been fully defined. We report here that PDE8A is expressed in Leydig cells, and using PDE8A knockout mice we provide evidence that PDE8A is a key regulator of LH signaling and steroidogenesis. A 4-fold increase in the sensitivity to LH for testosterone production was detected in Leydig cells isolated from PDE8A knockout mice. In Leydig cells from wild-type mice, 3-isobutyl-1-methylxanthine, a compound that inhibits all cAMP PDEs except PDE8A, elicited only a small increase in the sensitivity of testosterone production to LH. However, in the PDE8-null mice, the effect of this inhibitor is much more pronounced. These observations indicate that PDE8A and at least one other PDE control the same or a complementary pool of cAMP that mediates LH-regulated steroidogenesis. Overall, these results suggest that pharmacological manipulation of PDE8A, alone or in combination with other PDEs present in Leydig cells, may be exploited to modulate testosterone synthesis and possibly to treat various conditions where the local levels of this androgen need to be altered.
Collapse
Affiliation(s)
- Valeria Vasta
- Department of Pharmacology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7280
| | - Masami Shimizu-Albergine
- Department of Pharmacology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7280
| | - Joseph A. Beavo
- Department of Pharmacology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7280
| |
Collapse
|
41
|
Bribiescas RG. On the evolution, life history, and proximate mechanisms of human male reproductive senescence. Evol Anthropol 2006. [DOI: 10.1002/evan.20087] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
42
|
Abstract
Aging is associated with a progressive decline in physical and cognitive functions. The impact of age-dependent endocrine changes regulated by the central nervous system on the dynamics of neuronal behavior, neurodegeneration, cognition, biological rhythms, sexual behavior, and metabolism are reviewed. We also briefly review how functional deficits associated with increases in glucocorticoids and cytokines and declining production of sex steroids, GH, and IGF are likely exacerbated by age-dependent molecular misreading and alterations in components of signal transduction pathways and transcription factors.
Collapse
Affiliation(s)
- Roy G Smith
- Huffington Center on Aging, Baylor College of Medicine, One Baylor Plaza, M320, Houston, TX 77030, USA.
| | | | | |
Collapse
|
43
|
Harman SM, Blackman MR. Hormones and Supplements: Do They Work?: Use of Growth Hormone for Prevention or Treatment of Effects of Aging. J Gerontol A Biol Sci Med Sci 2004; 59:652-8. [PMID: 15304529 DOI: 10.1093/gerona/59.7.b652] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Decreases in growth hormone (GH) and insulin-like growth factor-I, estrogen deficiency in women, diminished testosterone in men, and loss of lean body mass, increased fat, and other changes consistent with hormone deficiencies occur during aging. Treatment of nonelderly GH-deficient adults with recombinant human GH (rhGH) improves body composition, muscle strength, physical function, and bone density, and reduces blood cholesterol and cardiovascular disease risk, but is often accompanied by carpal tunnel syndrome, peripheral edema, joint pain and swelling, gynecomastia, glucose intolerance, and possibly increased cancer risk. Reports that rhGH augments lean body mass and reduces body fat in aged individuals increased use of rhGH to delay aging effects. However, clinically significant functional benefits, prolongation of youth, and life extension have not been demonstrated. Moreover, marketing of rhGH and other hormone supplements largely ignores adverse effects. Until more research has better defined the risk/benefit relationships, treatment of elderly individuals with rhGH should be confined to controlled research studies.
Collapse
Affiliation(s)
- S Mitchell Harman
- Kronos Longevity Research Institute, 2222 E. Highland, Suite 220, Phoenix, AZ 85016, USA.
| | | |
Collapse
|
44
|
Niskanen L, Laaksonen DE, Punnonen K, Mustajoki P, Kaukua J, Rissanen A. Changes in sex hormone-binding globulin and testosterone during weight loss and weight maintenance in abdominally obese men with the metabolic syndrome. Diabetes Obes Metab 2004; 6:208-15. [PMID: 15056129 DOI: 10.1111/j.1462-8902.2004.00335.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Mild hypoandrogenism in men, usually defined by low levels of testosterone, is a peculiar feature of abdominal obesity that independently predicts the development of insulin resistance and diabetes mellitus. Little is known about the short- and long-term effects of weight loss on sex steroids in abdominally obese men, however. OBJECTIVES We assessed the effect of rapid weight loss and sustained weight maintenance on the plasma concentrations of testosterone and other sex hormones in 58 abdominally obese men (age, 46.3 +/- 7.5 years; body mass index, 36.1 +/- 3.8 kg/m(2); waist girth, 121 +/- 10 cm) with the metabolic syndrome. RESULTS The men lost on average 16.3 +/- 4.5 kg during a 9-week very low-calorie diet (VLCD) and maintained 14.3 +/- 9.1 kg weight loss after a 12-month maintenance period (vs. baseline, p < 0.001). Sex hormone-binding globulin (SHBG) increased from 27.6 +/- 11.9 to 48.1 +/- 23.5 nmol/l during the VLCD but decreased to 32.6 +/- 12.9 nmol/l during weight maintenance, which was still higher than at baseline (p < 0.001). Free testosterone (fT) increased from 185 +/- 66 to 208 +/- 70 pmol/l (p = 0.002) during the VLCD and remained high after 1 year of weight maintenance (212 +/- 84 pmol/l, p = 0.002). Total testosterone levels followed a pattern intermediate between fT and SHBG. Plasma estradiol and dehydroepiandrosterone sulphate concentrations changed only transiently or not at all. CONCLUSIONS Rapid weight loss with successful weight maintenance in abdominally obese men with the metabolic syndrome brings about a sustained increase in fT levels. The dramatic increase in SHBG attenuated initially during weight maintenance but remained elevated. These findings may be important with regard to prevention of progressive metabolic decompensation and cardiovascular disease associated with obesity and the metabolic syndrome.
Collapse
Affiliation(s)
- L Niskanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Any hope of a fountain of youth to stop people from getting older is a long way off, with science just beginning to understand the complex genetic, physical, and hormonal causes of aging. Clearly, modem research has demonstrated that the concept of a hormonal fountain of youth is predominantly mythology. The best evidence supporting use of hormonal replacement is vitamin D and estrogen replacement to prevent hip fractures. Other than that, treatment should be limited to hormone replacement in persons who have endocrine disease.
Collapse
Affiliation(s)
- Mohamad H Horani
- Division of Geriatric Medicine, Saint Louis University School of Medicine, MO 63104, USA
| | | |
Collapse
|
46
|
Kaweski S. Anti-aging medicine: hormone replacement therapy in men. Plast Reconstr Surg 2004; 113:1506-10. [PMID: 15060372 DOI: 10.1097/01.prs.0000125283.18798.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Susan Kaweski
- Craniofacial, Reconstructive, and Cosmetic Institute, San Diego, CA 92123, USA.
| |
Collapse
|
47
|
McMillan CV, Bradley C, Giannoulis M, Martin F, Sönksen PH. Preliminary development of a new individualised questionnaire measuring quality of life in older men with age-related hormonal decline: the A-RHDQoL. Health Qual Life Outcomes 2003; 1:51. [PMID: 14613571 PMCID: PMC269991 DOI: 10.1186/1477-7525-1-51] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 10/06/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing interest in hormone replacement therapy to improve health and quality of life (QoL) of older men with age-related decline in hormone levels. This paper reports the preliminary development and evaluation of the psychometric properties of a new individualised questionnaire, the A-RHDQoL, measuring perceived impact of age-related hormonal decline on QoL of older men. A-RHDQoL design was based on the HDQoL for people with growth hormone (GH) deficiency and the ADDQoL (for diabetes). METHODS Internal consistency reliability and some aspects of validity of the A-RHDQoL were investigated in a cross-sectional survey of 128 older men (age range: 64 - 80 yrs), being screened for inclusion in a trial of GH and testosterone (T) replacement, and who completed the A-RHDQoL once. Respondents rated personally applicable life domains for importance and impact of their hormonal decline. A single overview item measured present QoL. Serum levels of Insulin-like Growth Factor-I and total T were measured. RESULTS Of the 24 A-RHDQoL domains, 21 were rated as relevant and important for older men. All domains were perceived as negatively impacted by hormonal decline. The most negatively impacted domains were: memory (-4.54 +/- 3.02), energy (-4.44 +/- 2.49), sex life (-4.34 +/- 3.08) and physical stamina (-4.29 +/- 2.41), (maximum range -9 to +9). The shorter 21-domain A-RHDQoL had high internal consistency reliability (Cronbach's alpha coefficient = 0.935, N = 103) and applicable domains could be weighted and summed into an overall Average Weighted Impact score. The questionnaire was acceptable to the majority of respondents and content validity was good. The single overview item measuring present QoL correlated significantly with total T levels [r = 0.26, p <0.01, N = 114]. CONCLUSION The new 21-item A-RHDQoL is an individualised questionnaire measuring perceived impact of age-related hormonal decline on the QoL of older men. The internal consistency reliability and content validity of the A-RHDQoL are established, but the measure is at an early stage of its development and its sensitivity to change and other psychometric properties need now to be evaluated in clinical trials of hormone replacement in older men.
Collapse
Affiliation(s)
- Carolyn V McMillan
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
| | - Clare Bradley
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
| | | | | | | |
Collapse
|
48
|
Nord C, Bjøro T, Ellingsen D, Mykletun A, Dahl O, Klepp O, Bremnes RM, Wist E, Fosså SD. Gonadal hormones in long-term survivors 10 years after treatment for unilateral testicular cancer. Eur Urol 2003; 44:322-8. [PMID: 12932930 DOI: 10.1016/s0302-2838(03)00263-x] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether unilaterally orchiectomised testicular cancer survivors (TCSs) are more likely to display reduced Leydig cell function than healthy males. METHODS A national multi-centre survey of 1235 TCSs was performed in 1998-2000 (mean age: 44 years) treated between 1980 and 1994 (mean follow-up: 11 years). Serum hormone analyses were performed on 1183 TCSs, as 52 TCSs used androgen replacement (AR). TCSs were allocated to four treatment groups: Surgery only (251); Radiotherapy only (515); Chemotherapy 1, cisplatin </=850 mg (373); Chemotherapy 2, cisplatin >850 mg (96). The Controls were represented by 200 healthy blue-collar workers (mean age: 44 years). LH >12 IU/l and testosterone <8 nmol/l and the use of AR indicated hypogonadism. RESULTS Serum testosterone was similar in TCSs and Controls (16.9 vs.17.1 nmol/l), but TCSs had higher age-adjusted LH levels than the Controls (5.2 vs. 3.5 IU/l). LH increased with treatment intensity, but was elevated even in TCSs treated with surgery only. The age-adjusted odds ratio of hypogonadism was 3.8 (95%CI: 2.0-7.3) in TCSs, and increased with treatment intensity. CONCLUSION TCSs are at risk to develop pre-mature reduced Leydig cell function and hypogonadism. They may therefore be predisposed for the syndrome of androgen deficiency of aging males (ADAM).
Collapse
Affiliation(s)
- Carina Nord
- Department of Clinical Research, The Norwegian Radiumhospital, University Hospital, Montebello, 0310, Oslo, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
van der Lely AJ. Hormone use and abuse: what is the difference between hormones as fountain of youth and doping in sports? J Endocrinol Invest 2003; 26:932-6. [PMID: 14964448 DOI: 10.1007/bf03345246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
GH can induce changes in body composition that are considered to be advantageous to aging subjects especially. However, there are no results indicating that the use of GH during aging should be advocated, because of the lack of any proven efficacy for whatever parameter. Also, data indicate that calorie restriction can extend life spans by altering the rate of decline in reserve capacity as well as by reducing the cumulative exposure to GH. Moreover, animal data suggest that lower GH actions are positively correlated with longevity. The abuse of GH by sportsmen is based on the belief that it has potent anabolic effects, while it is difficult to detect the abuse. Again, this supposed efficacy cannot be supported by any scientific data.
Collapse
Affiliation(s)
- A J van der Lely
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
| |
Collapse
|
50
|
Abstract
Growth hormone (GH) is classically linked with linear growth in childhood but continues to have important metabolic actions throughout life. GH deficiency in adulthood causes a distinct syndrome with significant morbidities. These include increased total and visceral fat, decreased muscle mass and aerobic capacity, affective disturbances, abnormal lipids, and increased vascular mortality, all of which are ameliorated with GH replacement. The possibility of adult GH deficiency (AGHD) should always be considered in individuals with a history of childhood GH deficiency or significant hypothalamic-pituitary damage, and the diagnosis should then be confirmed by biochemical testing. Adult GH dosing is much lower than that in pediatric practice, as appropriate for physiologic reconstitution. Hormonal side effects are minimized by stepwise dose titration. Lingering concerns remain regarding the possibility of increased cancer risk with long-term treatment, but this hazard has not been unequivocally demonstrated. Compared with AGHD, there is much less information about GH replacement in other diseases or in normal aging, or about the use of supraphysiologic GH doses to treat catabolic states. In critical illness, high-dose GH therapy has proven clearly harmful, and the balance of risks and benefits of GH administration in most adult contexts other than AGHD has not been defined.
Collapse
Affiliation(s)
- David E Cummings
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, Washington 98108, USA.
| | | |
Collapse
|