Advances in understanding gender difference in cardiometabolic disease risk

Gender differences in the association between changes in the atherogenic index of plasma and cardiometabolic diseases: a cohort study

OBJECTIVE

The relationship between changes in Atherogenic Index of Plasma (AIP) and cardiometabolic diseases (CMD) in middle-aged and elderly individuals remains unclear. This study aims to explore the association between changes in AIP and CMD.

METHODS

This study included 3,791 individuals aged over 45 years from CHARLS. Participants were divided into four groups using the K-Means clustering method. Cumulative AIP was used as a quantitative indicator reflecting changes in AIP. Differences in baseline data and CMD incidence rates among these four groups were compared. Multifactorial logistic regression models were used to assess the relationship between changes in AIP and CMD, and subgroup analysis and interaction tests were conducted to evaluate potential relationships between changes in AIP and CMD across different subgroups. Restricted cubic splines (RCS) were used to assess the dose-response relationship between cumulative AIP and CMD.

RESULTS

Changes in AIP were independently and positively associated with CMD. In males, the risk significantly increased in class4 compared to class1 (OR 1.75, 95%CI 1.12-2.73). In females, changes in AIP were not significantly associated with CMD. Cumulative AIP was positively correlated with CMD (OR 1.15, 95%CI 1.01-1.30), with significant gender differences in males (OR 1.29, 95%CI 1.07-1.55) and females (OR 1.03, 95%CI 0.87-1.23) (p for interaction = 0.042). In addition, a linear relationship was observed between cumulative AIP and CMD in male.

CONCLUSION

Substantial changes in AIP may increase the risk of CMD in middle-aged and elderly Chinese males. Dynamic monitoring of AIP is of significant importance for the prevention and treatment of CMD.

Stress-induced brain responses are associated with BMI in women

Overweight and obesity are associated with altered stress reactivity and increased inflammation. However, it is not known whether stress-induced changes in brain function scale with BMI and if such associations are driven by peripheral cytokines. Here, we investigate multimodal stress responses in a large transdiagnostic sample using predictive modeling based on spatio-temporal profiles of stress-induced changes in activation and functional connectivity. BMI is associated with increased brain responses as well as greater negative affect after stress and individual response profiles are associated with BMI in females (pperm < 0.001), but not males. Although stress-induced changes reflecting BMI are associated with baseline cortisol, there is no robust association with peripheral cytokines. To conclude, alterations in body weight and energy metabolism might scale acute brain responses to stress more strongly in females compared to males, echoing observational studies. Our findings highlight sex-dependent associations of stress with differences in endocrine markers, largely independent of peripheral inflammation.

New inflammatory biomarkers (lymphocyte and monocyte percentage to high-density lipoprotein cholesterol ratio and lymphocyte to monocyte percentage ratio) and their association with some cardiometabolic diseases : Results from a large Kurdish cohort study in Iran

BACKGROUND

The incidence of metabolic heart diseases has increased significantly in Middle Eastern countries such as Iran. The present study aimed to investigate the association between monocyte percentage to high-density cholesterol ratio (MHR), lymphocyte percentage to high-density cholesterol ratio (LHR), and lymphocyte to monocyte percentage ratio (LMR) and cardiometabolic diseases in a Kurdish population in the west of Iran.

METHODS

This study recruited 9803 individuals, 4728 (48.2%) were male and 5084 (51.8%) were female from Ravansar, Iran. All biomarkers were analyzed by the standard methods.

RESULTS

The prevalence of cardiometabolic diseases was higher in overweight/obese participants and increased with age. MHR and LHR increased significantly in cardiometabolic individuals compared with healthy controls. Individuals in the fourth quartiles of LHR and MHR had higher odds ratio (ORs) for metabolic syndrome (MetS) and diabetes mellitus (DM) than the first quartiles. The LMR had a statistical association with non-alcoholic fatty liver disease (NAFLD) ORs and FLI. Besides, all these associations were stronger for females, and increased physical activity decreased inflammatory biomarkers.

CONCLUSION

The present study showed MHR and LHR had significant associations with ORs of MetS and DM. Also, MHR and LHR had a significant positive correlation with cardiometabolic risk factors. The LMR only had a statistical association with NAFLD and fatty liver index (FLI). Besides, the strong correlation between inflammatory biomarkers and cardiometabolic risk factors in females might be relevant to higher fat accumulation and metabolic inflammation background, and lower physical activity.

The older, the less potential benefit for type 2 diabetes from weight control

BACKGROUND

Although moderate weight loss improves outcomes of type 2 diabetes mellitus (T2DM) in young and middle-aged adults, there is a lack of high-quality evidence to support the strong relationship between obesity and T2DM in older people. This study aims to investigate whether the association of obesity with T2DM changes with aging.

METHODS

In this cross-sectional study, we recruited 63,180 Chinses and US subjects from 3 datasets. Subjects were divided into young & middle-aged (≤59 years), young-old (60-75 years), and old-old (≥75 years). Logistic regression was used to determine the odds ratio (OR) and 95% confidence intervals (95% CI) for the association between obesity and T2DM, stratified by common confounders. A sliding-window based algorithm and restricted cubic splines were used to smoothly estimate the changes with aging.

RESULTS

The OR (95% CI) for the associations between general obesity and T2DM were decreased from the young & middle-aged group (OR, 5.91; 95% CI, 5.33-6.56) to the young-old group (OR, 3.98; 95% CI, 3.56-4.45) and then to the old-old group (OR, 3.06; 95% CI, 2.57-3.66). The trend for this reduced association with aging persisted after stratification by obesity type, region, gender, recruiting time, hypertension, and hyperlipidemia in both Chinese and Americans. We also identified a weakened gender disparity for this association between the young & middle-aged subjects (P for disparity < 0.001) and the old-old group (P for disparity = ~ 0.36).

CONCLUSIONS

The obesity-T2DM association is clearly reduced with aging, which indicates that the elderly may gain fewer potential benefits in weight lose than the younger patients. Considering this attenuated association, as well as the increased incidence of geriatric syndrome in the elderly, clinicians should comprehensively balance the benefits and side effects of weight loss in geriatric T2DM interventions.

Melatonin delays ovarian aging in mice by slowing down the exhaustion of ovarian reserve

Studies have shown that melatonin (MLT) can delay ovarian aging, but the mechanism has not been fully elucidated. Here we show that granulosa cells isolated from mice follicles can synthesize MLT; the addition of MLT in ovary culture system inhibited follicle activation and growth; In vivo experiments indicated that injections of MLT to mice during the follicle activation phase can reduce the number of activated follicles by inhibiting the PI3K-AKT-FOXO3 pathway; during the early follicle growth phase, MLT administration suppressed follicle growth and atresia, and multiple pathways involved in folliculogenesis, including PI3K-AKT, were suppressed; MLT deficiency in mice increased follicle activation and atresia, and eventually accelerated age-related fertility decline; finally, we demonstrated that prolonged high-dose MLT intake had no obvious adverse effect. This study presents more insight into the roles of MLT in reproductive regulation that endogenous MLT delays ovarian aging by inhibiting follicle activation, growth and atresia.

Chronic hypoxaemia and gender status modulate adiponectin plasmatic level and its multimer proportion in severe COPD patients: new endotypic presentation?

BACKGROUND

Disease progression in COPD patient is associated to lung function decline, leading to a higher risk of hypoxaemia and associated comorbidities, notably cardiovascular diseases (CVD). Adiponectin (Ad) is an adipokine with cardio-protective properties. In COPD patients, conflicting results were previously reported regarding Ad plasmatic (Adpl) level, probably because COPD is a heterogeneous disease with multifactorial influence. Among these factors, gender and hypoxaemia could interact in a variety of ways with Ad pathway. Therefore, we postulated that these components could influence Adpl level and its multimers in COPD patients and contribute to the appearance of a distinct endotype associated to an altered CVD risk.

METHODS

One hundred COPD patients were recruited: 61 were men and 39 were women. Patients who were not severely hypoxemic were allocated to non-hypoxemic group which included 46 patients: 27 men and 19 women. Hypoxemic group included 54 patients: 34 men and 20 women. For all patients, Adpl level and proportion of its different forms were measured. Differences between groups were evaluated by Rank-Sum tests. The relationship between these measures and BMI, blood gas analysis (PaO2, PaCO2), or lung function (FEV1, FEV1/FVC, TLCO, TLC, RV) were evaluated by Pearson correlation analysis.

RESULTS

Despite similar age, BMI and obstruction severity, women had a higher TLC and RV (median: TLC = 105%; RV = 166%) than men (median: TLC = 87%; RV = 132%). Adpl level was higher in women (median = 11,152 ng/ml) than in men (median = 10,239 ng/ml) and was negatively associated with hyperinflation (R = - 0,43) and hypercapnia (R = - 0,42). The proportion of the most active forms of Ad (HMW) was increased in hypoxemic women (median = 10%) compared with non-hypoxemic women (median = 8%) but was not modulated in men.

CONCLUSION

COPD pathophysiology seemed to be different in hypoxemic women and was associated to Ad modulations. Hyperinflation and air-trapping in association with hypercapnia and hypoxaemia, could contribute to a modulation of Adpl level and of its HMW forms. These results suggest the development of a distinct endotypic presentation, based on gender.

The association between transition from metabolically healthy obesity to metabolic syndrome, and incidence of cardiovascular disease: Tehran lipid and glucose study

Considering that the data available on the cardiovascular (CV) risk of metabolically healthy obesity phenotype, and the effect of transition to an unhealthy status are inconsistent, the aim of this study was to investigate the possible role of transition to unhealthy status among metabolically healthy overweight/obese (MHO) subjects on CVD incidence over a median follow-up of 15.9 years. In this large population-based cohort, 6758 participants (41.6% men) aged ≥ 20 years, were enrolled. Participants were divided into 4 groups based on their obesity phenotypes and follow-up results, including persistent metabolically healthy normal weight (MHNW), persistent MHO, transitional MHO and metabolically unhealthy overweight/obese (MUO). Metabolic health was defined as not having metabolic syndrome based on the Joint Interim Statement (JIS) criteria. Multivariable adjusted hazard ratios (HRs) were calculated for cardiovascular events. During follow-up, rate of CVD Incidence per 1000 person-years were 12 and 7 in males and females, respectively. Multivariable adjusted HRs (CI 95%) of CVD incidence among males and females were 1.37 (.78–2.41) and .85 (.34–2.15) in persistent MHO group, 1.55 (1.02–2.37) and .93 (.41–2.12) in transitional MHO group and 2.64 (1.89–3.70) and 2.65 (1.24–5.68) in MUO group. Our findings showed that CVD risk did not increase in the persistent MHO phenotype over a 15.9-year follow-up in both sexes. However, transition from MHO to MUO status during follow-up increased the CVD risk just in male individuals. Further studies are needed to provide conclusive evidence in favor of benign nature of transitional MHO phenotype in females.

Risk factors for developing into critical COVID-19 patients in Wuhan, China: A multicenter, retrospective, cohort study

BACKGROUND

The ferocious global assault of COVID-19 continues. Critically ill patients witnessed significantly higher mortality than severe and moderate ones. Herein, we aim to comprehensively delineate clinical features of COVID-19 and explore risk factors of developing critical disease.

METHODS

This is a Mini-national multicenter, retrospective, cohort study involving 2,387 consecutive COVID-19 inpatients that underwent discharge or death between January 27 and March 21, 2020. After quality control, 2,044 COVID-19 inpatients were enrolled. Electronic medical records were collected to identify the risk factors of developing critical COVID-19.

FINDINGS

The severity of COVID-19 climbed up straightly with age. Critical group was characterized by higher proportion of dyspnea, systemic organ damage, and long-lasting inflammatory storm. All-cause mortality of critical group was 85•45%, by contrast with 0•58% for severe group and 0•18% for moderate group. Logistic regression revealed that sex was an effect modifier for hypertension and coronary heart disease (CHD), where hypertension and CHD were risk factors solely in males. Multivariable regression showed increasing odds of critical illness associated with hypertension, CHD, tumor, and age ≥ 60 years for male, and chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), tumor, and age ≥ 60 years for female.

INTERPRETATION

We provide comprehensive front-line information about different severity of COVID-19 and insights into different risk factors associated with critical COVID-19 between sexes. These results highlight the significance of dividing risk factors between sexes in clinical and epidemiologic works of COVID-19, and perhaps other coronavirus appearing in future.

FUNDING

10.13039/100000001 National Science Foundation of China.

High manganese exposure decreased the risk of high triglycerides in workers: a cross-sectional study

Background

Manganese (Mn) participates in lipid metabolism. However, the associations between Mn exposure and dyslipidaemia is unclear.

Methods

This was a cross-sectional study. Data were collected from the 2017 the Mn-exposed workers healthy cohort (MEWHC). Finally, 803 occupationally Mn-exposed workers included in the study. The workers were divided into two groups. The grouping of this study was based on Mn-Time Weighted Averages (Mn-TWA). The high-exposure group included participants with Mn-TWA greater than 0.15 mg/m³. The low-exposure group included participants with Mn-TWA less than or equal to 0.15 mg/m³. Mn-TWA levels and dyslipidaemia were assessed.

Results

After adjustment for seniority, sex, cigarette consumption, alcohol consumption, high-fat diet frequency, medicine intake in the past two weeks, egg intake frequency, drinking tea, WHR, and hypertension, Mn-TWA levels was negatively correlated with high triglycerides (TG) risk in workers overall (OR = 0.51; 95% CI: 0.36, 0.73; p <  0.01). The results of males and females were consistent (OR = 0.53; 95% CI: 0.34, 0.81; p <  0.01) and (OR = 0.47; 95% CI: 0.24, 0.94; p <  0.01), respectively. By performing interactions analyses of workers overall, we observed no significant interactions among confounders. Mn-TWA levels and pack-years on high TG risk (relative excess risk for the interactions (RERI = 2.29, 95% CI: − 2.07, 6.66), (RERI) = 2.98, 95% CI: − 2.30, 8.26). Similarly, smoking status, drinking status, high-fat diet frequency, and Waist-to-Hip Ratio (WHR) showed non-significant interactions with Mn-TWA levels on high TG risk.

Conclusions

This research indicates that high Mn exposure was negatively related to high TG risk in workers.

Sex-Specific Differences in the Association of Metabolically Healthy Obesity With Hyperuricemia and a Network Perspective in Analyzing Factors Related to Hyperuricemia

BACKGROUND

Although obesity is a well-known risk factor for hyperuricemia, it remains unclear whether obese subjects with metabolically healthy status have a decreased the risk of hyperuricemia and whether sex modifies the association of metabolically healthy obesity (MHO) with hyperuricemia risk. We aimed to investigate the sex-specific association between MHO and other obesity phenotypes and hyperuricemia, and to use Bayesian networks to determine and visualize the interactions among hyperuricemia and its related factors.

METHODS

This study was conducted using data from the China Health and Nutrition Survey 2009. Hyperuricemia was defined as serum uric acid ≥ 420 μmol/L in men and ≥ 360 μmol/L in women according to the guidelines. Body mass index (BMI) was used to define normal weight, overweight, and obese status in subjects, and metabolic health state was defined by the Adult Treatment Panel (ATP)-III and Visceral Adiposity Index (VAI) criteria, respectively. Subjects were categorized into six phenotypes according to their metabolic health and BMI level status.

RESULTS

Of the 7,364 Chinese adult individuals included, the prevalence of hyperuricemia among MHO women was only 8.5% (95% CI 4.8 to 14.3%), but increased to 30.7% among MUO women, whereas the highest prevalence among men was found in the MUOW phenotype (39.4%, 95% CI 35.4 to 43.6%), compared to 15.4% for male subjects with MHO. After adjusting for confounders, the MHO phenotype was significantly associated with an increased risk of hyperuricemia compared with their MHNW counterparts in women (OR: 1.95, 95% CI: 1.02-3.74) whereas a significant association was not found in men (OR: 1.46, 95% CI: 0.8-2.68). A complex network structure was established by BNs and then used to find connections between hyperuricemia and its related factors, as well as their interrelationships. By using BN reasoning, the probability of having hyperuricemia was 0.076 among MHO men, while it reached 0.124 in MHO women.

CONCLUSIONS

In conclusion, our results demonstrated that the MHO phenotype was significantly associated with the risk of hyperuricemia only in women, not in men. This sex-specific differences in the association may suggest a favorable condition of MHO for Chinese men with respect to hyperuricemia risk, meanwhile more attention should be paid to the increased risk of hyperuricemia among MHO women.

Repeated superovulation increases the risk of osteoporosis and cardiovascular diseases by accelerating ovarian aging in mice

Superovulation procedures and assisted reproductive technologies have been widely used to treat couples who have infertility problems. Although generally safe, the superovulation procedures are associated with a series of complications, such as ovarian hyper-stimulation syndrome, thromboembolism, and adnexal torsion. The role of long-term repeated superovulation in ovarian aging and especially in associated disorders such as osteoporosis and cardiovascular diseases is still unclear. In this study, we sought to determine if repeated superovulation by ten cycles of treatment with pregnant mare serum gonadotropin/human chorionic gonadotropin could affect ovarian reserve, ovarian function, bone density and heart function. Ovarian reserve and function were reflected by the size of the primordial follicle pool, anti-Mullerian hormone expressions, hormone levels and fertility status. Furthermore, we examined bone density and heart function by microCT and cardiovascular ultrasonography, respectively. After repeated superovulation, the size of the primordial follicle pool and the expression of anti-mullerian hormone decreased, along with the concentrations of estrogen and progesterone. Mice exposed to repeated superovulation showed an obvious decrease in fertility and fecundity. Furthermore, both bone density and heart ejection fraction significantly decreased. These results suggest that repeated superovulation may increase the risk of osteoporosis and cardiovascular diseases by accelerating ovarian aging.

Does gender influence cardiovascular remodeling in C57BL/6J mice fed a high-fat, high-sucrose and high-salt diet?

Animal models are widely used to study the physiopathology of human diseases. However, the influence of gender on modern society diet style-induced cardiovascular disease has not thus far been explored in these models. Thus, this study investigated cardiovascular remodelling in C57BL/6J mice fed a diet rich in saturated fat, sucrose and salt, evaluating gender effect on this process. Male and female C57BL/6J mice were fed AIN93M diet or a modified AIN93M rich in fat, sucrose and salt (HFSS) for 12 weeks. Body mass, water and food intake and cardiovascular remodelling were assessed. The HFSS diet did not lead to body mass gain or glucose metabolism disturbance as assessed by serum glucose, insulin and oral glucose tolerance test. However, female mice on a HFSS diet had increased visceral and subcutaneous adiposity. Only male mice displayed heart hypertrophy. The left ventricle was not hypertrophied in either male or female mice, but its lumen was dilated. Intramyocardial arteries and the thoracic aorta showed media thickening in male mice, but in the female it was only observed in the thoracic aorta. Finally, intramyocardial artery dilation was present in both genders, but not in the aorta. Therefore changes in LV dimensions and arterial remodelling were influenced by both gender and the HFSS diet. In conclusion, male and female C57BL/6J mice suffered cardiovascular remodelling after 12 weeks of HFSS feeding, although they did not develop obesity or diabetes. Sexual dimorphism occurred in response to diet for body adiposity, heart hypertrophy and intramyocardial artery remodelling.

Determinants of metabolic syndrome in obese workers: gender differences in perceived job-related stress and in psychological characteristics identified using artificial neural networks

OBJECTIVE

The metabolic syndrome (MS) is a multifactorial disorder associated with a higher risk of developing cardiovascular diseases and type 2 diabetes. However, its pathophysiology and risk factors are still poorly understood. In this study, we investigated the associations among gender, psychosocial variables, job-related stress and the presence of MS in a cohort of obese Caucasian workers.

METHODS

A total of 210 outpatients (142 women, 68 men) from an occupational medicine service was enrolled in the study. Age, BMI, waist circumference, fasting glucose, blood pressure, triglycerides and HDL cholesterol were collected to define MS. In addition, we evaluated eating behaviors, depressive symptoms, and work-related stress. Data analyses were performed with an artificial neural network algorithm called Auto Semantic Connectivity Map (AutoCM), using all available variables.

RESULTS

MS was diagnosed in 54.4 and 33.1% of the men and women, respectively. AutoCM evidenced gender-specific clusters associated with the presence or absence of MS. Men with a moderate occupational physical activity, obesity, older age and higher levels of decision-making freedom at work were more likely to have a diagnosis of MS than women. Women with lower levels of decision-making freedom, and higher levels of psychological demands and social support at work had a lower incidence of MS but showed higher levels of binge eating and depressive symptomatology.

CONCLUSION

We found a complex gender-related association between MS, psychosocial risk factors and occupational determinants. The use of these information in surveillance workplace programs might prevent the onset of MS and decrease the chance of negative long-term outcomes.

LEVEL OF EVIDENCE

Level V, observational study.

Can ovarian aging be delayed by pharmacological strategies?

Aging has been regarded as a treatable condition, and delaying aging could prevent some diseases. Ovarian aging, a special type of organ senescence, is the earliest-aging organ, as ovaries exhibit an accelerated rate of aging with characteristics of gradual declines in ovarian follicle quantity and quality since birth, compared to other organs. Ovarian aging is considered as the pacemaker of female body aging, which drives the aging of multiple organs of the body. Hence, anti-ovarian aging has become a research topic broadly interesting to both biomedical scientists and pharmaceutical industry. A marked progress has been made in exploration of possible anti-ovarian agents or approaches, such as calorie restriction mimetics, antioxidants, autophagy inducers etc., over the past years. This review is attempted to discuss recent advances in the area of anti-ovarian aging pharmacology and to offer new insights into our better understanding of molecular mechanisms underlying ovarian aging, which might be informative for future prevention and treatment of ovarian aging and its related diseases.

High-normal thyroid-stimulating hormone in euthyroid subjects is associated with risk of mortality and composite disease endpoint only in women

INTRODUCTION

The aim of the study was to evaluate whether serum thyroid-stimulating hormone (TSH) within the normal range in euthyroid subjects (having normal free triiodothyronine (fT3) and thyroxine (fT4)) is related to the risk of overall mortality or a composite endpoint of death and nonfatal events.

MATERIAL AND METHODS

In 614 middle-aged adult hospital screenees, free of uncontrolled diabetes at baseline, the association of sex-specific TSH tertiles with death was prospectively assessed using Cox regression, with the composite endpoint assessed using logistic regression in adjusted analyses, stratified by gender.

RESULTS

In total, 64 deaths and additional incident nonfatal events in 141 cases were recorded at a mean 7.55 years' follow-up. Multivariable linear regression revealed TSH to be significantly associated among men with age (p = 0.006), but in women inversely with fT3 and fT4 (p < 0.001, and p = 0.024 respectively). In logistic regression analysis, adjusted for age, fT3, fT4, systolic blood pressure and serum total cholesterol, sex-specific baseline TSH tertiles were associated in men neither with the risk of death nor with composite endpoint. In contrast, in women, the highest compared with the bottom TSH tertile predicted the risk of composite endpoint (relative risk: 2.02, 95% CI: 1.07-3.82) and, much more strongly, the mortality risk, independently of fT4 increments.

CONCLUSIONS

The significant association of higher range of normal serum TSH in euthyroid middle-aged adults with the risk of death and nonfatal adverse outcomes in women alone cannot be accounted for by the action of thyroid hormone and is consistent with involvement of TSH in the pro-inflammatory state.

Dietary ALA, EPA and DHA have distinct effects on oxylipin profiles in female and male rat kidney, liver and serum

There is much data on the effects of dietary n-3 fatty acids on tissue fatty acid compositions, but comparable comprehensive data on their oxygenated metabolites (oxylipins) is limited. The effects of providing female and male rats with diets high in α-linolenic acid (ALA), EPA or DHA for 6 weeks on oxylipins and fatty acids in kidney, liver and serum were therefore examined. The oxylipin profile generally reflected fatty acids, but it also revealed unique effects of individual n-3 fatty acids that were not apparent from fatty acid data alone. Dietary ALA increased renal and serum DHA oxylipins even though DHA itself did not increase, while dietary EPA did not increase DHA oxylipins in kidney or liver, suggesting that high EPA may inhibit this conversion. Oxylipin data generally corroborated fatty acid data that indicated that DHA can be retroconverted to EPA and that further retroconversion to ALA is limited. Dietary n-3 fatty acids decreased n-6 fatty acids and their oxylipins (except linoleic acid and its oxylipins), in order of effectiveness of DHA > EPA > ALA, with some exceptions: several arachidonic acid oxylipins modified at carbon 15 were not lower in all three sites, and EPA had a greater effect on 12-hydroxy-eicosatetraenoic acid and its metabolites in the liver. Oxylipins were predominantly higher in males, which was not reflective of fatty acids. Tissue-specific oxylipin profiles, therefore, provide further information on individual dietary n-3 fatty acid and sex effects that may help explain their unique physiological effects and have implications for dietary recommendations.

Female sex hormones are necessary for the metabolic effects mediated by loss of Interleukin 18 signaling

OBJECTIVE

Interleukin (IL)-18 plays a crucial role in maintaining metabolic homeostasis and levels of this cytokine are influenced by gender, age, and sex hormones. The role of gender on IL-18 signaling, however, is unclear. We hypothesized that the presence of female sex hormone could preserve the metabolic phenotype of the IL-18R^-/- animals.

METHODS

We studied female mice with a global deletion of the α isoform of the IL-18 receptor (IL-18R^-/-) and littermates control. Three studies were done: 1) animals fed a high fat diet (HFD) for 16 weeks; 2) animals fed chow diet for 72 weeks and 3) animals (3 weeks-old) randomized to either bilateral ovariectomy (OVX) or control surgery (SHAM) and followed for 16 weeks.

RESULTS

Female IL-18R^-/- mice gained less weight and maintained glucose homeostasis on a chow diet compared with HFD, but no differences between genotypes were observed. The maintenance of body weight and glucose homeostasis in IL-18R^-/- mice was lost with aging. By 72 weeks of age, IL-18R^-/- mice became heavier compared with WT mice due to an increase in both visceral and subcutaneous adiposity and displayed glucose intolerance. OVX did not affect body weight in IL-18R^-/- mice but exacerbated glucose intolerance and impaired liver insulin signaling when compared with SHAM mice.

CONCLUSIONS

Female mice harboring a global deletion of the IL-18R, only present the same phenotype as reported in male IL-18R^-/- mice if they are aged or have undergone OVX, in which circulating estrogen is likely to be blunted. The role of estrogen signaling in the protection against altered metabolic homeostasis in IL-18R^-/- mice appears to be mediated by liver insulin signaling. We therefore suggest that the metabolic effects mediated by loss of IL-18 signaling are only present in a female sex hormone free environment.

Population-based serum omentin-1 levels: paradoxical association with cardiometabolic disorders primarily in men

AIM

The conflicting relationships of serum omentin with inflammation markers and cardiometabolic disorders were investigated. Results & methods: Unselected 864 population-based middle-aged adults were cross-sectionally studied by sex-specific omentin tertiles. Men in the lowest omentin tertile (T1) had lower systolic blood pressure, HbA1c and glucose values and tended in T3 to higher lipoprotein(a) levels. Logistic regression analysis, adjusted for four covariates, revealed significant independent associations with the presence of hypertension and diabetes only in men. Sex- and age-adjusted odds ratio in gender combined for T2 & T3 versus T1 was 1.34 (95% CI: 1.00-1.79) for metabolic syndrome.

DISCUSSION & CONCLUSION

The elicited adverse relationships of omentin-1 support the notion of oxidative stress-induced proinflammatory conversion of omentin, rendering loss of anti-inflammatory properties.

Sex-dependent independent prediction of incident diabetes by depressive symptoms

OBJECTIVE

To study the predictive value of depressive symptoms (DeprSs) in a general population of Turkey for type 2 diabetes.

METHODS

Responses to three questions served to assess the sense of depression. Cox regression analyses were used regarding risk estimates for incident diabetes, after exclusion of prevalent cases of diabetes. Mean follow-up consisted of 5.15 (±1.4) years.

RESULTS

Depressive symptoms were present at baseline in 16.2% of the whole study sample, threefold in women than men. Reduced physical activity grade was the only significant covariate at baseline in men, while younger age and lower blood pressure were significantly different in women compared with those without DeprS. In men, presence of DeprS predicted incident diabetes at a significant 2.58-fold relative risk (95% confidence interval 1.03; 6.44), after adjustment for age, systolic blood pressure, and antidepressant drug usage. When further covariates were added, waist circumference remained the only significant predictor, while DepS was attenuated to a relative risk of 2.12 (95% confidence interval 0.83; 5.40). DeprS was not associated with diabetes in women, whereas antidepressant drug usage only tended to be positively associated.

CONCLUSION

Gender difference existed in the relationship between DeprS and incident diabetes. DeprS predicted subsequent development of diabetes in men alone, not in women. Copyright © 2016 John Wiley & Sons, Ltd.

Associations of Fasting Blood Glucose with Influencing Factors in Northeast China: A Quantile Regression Analysis

Background: Diabetes mellitus (DM) has become a major public health problem in China. Although a number of researchers have investigated DM risk factors, little is known about the associations between values of fasting blood glucose (FBG) and influencing factors. This study aims to explore these associations by the quantile regression (QR) model. Methods: A cross-sectional survey based on a sample of 23,050 adults aged 18 to 79 years was conducted in Jilin in 2012, and some subjects were excluded due to missing values with respect to necessary variables or having glycemic control, in accordance with the purposes of this study. Finally, in total 14,698 people were included in this study. QR was performed to identify the factors influencing the level of FBG in different quantiles of FBG. Results: The distribution of FBG status was different between males and females (χ² = 175.30, p < 0.001). The QR model provided more detailed views on the associations of FBG with different factors and revealed apparent quantile-related patterns separately for different factors. Body mass index (BMI) was positively associated with the low and middle quantiles of FBG. Waist circumference (WC) had a positive association with the high quantiles of FBG. Conclusions: FBG had a positive association with BMI in normal FBG, and a positive association with WC in high FBG. Diet and alcohol intake were associated with FBG in normal FBG. FBG was more likely to be elevated in the elderly, female workers, and people with family history of DM.

Associations of Blood Pressure with the Factors among Adults in Jilin Province: A Cross-Sectional Study Using Quantile Regression Analysis

Hypertension has become a major public health challenge. However, numerous research results reported in the literature focus primarily on risk factors of hypertension, little is known about how the whole continuum of blood pressure (BP) is associated with risk factors of hypertension. This study aims to reveal quantile-specific associations of BP with its risk factors. A cross-sectional survey based on a sample of 23,050 adults aged 18 to 79 years was conducted in Jilin Province in 2012, and some subjects were excluded due to missing values in BP or having BP control according to the purpose of this study. Quantile regression (QR) was employed to investigate the associations between systolic/diastolic blood pressure (SBP/DBP) and the risk factors. The SBP and DBP in males presented statistically higher than females (P < 0.001). High-salt diet for males manifested a slightly increasing positive association with higher SBP only for high quantiles (≥70), but with a higher DBP for middle part of the quantiles (30~75), compared with bland diet. High-salt diet, drinking and high-density lipoprotein cholesterol (HDL-C) were positively associated with BP measures in males. And the coefficient of total cholesterol (TC) in QR increased with BP in females who used to live in town.

Dietary LA and sex effects on oxylipin profiles in rat kidney, liver, and serum differ from their effects on PUFAs

A vast literature on fatty acids in mammals exists, but comparable compositional data on oxylipins is lacking. Weanling Sprague-Dawley rats were therefore provided control diets or diets with higher linoleic acid (LA) or with higher LA and α-linolenic acid (LA+ALA) for 6 weeks. Kidneys, livers, and serum were analyzed for oxylipins and fatty acids. The proportion of tissue oxylipins derived from LA was greater than the relative proportion of LA itself, whereas arachidonic acid (AA) oxylipins were overrepresented in serum. Higher dietary LA increased kidney LA and AA oxylipins, despite not altering LA or AA. In liver, both LA and AA and their oxylipins were higher, whereas in serum only LA oxylipins were higher with higher dietary LA. Higher LA resulted in a higher ratio of n-6/n-3 PUFA-derived oxylipins; adding ALA to the LA diet mitigated this and many, but not all, effects of the LA diet. Approximately 40% of oxylipins detected were influenced by sex and, unlike their PUFA precursors, most (>90%) of these were higher in males. These differences in dietary LA and sex on oxylipin and fatty acid profiles further our understanding of the effects of fatty acids and may have implications for dietary LA recommendations.

Little contribution of conventional factors in an algorithm to predicting death risk in Turkish adults

OBJECTIVE

Determinants of risk of death are highly relevant for the management strategy of individuals. We aimed to determine an algorithm for predicting risk of death in Turkish adults who have a high prevalence of metabolic syndrome (MetS).

METHODS

Nine-year risk of death was estimated in 3348 middle-aged adults, followed over 8.81±4.2years. Cox proportional hazard regression was used to predict risk of death. Discrimination was assessed using C-statistics.

RESULTS

Death occurred in 565 subjects. In multivariable analysis, high-density lipoprotein (HDL) and non-HDL cholesterol levels were not predictive in either sex; in women, current smoking was also not predictive. Age, presence of diabetes, systolic blood pressure ≥160mmHg and low physical activity were predictors in both sexes, beyond smoking status in men. Exclusion of coronary disease at baseline did not change risk estimates materially. Using an algorithm of the stated 7 variables showed an 11- to 18-fold spread in the absolute risk of dying among individuals in the highest than in the lowest of 4 risk score categories. C-statistics of the model using age alone was 0.790 in men, 0.808 in women (p<0.001 each), while the incorporation of 6 conventional risk factors contributed to C-index was >0.020 in males and 0.009 in females.

CONCLUSIONS

In a middle-aged population with prevalent MetS, serum lipoproteins and, in women, smoking status, were not relevant for the risk of death. The contribution of conventional risk factors beyond age to estimating risk of death was modest among Turkish men, and little in women in whom autoimmune activation is operative.

The Role of Sex and Sex Hormones in Regulating Obesity-Induced Inflammation

Metabolic and non-metabolic complications due to obesity are becoming more prevalent, yet our understanding of the mechanisms driving these is not. This is due to individual risk factor variability making it difficult to predict disease outcomes such as diabetes and insulin resistance. Gender is a critical factor in obesity outcomes with women having more adiposity but reduced metabolic complications compared to men. The role of immune system activation during obesity is an emerging field that links adiposity to metabolic syndrome. Furthermore, evidence from animal models suggests that sex differences exist in immune responses and, therefore, could be a possible mechanism leading to sex differences in metabolic disease. While there is still much to learn in the area of sex-differences research, this chapter will review the current knowledge and literature detailing the role of sex and sex hormones on adiposity and metabolically induced inflammation in obesity.

Dietary intake of manganese and the risk of the metabolic syndrome in a Chinese population

Animal studies have suggested that Mn might be associated with some components of the metabolic syndrome (MetS). A few epidemiological studies have assessed dietary Mn intake and its association with the risk of the MetS and its components among Chinese adults. In this study, we assessed daily dietary Mn intake and its relationship with MetS risk among Chinese adults in Zhejiang Province using data from the 5th Chinese National Nutrition and Health Survey (2010–2012). A total of 2111 adults were included. Dietary Mn intake was assessed using 3-d 24-h dietary recalls; health-related data were obtained by questionnaire surveys, physical examinations and laboratory assessments. The mean intake of Mn was 6·07 (sd 2·94) mg/d for men (n 998) and 5·13 (sd 2·65) mg/d for women (n 1113). Rice (>42 %) was the main food source of Mn. The prevalence of the MetS was 28·0 % (590/2111). Higher Mn intake was associated with a decreased risk of the MetS in men (Q4 v. Q1 OR 0·62; 95 % CI 0·42, 0·92; P_trend=0·043) but an increased risk in women (Q4 v. Q1 OR 1·56; 95 % CI 1·02, 2·45; P_trend=0·078). In addition, Mn intake was inversely associated with abdominal obesity (P_trend=0·016) and hypertriacylglycerolaemia (P_trend=0·029) in men, but positively associated with low HDL-cholesterol in both men (P_trend=0·003) and women (P_trend<0·001). Our results suggest that higher Mn intakes may be protective against the MetS in men. The inverse association between Mn intake and the MetS in women might be due to the increased risk for low HDL-cholesterol.

Sexually dimorphic myeloid inflammatory and metabolic responses to diet-induced obesity

It is well known in clinical and animal studies that women and men have different disease risk as well as different disease physiology. Women of reproductive age are protected from metabolic and cardiovascular disease compared with postmenopausal women and men. Most murine studies are skewed toward the use of male mice to study obesity-induced metabolic dysfunction because of similar protection in female mice. We have investigated dietary obesity in a mouse model and have directly compared inflammatory responses in males and females. In this review we will summarize what is known about sex differences in diet-induced inflammation and will summarize our data on this topic. It is clear that sex differences in high-fat diet-induced inflammatory activation are due to cell intrinsic differences in hematopoietic responses to obesogenic cues, but further research is needed to understand what leads to sexually dimorphic responses.