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Alemany M. The Metabolic Syndrome, a Human Disease. Int J Mol Sci 2024; 25:2251. [PMID: 38396928 PMCID: PMC10888680 DOI: 10.3390/ijms25042251] [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] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
This review focuses on the question of metabolic syndrome (MS) being a complex, but essentially monophyletic, galaxy of associated diseases/disorders, or just a syndrome of related but rather independent pathologies. The human nature of MS (its exceptionality in Nature and its close interdependence with human action and evolution) is presented and discussed. The text also describes the close interdependence of its components, with special emphasis on the description of their interrelations (including their syndromic development and recruitment), as well as their consequences upon energy handling and partition. The main theories on MS's origin and development are presented in relation to hepatic steatosis, type 2 diabetes, and obesity, but encompass most of the MS components described so far. The differential effects of sex and its biological consequences are considered under the light of human social needs and evolution, which are also directly related to MS epidemiology, severity, and relations with senescence. The triggering and maintenance factors of MS are discussed, with especial emphasis on inflammation, a complex process affecting different levels of organization and which is a critical element for MS development. Inflammation is also related to the operation of connective tissue (including the adipose organ) and the widely studied and acknowledged influence of diet. The role of diet composition, including the transcendence of the anaplerotic maintenance of the Krebs cycle from dietary amino acid supply (and its timing), is developed in the context of testosterone and β-estradiol control of the insulin-glycaemia hepatic core system of carbohydrate-triacylglycerol energy handling. The high probability of MS acting as a unique complex biological control system (essentially monophyletic) is presented, together with additional perspectives/considerations on the treatment of this 'very' human disease.
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Affiliation(s)
- Marià Alemany
- Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain
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Nguyen Hoai B, Hoang L, Nguyen Cao T, Pham Minh Q, A Jannini E. Testosterone and aging male, a perspective from a developing country. Aging Male 2023; 26:2223712. [PMID: 37335039 DOI: 10.1080/13685538.2023.2223712] [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: 04/16/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE Hypogonadism is associated with a wide range of physical and psychological symptoms that can affect the overall health of men. However, in a developing country, there are several imposing challenges in the diagnosis and treatment of hypogonadism, including a lack of awareness and understanding of the condition among healthcare providers and patients, limited resources and the high cost of treatment. This review aimed to examine the potential benefits and risks of testosterone replacement therapy (TRT) and provides a perspective of a developing country on the topic. MATERIALS AND METHODS A comprehensive literature review was conducted to gather relevant information on the impact of testosterone deficiency on ageing males and the effectiveness of TRT for treating hypogonadism. Published peer-reviewed articles were analyzed to evaluate the benefits and risks of TRT. Additionally, the unique challenges faced in the diagnosis and treatment of hypogonadism in a developing country were considered. RESULTS Testosterone replacement therapy has been shown to be an effective treatment for hypogonadism, particularly in symptomatic men with low testosterone levels. It offers potential benefits such as improvements in symptoms and overall quality of life. However, there are associated risks and side effects that need to be considered. In a developing country, challenges such as limited awareness and understanding of hypogonadism, resource constraints, and high treatment costs pose additional barriers to accessing TRT and comprehensive care. CONCLUSION In conclusion, TRT holds promise as a treatment for hypogonadism, but its implementation and accessibility face significant challenges in a developing country. Addressing these challenges, including raising awareness, allocating resources, and finding cost-effective solutions, is crucial for ensuring that men with hypogonadism in such settings receive appropriate diagnosis and treatment. Further research and efforts are needed to improve the management of hypogonadism in developing countries and optimize the potential benefits of TRT for affected individuals.
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Affiliation(s)
- Bac Nguyen Hoai
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Long Hoang
- Department of Urology, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Thang Nguyen Cao
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Quan Pham Minh
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Emmanuele A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), University of Rome Tor Vergata, Rome, Italy
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Yang HH, Tu SK, Chen HH, Hung CL, Kuo CW, Tsan YT, Chu WM, Lee MC, Liao CC. Testosterone Level Reduction Increases the 10-Year Risk of Cardiovascular Diseases: A Retrospective Cohort Study in a Taiwanese Young Male Population. Front Cardiovasc Med 2022; 9:869251. [PMID: 35498035 PMCID: PMC9047944 DOI: 10.3389/fcvm.2022.869251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Low testosterone levels are associated with increased risk of cardiovascular disease; however, most previous studies assessed the relationship of testosterone levels with a history of cardiovascular (CV) events rather than with CV risk prediction scores consequently neglecting the effect of testosterone on CV risk in healthy young individuals. The aim of this study was to investigate the relationship between testosterone levels and predict the 10-year risk of cardiovascular disease. This retrospective cohort study was conducted through a large medical health examination system in four metropolises in Taiwan. Two risk scores were used to predict the 10-year cardiovascular risk of participants: the Framingham Risk Score (FRS) (2008) and the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator (2013). Multivariate-adjusted logistic regression was used to calculate odds ratios (ORs) for the correlation of testosterone level reduction with the increase in predicted CV risk. We used the MJ Health Research Foundation database to collect reports of 125,414 individuals who underwent medical checkups between 2007 and 2016. The final sample size included 1,253 male participants. A reduction in testosterone level between two subsequent medical checkups was associated with higher CV risk estimated by the FRS and ASCVD Risk Estimator in young participants aged 30–49 years (OR = 0.804, 95% CI: 0.711–0.909, p < 0.01 and OR = 0.841, 95% CI: 0.742–0.953, p < 0.01, respectively). Reduction in total testosterone levels increases CV risk in men aged 30 to 49 years, while the CV risk is not influenced by low testosterone levels at baseline.
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Affiliation(s)
- Han-Hsuan Yang
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Professional Education and Continuing Studies, National Taiwan University, Taipei City, Taiwan
| | - Shih-Kai Tu
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
- Department of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Hsin-Hung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Chung Sheng Clinic, Nantou City, Taiwan
| | - Chia-Lien Hung
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - Chia-Wen Kuo
- Department of Medicine, National Defense Medical Center, Taipei City, Taiwan
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - Yu-Tse Tsan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Wei-Min Chu
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung City, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- College of Management, Chaoyang University of Technology, Taichung City, Taiwan
- *Correspondence: Meng-Chih Lee
| | - Chun-Cheng Liao
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
- Department of Medicine, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung City, Taiwan
- Chun-Cheng Liao
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Wang SK, Lee MC, Hung CL, Chen HH, Liao CC, Chiu YL. Association between hypertriglyceridemic waist phenotype and hypogonadism in Taiwanese adult men. PLoS One 2022; 17:e0265629. [PMID: 35320301 PMCID: PMC8942218 DOI: 10.1371/journal.pone.0265629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background Aging-related hypogonadism in men is related to the deterioration of overall health. Those with this disease rarely receive treatment. The hypertriglyceridemic waist (HTGW) phenotype is a tool for predicting abnormalities of cardiovascular metabolism. However, the relationship between the HTGW phenotype and hypogonadism remains undetermined. This study aimed to determine the association between HTGW phenotype and hypogonadism in different age groups. Methods Data of this cross-sectional study were obtained from MJ Health Screening Center in Taiwan from 2007 to 2016. The HTGW phenotype was divided into four categories based on whether the waist circumference (WC) and triglyceride levels were normal. WC of <90 cm and triglyceride level of <150 mg/dL were defined as normal. Hypogonadism was defined as a testosterone level of <300 ng/dL. Results Overall, 6442 male participants were divided into three age groups: <50, 50–64, and ≥65 years (n = 4135, 1958, and 349; age groups 1, 2, and 3, respectively). The overall prevalence of hypogonadism was 10.6%. In group 1, participants with HTGW (odds ratio, 1.98; 95% confidence interval (CI), 1.354–2.896) had a higher risk of hypogonadism than those with normal WC and normal triglyceride levels after adjustment for body mass index and fasting blood glucose level. In group 2, participants with HTGW (odds ratio, 1.873; 95% CI, 1.099–3.193) had an increased risk of hypogonadism after adjustment for body mass index, fasting blood glucose level, Cholesterol levels, high-density lipoprotein (HDL) levels, low-density lipoprptein (LDL) levels and smoking status. However, no relationship was observed between HTGW phenotype and hypogonadism in group 3. Conclusion HTGW phenotype was highly associated with hypogonadism in Taiwanese adult men. More attention should be paid to men aged <50 years with HTGW.
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Affiliation(s)
- Sheng-Kuang Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Medical Administrative Department, Taichung Army Forces General Hospital, Taichung, Taiwan
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- College of Management, Chaoyang University of Technology, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chia-Lien Hung
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Hsin-Hung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Law, Providence University, Taichung, Taiwan
- Chung Sheng clinic, Nantou, Taiwan
| | - Chun-Cheng Liao
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung, Taiwan
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (CCL); (YLC)
| | - Yu-Lung Chiu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (CCL); (YLC)
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Hsu PS, Hung CL, Tu SK, Chen HH, Yang DH, Liao CC. Waist Circumference Is More Closely Associated with Hypogonadism than Is Hyperglycemia, Independent of BMI in Middle-Aged Men. J Diabetes Res 2021; 2021:1347588. [PMID: 34966822 PMCID: PMC8712173 DOI: 10.1155/2021/1347588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION To evaluate whether waist circumference (WC) or hyperglycemia is more closely associated with hypogonadism in middle-aged men. Research Design and Methods. This cross-sectional study analyzed male participants under 65 years old from the MJ Health Screening Center in Taiwan from 2007 to 2016. Basic patient characteristics with relevant parameters were obtained. We used the chi-square test to perform a correlation analysis for HbA1c and WC between participants with and without hypogonadism. A one-way ANOVA with post hoc Scheffe's method was applied to compare the mean testosterone (T) among the HbAlc and WC groups (normal blood sugar with normal WC (NBSNW), abnormal blood sugar with normal WC (ABSNW), normal blood sugar with abnormal WC (NBSAW), and abnormal blood sugar with abnormal waist circumference (ABSAW)). RESULTS The 5,680 participants were divided into two groups based on the presence (n = 599) or absence of hypogonadism (n = 5,081), which was defined as total testosterone (TT) < 300 ng/dL. The mean TT of group NBSAW (443.71 ± 220.59 ng/dl) was significantly lower than that of group ABSNW (506.64 ± 191.08 ng/dl, p < 0.001). Moreover, the mean TT of group ABSAW (398.89 ± 146.24 ng/dl) was significantly lower than that of group ABSNW (506.64 ± 191.08 ng/dl, p < 0.001). The ORs after adjusting for BMI, TG, HDL, SBP, and DBP were statistically significant when comparing NBSAW vs. NBSNW (OR = 2.846; 95%CI = 2.266-3.575; p < 0.001), ABSNW vs. NDNW (OR = 1.693; 95%CI = 1.309-2.189; p < 0.001), and ABSAW vs. NBSNW (OR = 4.613; 95%CI = 3.634-5.856; p < 0.001). CONCLUSION The current study showed that WC should be the risk factor that is more closely associated with hypogonadism than hyperglycemia in middle-aged men.
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Affiliation(s)
- Po-Sheng Hsu
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Chia-Lien Hung
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Shih-Kai Tu
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Chung Sheng Clinic, Nantou, Taiwan
| | - Deng-Ho Yang
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Chun-Cheng Liao
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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