Development of a Model of Functional Endocrine Age in Japanese People

Evaluating how much dutasteride actually reduces serum dihydrotestosterone level: A Reconsideration based on unexpected results from a study of treatment of benign prostatic hyperplasia with dutasteride

Objective:

This study aimed to evaluate the effect of dutasteride treatment of benign prostatic hyperplasia on serum steroidal sex hormones and prostate volume (PV).

Methods:

Thirty patients with benign prostate hyperplasia treated with dutasteride for one year were assessed for changes in PV and serum sex hormones (testosterone (T), dihydotestosterone (DHT), estradiol (E2) and dehydroepiandrosterone sulphate (DHEAS)). PV was measured by ultrasonography. A paired or unpaired t-test and Pearson’s correlation coefficient test were used for statistical analysis.

Results:

DHT and DHEAS decreased by 38.5% and 20.3%, respectively. On the contrary, T and E2 increased by 34.3% and 9.4%, respectively. PV and prostate-specific antigen decreased by 17.7% and 63.4%, respectively. The rate of decrease of DHT had a negative correlation with PV, and the rate of decrease of DHEAS had positive correlation with PV.

Conclusion:

DHT did not decrease as expected (previous studies showed a decrease of approximately 90%). However, DHEAS decreased more than a natural decrease. It is possible that the conversion from DHEAS to DHT, via the conversion to T, in the prostate was accelerated by the decrease of DHT, especially in larger prostates. However, this discrepancy cannot be full explained by the conversion from DHEAS to DHT, as mentioned above.

Level of evidence:

Level 2c

Cross-sectional analysis between prostate volumes and serum sex hormones in Japanese men attending a urological clinic

AIM

To evaluate epidemiologically the association between measured prostate volume and sex hormones.

METHODS

Between December 2012 and September 2014, 226 patients attending the urological clinic were assessed for the relationship between prostate volume (PV) and, serum sex hormones, physical size, personal habits, etc. Prostate volume was measured by using transabdominal ultrasonography. Statistically, the Pearson correlation coefficients test was used.

RESULTS

Total cases, the cases of PV ≤ 25 ml, and the cases of PV > 25 ml were evaluated respectively. Total cases and the cases of PV > 25 ml showed a positive significant correlation with testosterone (T), but the cases of PV ≤ 25 ml showed no such correlation. The cases of PV > 25 ml had a positive significant correlation with estradiol (E2), but total cases and cases of PV ≤ 25 ml did not. Dehydroepiandrosterone sulfate (DHEAS) showed no correlation with any case of PV, however it decreased significantly with age and had a correlation with alopecia. The E2/T ratio had no correlation with any case of PV, but on the other hand, the T/DHEAS and E2/DHEAS ratios had significant positive correlation with PV > 25 ml.

CONCLUSIONS

Serum T and E2 had significant positive correlation with measured PV especially in larger prostates. This result seems to correspond with the conventional theory that T and E2 have an etiological effect on benign prostatic hyperplasia. DHEAS did not show direct correlation with PV, however it appeared to suppress the role of T and E2 on benign prostatic hyperplasia growth. DHEAS might be a key to understanding the etiology of benign prostatic hyperplasia with aging.

Lower levels of insulin-like growth factor-1 standard deviation score are associated with histological severity of non-alcoholic fatty liver disease

AIM

Growth hormone (GH) deficiency may be associated with histological progression of non-alcoholic fatty liver disease (NAFLD) which includes non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Insulin-like growth factor 1 (IGF-1) is mainly produced by hepatocytes and its secretion is stimulated by GH. Our aim was to determine whether more histologically advanced NAFLD is associated with low circulating levels of IGF-1 in Japanese patients.

METHODS

Serum samples were obtained in 199 Japanese patients with biopsy-proven NAFLD and in 2911 sex- and age-matched healthy people undergoing health checkups. The serum levels of IGF-1 were measured using a commercially available immunoradiometric assay. The standard deviation scores (SDS) of IGF-1 according to age and sex were also calculated in NAFLD patients.

RESULTS

The serum IGF-1 levels in NAFLD patients were significantly lower (median, 112 ng/mL) compared with the control population (median, 121 ng/mL, P < 0.0001). IGF-1 SDS less than -2.0 SD from median were found in 11.6% of 199 patients. NASH patients exhibited significantly lower levels of IGF-1 SDS (n = 130; median, -0.7) compared with NAFL patients (n = 69; median, -0.3; P = 0.026). The IGF-1 SDS values decreased significantly with increasing lobular inflammation (P < 0.001) and fibrosis (P < 0.001). In multiple regressions, the association between the IGF-1 SDS values and the severity of NAFLD persisted after adjusting for age, sex and insulin resistance.

CONCLUSION

Low levels of circulating IGF-1 may have a role in the development of advanced NAFLD, independent of insulin resistance. Supplementation with GH/IGF-1 may be a candidate for the treatment of NASH.

[Significance of anti-aging medical checkups for the elderly]

AIM

The purpose of anti-aging medical checkups is to evaluate the functional age of the patient, aiming to prevent functional aging and rejuvenate the functional age. In this study, a comparison of the medical checkup results was conducted in elderly groups with different levels of activities of daily living (ADL).

METHODS

There were three groups of subjects; and an independent group that included 43 independently-living subjects (68.9±6.3 years) in the Kyoto Yurin area, a support-requiring group that included 31 subjects (77.8±7.2 years) routinely visiting a day care center and a nursing-requiring group that included 19 subjects (83.7±6.8 years) who were living in a medical care facility for the elderly. We conducted anti-aging medical checkups, and the following five factors were evaluated: muscle mass by the bioelectric impedance method (Physion MD), bone strength by an ultrasonic wave method (A-1000: Yokogawa, AOS-100NW: Aloka), fingertip pulse wave analysis (SDP-100: Fukuda), cognitive function (Wisconsin card sorting test) and the serum insulin-like growth factor-I and dehydroepiandrosterone-sulfate (DHEA-s) level. To calculate the functional age of the subjects, we used the Age Management Check (Ginga Kobo, Nagoya), and the Δage (functional age-chronological age) was analyzed and compared between the groups.

RESULTS

The functional ages in the independent group were muscle age, 55.5±7.0; blood vascular age, 65.4±8.5; neural age, 63.6±14.8; hormone age, 70.4±7.6 and bone age, 60.2±14.6 years. As a result of an increase in 1,506 daily steps based on walking instruction with pedometer monitoring, the subjects significantly improved their body weight, BMI, waist size, fasting plasma glucose level and serum DHEA-s in six months. By showing them their functional age, their motivation to participate in the health promotion program was increased, and the compliance was high, with an omission rate of less than 20% in 2.5 years. The support- and nursing-requiring groups showed muscle ages of 58.8±3.3 and 61.9±4.0, blood vascular ages of 75.5±12.6 and 71.8±11.1, neural ages of 86.5±8.8 and 88.5±5.8 and bone ages of 81.0±12.0 and 75.7±12.3, respectively. The Δage analysis in the three groups revealed that the Δneural age increased as the ADL decreased.

CONCLUSIONS

The Δage analysis indicated that the decreased ADL in the elderly may be mainly associated with their neural function in the factors examined. Anti-aging medical checkups are high in terms of their cost-performance ratio and are easily accepted by the elderly, and are thus recommended for elderly with all grades of ADL.