Obesity and Decreased Hormone Production

Researchers writing in the medical journal Clinical Endocrinology say that “Obesity may predict greater decline in testosterone and SHBG levels with age.”

Derby CA, Zilber S, Brambilla D, Morales KH, McKinlay JB. Body mass index, waist circumference and waist to hip ratio and change in sex steroid hormones: the Massachusetts Male Ageing Study. Clin Endocrinol (Oxf). 2006 Jul 1;65(1):125-31.

From the study abstract:
Objective Cross-sectional data suggest that obesity, particularly central obesity, may be associated with decreased production of sex steroid hormones in men. However, longitudinal hormone data on men in relation to obesity status are limited. Previous studies have not consistently demonstrated whether sex steroids are associated specifically to body mass index or to measures of central obesity.

Our objective was to examine the relation of obesity and of central obesity to longitudinal change in sex steroid hormones in men.

Measurements Free and total testosterone (FT and TT), dehydroepiandrosterone sulphate (DHEAS), and sex hormone-binding globulin (SHBG) were assessed using standardized methods. Health behaviours and medical history were obtained by structured interview.

Repeated measures regression was used to describe trends in steroid hormones and SHBG in relation to obesity status, adjusting for age, smoking, alcohol, comorbidities, and physical activity.

Results: Obesity was associated with decreased levels of total and free testosterone, and of SHBG at follow-up relative to baseline. For any given baseline concentration of TT, FT or SHBG, follow-up levels were lowest among men who remained obese or who became obese during follow-up.

This was true for all three indices of obesity. Central adiposity was associated with lower DHEAS levels at follow-up, while elevated body mass index was not.

Conclusions: Obesity may predict greater decline in testosterone and SHBG levels with age. Central adiposity may be a more important predictor of decline in DHEAS than is body mass index.

Exercise, Diabetes, Diabetes Risk

Researchers writing in the Medical Journal Diabetes Care say patients may need more convincing that exercise assists in diabetes management and diabetes risk management.

From the study abstract:
“With increased focus on the obesity and diabetes epidemics, and the clear benefit of exercise in disease prevention and management, this study determined the lifetime prevalence of health professional advice to exercise among individuals with or at risk for diabetes.

A total of 73% of adults with diabetes were told by a health professional to exercise more versus 31% of adults without diabetes. The proportion receiving advice increased as the number of diabetes risk factors increased until reaching similar rates as people with diabetes.

Health professionals advised most patients with or at highest risk for diabetes to exercise, suggesting recognition of its importance for disease management. As risk factors declined, fewer patients were advised to exercise, suggesting missed opportunities for disease prevention. However, exercise has not increased proportional to exercise advice. The challenge remains converting patient awareness into behavior change.”

Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Are Health Care Professionals Advising Patients With Diabetes or At Risk for Developing Diabetes to Exercise More? Diabetes Care 29:543-548, 2006

Click for article abstract

You May Need To Exercise More To Avoid Fat Accumulation Associated With Aging

Researchers publishing in the journal Clinical Nutrition say: “Cross-sectional data have shown that sarcopenia (age associated muscle loss) and fat accumulation are associated with aging and can be limited by structured physical training. However, it is often difficult to maintain a long-term compliance to training programs. It is not clear whether leisure-time physical activity is effective in preventing sarcopenia and fat accumulation.

CONCLUSIONS: Mild but significant decline in muscle mass and its TBK (Total Body Potassium) content, and body fat accumulation were observed over a 3-year period in healthy elderly subject: leisure-time physical activity does not seem to prevent them. However, a higher level of physical activity is associated with higher muscle mass and TBK content, and less total and truncal fat.” Read the abstract

Raguso CA, Kyle U, Kossovsky MP, Roynette C, Paoloni-Giacobino A, Hans D, Genton L, Pichard C. A 3-year longitudinal study on body composition changes in the elderly: Role of physical exercise. Clin Nutr. 2005 Dec 2

Researchers examine the role of exercise on anxiety, depression and quality of life in seniors

Depression, anxiety and quality of life scores in seniors after an endurance exercise program.

Antunes HK, Stella SG, Santos RF, Bueno OF, Mello MT.Rev Bras Psiquiatr. 2005 Dec;27(4):266-271.

Writing in the medical journal Revista Brasileira de Psiquiatria, researchers sought to examine 46 sedentary seniors aged 60-75. The seniors were divided into two groups. One group began an aerobic exercise regiment, the other group (the control group) did not.

The researchers stated from the study abstract: “Mood disorders are a frequent problem in old age, and their symptoms constitute an important public health issue. These alterations affect the quality of life mainly by restricting social life. The participation in a regular exercise program is an effective way of reducing or preventing the functional decline associated with aging.”

“Comparing the groups after the study period, we found a significant decrease in depressive and anxiety scores and an improvement in the quality of life in the experimental group, but no significant changes in the control group.”

Read Entire Article

Decreased Testosterone and ED

Researchers writing in the Journal of Urology say that their study clearly demonstrated a decrease in testosterone level throughout a 4-year follow up in patients with ED.

El-Sakka AI, Hassoba HM. Age related testosterone depletion in patients with erectile dysfunction. J Urol. 2006 Dec;176(6):2589-93.

PURPOSE: We assessed the pattern of age related testosterone depletion in patients with erectile dysfunction.

MATERIALS AND METHODS: A total of 305 patients with erectile dysfunction who had a normal testosterone level at baseline visit and who completed the study were candidates for analysis. Erectile function was assessed using the International Index of Erectile Function. Patients underwent routine laboratory investigations plus total testosterone and prolactin assessment at the baseline visit and on a yearly basis for 4 years.

RESULTS: The mean age +/- SD was significantly higher in 210 patients with decreased testosterone (55.3 +/- 7.3 years) than in 95 patients with steady testosterone (remaining within the normal range) (50.8 +/- 10.2 years).

There was a significant decrease in yearly mean testosterone level throughout the study in all the age groups (determined by decades) older than 30 years.

Of the study population 68.9% had decreases in testosterone levels throughout the 4 years of visits.

Hypogonadism (testosterone lower than normal range) developed in 7.6% of the study population.

There was a significant decrease in mean testosterone at any visit in comparison to previous visits.

There were significant associations between decreased levels of testosterone and increased severity of erectile dysfunction at baseline visit, longer duration and poor metabolic control of diabetes, ischemic heart disease, hyperprolactinemia and low desire.

CONCLUSIONS: This study clearly demonstrated a decrease in testosterone level throughout the 4-year followup in patients with erectile dysfunction. Patients with decreasing testosterone were older than patients with a steady testosterone level.

Hip Fracture in High Risk Groups

Researchers writing in the Journal of Postgraduate Medicine say “prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.”

Peng EW, Elnikety S, Hatrick NC. Preventing fragility hip fracture in high risk groups: an opportunity missed. Postgrad Med J. 2006 Aug;82(970):528-31

From the study abstract:
OBJECTIVE: The national guideline recommends selective case finding as the main strategy by identification of high risk people. This study assessed whether high risk patients were identified before their presentation with fragility fracture.

METHODS: A prospective study for 3.5 consecutive months on patients with low energy hip fractures to Brighton and Sussex University Hospital NHS Trusts, which serves a population of 460,000. Data were collected by interview using standardised form, medical record review, and communication with family physicians.

Definition of high risk:
(1) untreated hypogonadism
(2) corticosteroid users
(3) disorders with increased bone loss
(4) previous fragility fractures.

RESULTS: 98 patients were admitted with hip fracture. Thirty nine (40%) had at least one high risk factor. High risk patients (7 of 39, 18%) were no more likely to receive prophylaxis compared with patients without high risk factor (5 of 59, 8%) (p = 0.21). Previous fragility fracture (23) was the commonest risk factor followed by disorders with increased bone loss (10), premature menopause (10), and corticosteroid users (5). Fifteen patients (15%) had susceptibility to frequent falls and two had maternal history of osteoporosis. The proportion of treated patients were 20% (2 of 10) in premature menopause, 10% (1 of 10) in diseases with secondary osteoporosis, 13% (3 of 23) in previous fragility fracture, and 80% (4 of 5) in corticosteroid users (p = 0.01)

CONCLUSION: Prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.

Aging Men and Their Hormones

Writing in the medical journal Minerva Ginecologica, researchers say that “The ability to maintain active and independent living for as long as possible is a crucial factor for (aging healthfully)” and that “Interventions such as hormone replacement therapy may alleviate the debilitating conditions of secondary partial endocrine deficiencies by preventing the preventable and delaying the inevitable.”

Lunenfeld B. Endocrinology of the aging male. Minerva Ginecol. 2006 Apr;58(2):153-70.

From the study abstract:
“Despite enormous medical progress during the past few decades, the last years of life are still accompanied by increasing ill health and disability.

The ability to maintain active and independent living for as long as possible is a crucial factor for ageing healthily and with dignity. The most important and drastic gender differences in aging are related to the reproductive organs. In distinction to the course of reproductive ageing in women, with the rapid decline in sex hormones expressed by the cessation of menses, men experience a slow and continuous decline. This decline in endocrine function involves: a decrease of testosterone, dehydroepiandrosterone (DHEA), oestrogens, thyroid stimulating hormone (TSH), growth hormone (GH), IGF1, and melatonin.

The decrease of sex hormones is concomitant with a temporary increase of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In addition sex hormone binding globulins (SHBG) increase with age resulting in further lowering the concentrations of free biologically active androgens.

These hormonal changes are directly or indirectly associated with changes in body constitution, fat distribution (visceral obesity), muscle weakness, osteopenia, osteoporosis, urinary incontinence, loss of cognitive functioning, reduction in well being, depression, as well as sexual dysfunction.

The laboratory and clinical findings of partial endocrine deficiencies in the aging male will be described and discussed in detail. With the prolongation of life expectancy both women and men today live 1/3 of their life with endocrine deficiencies. Interventions such as hormone replacement therapy may alleviate the debilitating conditions of secondary partial endocrine deficiencies by preventing the preventable and delaying the inevitable.”

Article Notes:
Luteinizing hormone is produced in the pituary gland and helps regulate the production of testosterone.
Follicle-stimulating hormone is produced in the pituary gland and helps regulate the production of sperm.

Predicting Mortality: Researchers Have A Formula

Lee SJ, Lindquist K, Segal MR, Covinsky KE, Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults. JAMA. 2006;295:801-808.

From the Journal of the American Medical Association (JAMA)
ABSTRACT: “Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.

Objective: To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.

Results:…Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and (being male), 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk….

Conclusion: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.

Aging

Researchers look at what makes people age successfully
Factors associated with the successful aging of the socially-active elderly in the metropolitan region of Porto Alegre. Rev Bras Psiquiatr. 2005 Dec;27(4):302-308. Moraes JF, Souza VB.

Writing in the medical journal Revista Brasileira de Psiquiatria, researchers studied some of the inhabitants of the metropolitan region of the Brazialian city Porto Alegre. What they sought to do was “identify the factors associated with aging of the socially-active elderly in the metropolitan region of Porto Alegre.” Read more

Predicting Mortality: Researchers Have A Formula
From the Journal of the American Medical Association (JAMA)
ABSTRACT: “Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment. Read more

Researchers Say Marital Strain Can Affect Aging
You make me sick: marital quality and health over the life course. Umberson D, Williams K, Powers DA, Liu H, Needham B.J Health Soc Behav. 2006 Mar;47(1):1-16.

From the press release of the American Sociological Association:
“Researchers have found that marital strain accelerates the typical decline in self-rated physical health that occurs over time and that this adverse effect is greater at older ages. As men and women age, they become increasingly vulnerable to marital stress, according to a team of sociologists from the University of Texas-Austin and Ohio State University. Their findings appear in an article on marital quality and health over the life course in this month’s Journal of Health and Social Behavior, a publication of the American Sociological Association.”

Click here to go to our links page for the press release from American Sociological Association

Aging Men and Their Hormones
Writing in the medical journal Minerva Ginecologica, researchers say that “The ability to maintain active and independent living for as long as possible is a crucial factor for (aging healthfully)” and that “Interventions such as hormone replacement therapy may alleviate the debilitating conditions of secondary partial endocrine deficiencies by preventing the preventable and delaying the inevitable.”

Why Do Some People Age Healthily and Happily, While others do not?
Coping with Stress and Adversity May Be A Key

Arizona State University researchers will begin a five year study to examine how “factors of risk and resilience contribute to health and well-being.” Read more

Thyroid Research

Selected research:
Hypothyroidim, quality of life and mental health
Larisch R, Kley K, Nikolaus S, et al. Depression and anxiety in different thyroid function states. Horm Metab Res. 2004 Sep;36(9):650-3

Study purpose: The researchers stated: “Previous studies on hypothyroid subjects have indicated serious psychiatric symptoms affecting the patients’ quality of life. The present prospective cross-sectional study’s aim was to examine these symptoms in thyroid patients with different functional states.”

They noted: “Hypothyroidism represents a widely underestimated functional condition that may severely affect mental health.”

Cognitive function
Prinz PN, Scanlan JM, Vitaliano PP, et al. Thyroid hormones: positive relationships with cognition in healthy, euthyroid older men. J Gerontol A Biol Sci Med Sci. 1999 Mar;54(3):M111-6.

Study: The researchers acknowledged the well know link between hypothyroidism and cognitive function. What they sought to uncover was thyroid levels and cognitive function in elderly men with “normal” thyroid function.

The Researchers stated: “Our data suggest that older subjects may require circulating thyroid hormones in middle to high levels in order to maintain optimal brain function.”

Heart Disease
Klein I, Ojamaa K. Thyroid hormone treatment of congestive heart failure. Am J Cardiol. 1998;81:443-7.

Study: An editorial discussing the effects of hypothyroidism on heart disease with special emphasis on T3.

T3 and T4 Supplementation
Hennemann G, Docter R, Visser TJ, et al. Thyroxine plus low-dose, slow-release triiodothyronine replacement in hypothyroidism: proof of principle. Thyroid 2004;14:271-275

Study: Examination of the effects of T4 and T3 supplementation in hypothyroid patients.

The researchers noted: “In the study reported here we show that treatment of hypothyroid subjects with a combination of T(4) plus slow-release T(3) leads to a considerable improvement of serum T(4) and T(3) values, the T(4)/T(3) ratio and serum TSH as compared to treatment with T(4)- only. Serum T(3) administration with slow-release T(3) did not show serum peaks, in contrast to plain T(3).”

Subclinical thyroid disease
Elte JW, Mudde AH, Nieuwenhuijzen Kruseman AC. Subclinical thyroid disease. Postgrad Med J. 1996;72:141-6

Study: A review article on the “clinical effects, prognostic significance and the need for and response to therapy,” of subclinical thyroid disease.

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