Vascular Dysfunction among Malaysian Men with Increased BMI: An Indication of Synergistic Effect of Free Testosterone and Inflammation

Background and objectives: Obesity is associated with poor vascular function and may lead to future cardiovascular disease (CVD). Obesity is also related to increased inflammation and a low testosterone level. This study was conducted to determine the relationship between inflammation, testosterone level, and vascular function among subjects with an increased body mass index (BMI) and to determine whether both low testosterone and high inflammation have synergistic effects towards vascular dysfunction. Materials and Methods: A total of 303 men aged 40–80 years were recruited from Klang Valley, Malaysia. Their height, weight, blood pressure (BP), lipid, blood glucose level, total testosterone (TT), free testosterone (FT), and C-reactive protein (CRP) were measured. The carotid femoral pulse wave velocity (PWVCF) and augmentation index (AI) were also recorded as markers of vascular function. Results: The mean age of all the subjects was 54.46 ± 9.77 years. Subjects were divided into a low/normal body mass index (BMI) group (BMI < 25 kg/m2; NG, n = 154) and high BMI group (BMI ≥ 25 kg/m2; OG, n = 149). The mean BMI for NG was 22.20 ± 1.94 kg/m2 while for OG was 28.87 ± 3.24 kg/m2 (p < 0.01). The level of TT (OG = 21.13 ± 6.44 versus NG = 16.18 ± 6.16 nmol/L, p < 0.01) and FT (OG = 0.34 ± 0.12 versus NG = 0.39 ± 0.11 nmol/L, p < 0.01) were reduced while the level of CRP [OG = 1.05 (2.80) versus NG = 0.50 (1.50) mmol/L, p = 0.01] was increased in OG compared to NG. PWVCF (OG = 8.55 ± 1.34 versus NG = 8.52 ± 1.42 m/s, p = 0.02) and AI (OG = 16.91% ± 6.00% versus 15.88% ± 5.58%, p < 0.01) were significantly increased in OG after adjustment for other CVD risk factors. The subjects that had both a low FT and an increased CRP had higher AI when compared to those with a high CRP and high FT (p < 0.01). Conclusions: The increased BMI was associated with vascular dysfunction, mediated by a low testosterone level and increased inflammation. Furthermore, having both conditions concurrently lead to higher vascular dysfunction. Weight loss, testosterone supplementation, and the anti-inflammatory agent may be beneficial for men to prevent vascular dysfunction.

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Relationship of high density lipoprotein cholesterol with total and free testosterone and sex hormone binding globulin

Acta Endocrinologica ◽

10.1530/acta.0.1040253 ◽

1983 ◽

Vol 104 (2) ◽

pp. 253-256 ◽

Cited By ~ 54

Author(s):

R. F. Heller ◽

M. J. Wheeler ◽

J. Micallef ◽

N. E. Miller ◽

B. Lewis

Keyword(s):

Body Mass Index ◽

High Density Lipoprotein ◽

Body Mass ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Free Testosterone ◽

Sex Hormone ◽

Sex Hormone Binding Globulin ◽

Total Testosterone ◽

Hormone Binding

Abstract. A cross-sectional study was performed to see if the previously described association between high density lipoprotein (HDL) cholesterol and plasma total testosterone concentration reflected a relationship with free testosterone or with sex hormone binding globulin (SHBG). In 295 employed middle-aged men, measurements were made of total testosterone and SHBG in serum and of testosterone in saliva, and also of plasma total and HDL cholesterol, plasma triglycerides and other factors which might influence HDL cholesterol levels such as body mass index, alcohol and smoking habits and thyroid hormone levels. In a multiple regression analysis using the GLIM package programme total testosterone concentrations had a persistent positive association with HDL cholesterol (t = 3.5, P < 0.001) – this association was independent of SHBG (which had a negative association with HDL: t = −1.8, P <0.07. The association of HDL cholesterol with testosterone was independent of and stronger than the association of HDL cholesterol with body mass index, alcohol intake and cigarette smoking. Salivary testosterone (a measure of the circulating free hormone) also had a positive independent association with HDL cholesterol. The relationship between HDL cholesterol and testosterone thus appears to reflect an association with circulating hormone levels rather than with the hormone binding globulin.

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Relationship between body mass index and osteoporosis

Medicinski pregled ◽

10.2298/mpns16s1085m ◽

2016 ◽

Vol 69 (suppl. 1) ◽

pp. 85-88

Author(s):

Radmila Matijevic ◽

Vladimir Harhaji ◽

Srdjan Ninkovic ◽

Zoran Gojkovic ◽

Predrag Rasovic ◽

...

Keyword(s):

Bone Mineral Density ◽

Body Mass Index ◽

Body Mass ◽

Bone Mineral ◽

Dual Energy ◽

Normal Body Mass Index ◽

Mineral Density ◽

X Ray ◽

T Score ◽

The Mean

Introduction. Osteoporosis is a metabolic skeletal disease characterized by bone mineral density reduction, which may lead to an increased risk of bone fractures. Obesity is a condition of excessive body fat that causes or aggravates many public health problems. As it is easy to be measured, body mass index is widely used as an index of the degree of obesity. Material and Methods. The study included 1.372 female orthopedic patients between the ages of 30 to 79 years who visited the Clinical Centre of Vojvodina in Novi Sad to have a dual-energy x-ray absorptiometry (DEXA) examination in the period from March, 2010 to June, 2013. The following anthropometric data were collected: body mass index, body weight, height, dual-energy x-ray absorptiometry T-score and bone mineral density (BMD), as well as some other data. Results. The mean age was 62.08 years, the mean weight was 73.59 kg and the mean height was 1.6 m. There were 392 participants in the group of normal body mass index, 14 participants were underweight, and 966 were overweight and obese. In the overweight and obese group, 25.25% participants had osteoporosis, 35.4% had osteopenia and 39.33% had the normal T-score. In the normal body mass index group, 42.34% of the participants had osteoporosis, 29.3% had osteopenia and 28.31 had the normal T-score. In the underweight group, 57.14% of the participants had osteoporosis, 21.42% had osteopenia and 21.42% had the normal T-score. Conclusion. No strong correlation between body mass index and bone mineral density was found in our study, but it is obvious that there was a stronger correlation between body mass index and bone mineral density of the total hip than between body mass index and bone mineral density of the lumbar spine.

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Metabolic clearance rate of testosterone in male epileptic patients on anti-convulsant therapy

Journal of Endocrinology ◽

10.1677/joe.0.1290465 ◽

1991 ◽

Vol 129 (3) ◽

pp. 465-468 ◽

Cited By ~ 11

Author(s):

M. J. Wheeler ◽

B. K. Toone ◽

A. Dannatt ◽

P. B. C. Fenwick ◽

S. Brown

Keyword(s):

Clearance Rate ◽

Patient Population ◽

Free Testosterone ◽

Sex Hormone Binding Globulin ◽

Total Testosterone ◽

Metabolic Clearance ◽

Metabolic Clearance Rate ◽

Testosterone Concentration ◽

The Mean ◽

Low Testosterone

ABSTRACT There are several reports which state that male epileptics on anti-convulsant therapy have reduced sexual activity. We and others have shown that, although total testosterone is raised, the free testosterone concentration is reduced in this patient population. This could be a result of an increased metabolic clearance rate (MCR) of testosterone, inadequate secretion of LH to stimulate testosterone synthesis or inappropriately low testosterone production by the Leydig cells. We have examined these possibilities by measuring the MCR of testosterone in 15 male epileptics on anti-convulsant therapy. In this group of patients, the mean LH (9·3±5·9 IU/l) and sex-hormone binding globulin (SHBG) (54·5±22·9 nmol/l) concentrations were significantly greater than those of five normal control subjects (4·7±1·11 IU/l and 26·0 ±7·0 nmol/l respectively). Mean total testosterone concentrations of the two groups were not significantly different but the mean percentage of free testosterone and free testosterone concentration were significantly lower in the patient population (2·06±0·43 vs 2·98±0·27 and 0·56±1·1 vs 0·79±0·7 pmol/l). The MCR of testosterone was significantly lower in the patients (773±322 vs 1354±443 1/day) and showed a positive correlation with the percentage of free testosterone. Therefore, our results suggest that the lowered free testosterone in male epileptics on anti-convulsant therapy is not due to an increased MCR of testosterone. The increased LH concentration suggests primary hypogonadism. This, in turn, could be responsible for low free testosterone levels in the presence of normal testosterone. Journal of Endocrinology (1991) 129, 465–468

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Influence of Body Mass Index and Total Testosterone Level on Biochemical Recurrence Following Radical Prostatectomy

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hym162 ◽

2008 ◽

Vol 38 (2) ◽

pp. 129-133 ◽

Cited By ~ 7

Author(s):

S.-i. Hisasue ◽

M. Yanase ◽

T. Shindo ◽

H. Iwaki ◽

F. Fukuta ◽

...

Keyword(s):

Body Mass Index ◽

Radical Prostatectomy ◽

Body Mass ◽

Testosterone Level ◽

Biochemical Recurrence ◽

Total Testosterone

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The Association of Testosterone Levels with Overall Sleep Quality, Sleep Architecture, and Sleep-Disordered Breathing

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-2622 ◽

2008 ◽

Vol 93 (7) ◽

pp. 2602-2609 ◽

Cited By ~ 78

Author(s):

Elizabeth Barrett-Connor ◽

Thuy-Tien Dam ◽

Katie Stone ◽

Stephanie Litwack Harrison ◽

Susan Redline ◽

...

Keyword(s):

Body Mass Index ◽

Sleep Apnea ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Older Men ◽

Sleep Efficiency ◽

Total Testosterone ◽

Testosterone Levels ◽

Low Testosterone ◽

Disordered Breathing

Abstract Context: Little is known about the association of low endogenous testosterone levels and abnormal sleep patterns in older men, although pharmacological doses of testosterone are associated with increased severity of sleep apnea and other sleep disturbances. Objective: The objective of the study was to examine the association between serum testosterone levels with objectively measured sleep characteristics. Design: This was a cohort study. Setting: Community-dwelling men aged 65 yr or older from six clinical centers in the United States participated in the study. Participants and Main Outcome Measures: A total of 1312 men had baseline total testosterone levels measured in 2000–2002, followed 3.4 yr later by 72-h (minimum) actigraphy and one-night in-home polysomnography to assess sleep duration, sleep fragmentation, and sleep apnea. Analyses were performed by quartile of total testosterone and categorically defined low vs. higher total testosterone (<250 ng/dl vs. ≥250 ng/dl). Lifestyle and body size were covariates. Results: Total testosterone levels were unrelated to age or duration of sleep. Men with lower testosterone levels had lower sleep efficiency, with increased nocturnal awakenings and less time in slow-wave sleep as well as a higher apnea-hypopnea index and more sleep time with O2 saturation levels below 90%. Low testosterone levels were associated with overweight, and all significant associations were attenuated or absent after adjusting for body mass index or waist circumference. In a post hoc analysis in men with higher body mass index (>27 kg/m2), testosterone was significantly associated with more periods awake after sleep onset and lower sleep efficiency. Conclusion: Low total testosterone levels are associated with less healthy sleep in older men. This association is largely explained by adiposity. Clinical trials are necessary to determine whether body weight acts directly or indirectly (via low testosterone) in the causal pathway for sleep-disordered breathing in older men.

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KEJADIAN PENYAKIT HIPERTENSI DAN INDEKS MASSA TUBUH PADA PEREMPUAN YANG TINGGAL DI PEDESAAN DAN PERKOTAAN

Jurnal Kesehatan Kusuma Husada ◽

10.34035/jk.v10i2.388 ◽

2019 ◽

pp. 127-136

Author(s):

Venti Agustina

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Body Mass ◽

Rural Women ◽

Urban Areas ◽

Stage I ◽

Normal Body Mass Index ◽

Cross Sectional ◽

Normal Body ◽

Stadium I

Hipertensiadalah penyebab kematian utama di Indonesia. Kematian akibat hipertensi lebih banyak terjadi di perkotaan dibandingkan di desa. Tingginya kejadian hipertensi dipengaruhi oleh faktor yang dapat dikontrol (obesitas,berat badan lebih, konsumsi garam berlebih,aktivitas fisik rendah, perokok, dan konsumsi alkohol) dan faktor yang tidak dapat dikontrol (genetik, usia, dan jenis kelamin). Penelitian bertujuan memberikan gambarandistribusi tekanan darah dan indeks massa tubuh (IMT) pendudukperempuan di kota maupun di desa.Desain penelitian adalah deskriptif kuatitatif dengan pendekatan cross sectional. Data primer didapatkan melalui pengukuran tekanan darah, tinggi badan dan berat badan. Penelitian dilakukan di Desa Kutowinangun Kidul, Kecamatan Tingkir,Salatiga yang mewakili penduduk perempuan di perkotaan dan Desa Batur, Kecamatan Getasan, Kabupaten Semarangyang mewakili penduduk perempuan pedesaan. Adapun jumlah sampel masing-masing 66 respondendan 72responden. Hasil penelitian menunjukkan bahwa kejadian penyakit hipertensi, resiko obese dan obese lebih didominasi oleh respondendi perkotaan dibandingkan di pedesaan dengan rentang usia di atas 46 tahun. Respondendi desa dengan indeks massa tubuh normal cenderung mengalami pre-hipertensi (8,3%) dan hipertensi stadium I (6,9%) sementararesponden dengan resiko obese dan obese cenderung mengalami hipertensi stadium I (1,4%).Respondendi kota dengan indeks massa tubuh normal cenderung mengalami pre hipertensi (6,06%), hipertensi stadium I (4,5%) dan II (7,5%). Responden dengan resiko obese cenderung mengalami hipertensi stadium I (4,5%), dan responden dengan obese I dan II cenderung mengalami pre-hipertensi (4,5%). Hypertension is the leading cause of death in Indonesia. Deaths due to hypertension are more common in urban areas than in villages. The high incidence of hypertension is influenced by factors that can be controlled (obesity, overweight, excessive salt consumption, low physical activity, smokers, and alcohol consumption) and factors that cannot be controlled (genetic, age, and sex). The study aimed to provide an overview of blood pressure distribution and body mass index (BMI) of female residents in cities and villages. The study design was descriptive quantitative with a cross sectional approach. Primary data was obtained through measurements of blood pressure, height and weight. The study was conducted in Kutowinangun Kidul Village, Tingkir Subdistrict, Salatiga representing women in urban areas and Batur Village, Getasan Subdistrict, Semarang Regency, representing rural women. The number of samples was 66 respondents and 72 respondents respectively. The results showed that the incidence of hypertension, the risk of obese and obese was more dominated by respondents in urban areas than in rural areas with ages above 46 years. Respondents in villages with normal body mass index tended to experience pre-hypertension (8.3%) and stage I hypertension (6.9%) while respondents with obese and obese risk tended to experience stage I hypertension (1.4%). Respondents in cities with normal body mass index tended to experience pre-hypertension (6.06%), stage I hypertension (4.5%) and II (7.5%). Respondents with obese risk tended to experience stage I hypertension (4.5%), and respondents with obese I and II tended to experience pre-hypertension (4.5%).

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Five-year Outcomes of Sleeve Gastrectomy: A Prospective Multicenter study

The American Surgeon ◽

10.1177/0003134821991984 ◽

2021 ◽

pp. 000313482199198

Author(s):

Imad El Moussaoui ◽

Etienne Van Vyve ◽

Hubert Johanet ◽

André Dabrowski ◽

Arnaud Piquard ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Sleeve Gastrectomy ◽

Body Mass ◽

Excess Weight Loss ◽

Prospective Multicenter Study ◽

Weight Loss Failure ◽

Obstructive Sleep ◽

The Mean ◽

Predictors Of Weight Loss

Background Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in the world. Our purpose was to evaluate the percentage of excess weight loss (%EWL), resolution of obesity-related comorbidities after SG, and identify predictive factors of weight loss failure. Methods A prospective cohort study of adults who underwent SG during 2014 in 7 Belgian-French centers. Their demographic, preoperative, and postoperative data were prospectively collected and analyzed statistically. Results Overall, 529 patients underwent SG, with a mean preoperative weight and body mass index (BMI) of 118.9 ± 19.9 kg and 42.9 ± 5.5 kg/m2, respectively. Body mass index significantly decreased to 32.2 kg/m2 at 5 years ( P < .001). The mean %EWL was 63.6% at 5 years. A significant reduction in dyslipidemia (28.0%-18.2%), obstructive sleep apnea (OSAS) (34.6%-25.1%), and arterial hypertension (HTN) (30.4%-21.5%) was observed after 5 years, but not for diabetes and gastroesophageal reflux disease (GERD). At multivariate analysis, age >50 years old, BMI >50 kg/m2, and previous laparoscopic adjustable gastric banding (LAGB) remained independent predictors of weight loss failure. Conclusions Five years after SG, weight loss was satisfactory; the reduction of comorbidities was significant for dyslipidemia, OSAS, and HTN, but not diabetes and GERD. Age >50 years old, BMI >50 kg/m2, and previous LAGB were independent predictors of weight loss failure.

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Minimum 2-Year Outcomes of All-Arthroscopic Capsular Autograft Labral Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00242 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0024

Author(s):

Michael Kucharik ◽

Paul Abraham ◽

Mark Nazal ◽

Nathan Varady ◽

Wendy Meek ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Donor Site ◽

Donor Site Morbidity ◽

Labral Tear ◽

Labral Repair ◽

Inclusion Criteria ◽

The Mean ◽

Tönnis Grade

Objectives: Acetabular labral tears distort the architecture of the hip and result in accelerated osteoarthritis and increases in femoroacetabular stress. Uncomplicated tears with preserved, native fibers can be fixed to acetabular bone using labral repair techniques, which have shown improved outcomes when compared to the previous gold standard, labral debridement and resection. If the tear is complex or the labrum is hypoplastic, labral reconstruction techniques can be utilized to add grafted tissue to existing, structurally intact tissue or completely replace a deficient labrum. The ultimate goal is to reconstruct the labrum to restore the labral seal and hip biomechanics. Clinical outcomes using autografts and allografts from multiple sources for segmental and whole labral reconstruction have been reported as successful. However, reconstruction using autografts has been associated with substantial donor-site morbidity. More recently, all-arthroscopic capsular autograft labral reconstruction has been proposed as a way to repair complex or irreparable tears without the downside of donor-site morbidity. Since all-arthroscopic capsular autograft labral reconstruction is a novel technique, there is limited data in the literature on patient outcomes. The purpose of this study is to report outcomes in patients who have undergone this procedure at a minimum 2-year follow-up. Methods: This is a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral repair by a senior surgeon between December 2013 and May 2017. Patients who failed at least 3 months of conservative therapy and had a symptomatic labral tear on magnetic resonance angiography (MRA) were designated for hip arthroscopy. The inclusion criteria for this study were adult patients age 18 or older who underwent arthroscopic labral repair with capsular autograft labral reconstruction and completion of a minimum 2-year follow-up. Intraoperatively, these patients were found to have a labrum with hypoplastic tissue (width < 5 mm), complex tearing, or frank degeneration of native tissue. Patients with lateral center edge angle (LCEA) ≤ 20° were excluded from analysis. Using the patients’ clinical visit notes with detailed history and physical exam findings, demographic and descriptive data were collected, including age, sex, laterality, body mass index (BMI), and Tönnis grade to evaluate osteoarthritis. Patients completed patient-reported outcome measures and postoperatively at 3 months, 6 months, 12 months, and annually thereafter. Results: A total of 72 hips (69 patients) met inclusion criteria. No patients were excluded. The cohort consisted of 37 (51.4%) male and 35 (48.6%) female patients. The minimum follow-up was 24 months, with an average follow-up of 30.3 ± 13.2 months (range, 24-60). The mean patient age was 44.0 ± 10.4 years (range 21-64), with mean body mass index of 26.3 ± 4.3. The cohort consisted of 6 (8.3%) Tönnis grade 0, 48 (66.7%) Tönnis grade 1, and 18 (25.0%) Tönnis grade 2. Two (2.8%) progressed to total hip arthroplasty. Intraoperatively, 5 (6.9%) patients were classified as Outerbridge I, 14 (19.4%) Outerbridge II, 45 (62.5%) Outerbridge III, and 8 (11.1%) Outerbridge IV. Seventy-two (100.0%) patients had a confirmed labral tear, 34 (47.2%) isolated pincer lesion, 4 (5.6%) isolated CAM lesion, and 27 (37.5%) had both a pincer and CAM lesion. The mean of differences between preoperative and 24-month postoperative follow-up PROMs was 22.5 for mHHS, 17.4 for HOS-ADL, 32.7 for HOS-Sport, 22.9 for NAHS, 33.9 for iHOT-33. (Figure 1) The mean of differences between preoperative and final post-operative follow-up PROMs was 22.1 for mHHS, 17.6 for HOS-ADL, 33.2 for HOS-Sport, 23.3 for NAHS, and 34.2 for iHOT-33. (Table 1) Patient age and presence of femoroacetabular impingement were independently predictive of higher postoperative PROM improvements at final follow-up, whereas Tönnis grade was not. (Table 2) The proportion of patients to achieve the minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) thresholds were also calculated. (Table 3) Conclusions: In this study of 72 hips undergoing arthroscopic labral repair with capsular autograft labral reconstruction, we found excellent outcomes that exceeded the MCID thresholds in the majority of patients at an average 30.3 months follow-up. When compared to capsular reconstruction from autografts and allografts, this technique offers the potential advantages of minimized donor-site morbidity and fewer complications, respectively. [Table: see text][Table: see text][Table: see text]

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Maternal Body Mass Index and Use of Labor Neuraxial Analgesia

Anesthesiology ◽

10.1097/aln.0000000000002322 ◽

2018 ◽

Vol 129 (3) ◽

pp. 448-458 ◽

Cited By ~ 13

Author(s):

Alexander J. Butwick ◽

Cynthia A. Wong ◽

Nan Guo

Keyword(s):

Body Mass Index ◽

Relative Risk ◽

Body Mass ◽

Normal Body Mass Index ◽

Adjusted Relative Risk ◽

Obese Women ◽

Obesity Class ◽

Normal Body ◽

Neuraxial Analgesia ◽

Obese Class

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Neuraxial labor analgesia may benefit obese women by optimizing cardiorespiratory function and mitigating complications related to emergency general anesthesia. We hypothesized that obese women have a higher rate of neuraxial analgesia compared with nonobese parturients. Methods Using U.S. natality data, our cohort comprised 17,220,680 deliveries, which accounts for 61.5% of 28 million births in the United States between 2009 and 2015. We examined the relationships between body mass index class and neuraxial labor analgesia, adjusting for sociodemographic, antenatal, pregnancy, and peripartum factors. Results The study cohort comprised 17,220,680 women; 0.1% were underweight, 12.7% were normal body mass index, 37% were overweight, and 28.3%, 13.5%, and 8.4% were obesity class I, II, and III, respectively. Rates of neuraxial analgesia by body mass index class were as follows: underweight, 59.7% (9,030/15,128); normal body mass index, 68.1% (1,487,117/2,182,797); overweight, 70.3% (4,476,685/6,368,656); obesity class I, 71.8% (3,503,321/4,881,938); obesity class II, 73.4% (1,710,099/2,330,028); and obesity class III, 75.6% (1,089,668/1,442,133). Compared to women with normal body mass index, the likelihood of receiving neuraxial analgesia was slightly increased for overweight women (adjusted relative risk, 1.02; 95% CI, 1.02 to 1.02), obese class I (adjusted relative risk, 1.04; 95% CI, 1.04 to 1.04), obese class II (adjusted relative risk, 1.05; 95% CI, 1.05 to 1.05), and obese class III (adjusted relative risk, 1.06; 95% CI, 1.06 to 1.06). Conclusions Our findings suggest that the likelihood of receiving neuraxial analgesia is only marginally increased for morbidly obese women compared to women with normal body mass index.

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