Association of low serum 25-hydroxyvitamin D levels with the frailty syndrome in Mexican community-dwelling elderly

Objective: Since vitamin D is an important regulator of muscle function, the effect of vitamin D deficiency on frailty syndrome has been recently studied. This cross-sectional study aimed to determine the association between 25(OH)-vitamin D levels and frailty status in Mexican community-dwelling elderly.

Methods: Sample of 331 community-dwelling elderly aged 70 or older, a subset of those included in the “Coyoacán cohort” were included. 25(OH)-vitamin D assay and frailty status were measured.

Results: Mean age was 79.3 years and 54.1% were women. Those classified as frail were more likely to have lower Mini-Mental State Examination score (p?=?0.015), more disability for instrumental activities of daily living (p?p?p?Conclusion: These results suggest that older adults with low 25(OH)-vitamin D levels are associated with the probability to being frail compared with those with sufficient vitamin D levels.     

Evaluation of the relationship between microalbuminuria and 25-(OH) vitamin D levels in patients with type 2 diabetes mellitus

Background: 25-(OH) vitamin D (VD) deficiency has been described as potential risk factor for the development of diabetes in many epidemiological studies. 25-(OH) VD deficiency and insulin resistance associated with this deficiency are common findings in patients with type 2 diabetes mellitus. The objective of this study is to evaluate the relationship between 25-(OH) VD levels and microalbuminuria.

Methods: The patients with type 2 diabetes mellitus aged between 40 and 65 years, who were admitted to the diabetes outpatient clinics of our hospital, were evaluated in two different groups. The first group consisted of 119 patients with insufficient 25-(OH) VD levels (10–30?ng/mL) and the second group consisted of 121 patients with 25-(OH) VD deficiency (≤10?ng/mL). The relationship between 25-(OH) VD levels and the level of microalbuminuria was evaluated in the two groups.

Results: The mean 25-(OH) VD level was 11.5?ng/mL and the mean HbA1c level was 9.1%. When the patient groups were evaluated according to 25-(OH) VD levels, HbA1c values were significantly higher in patients with a 25-(OH) VD level of 10?ng/mL or lower (p?=?.039). 25-(OH) VD levels were not significantly different between patients with different stages of renal failure (p?=?.119), whereas the level of microalbuminuria was significantly different (p?=?.030).

Conclusions: This study found that the level of microalbuminuria was significantly higher in patients with 25-(OH) vitamin D deficiency compared to patients with 25-(OH) VD insufficiency.     

Association of vitamin D status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems in patients with type 2 diabetes mellitus

Objective: The aim of the present study was to evaluate the relationship between vitamin D (25[OH]D) status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems such as QRISK2, BNF, ASSING, SCORE, and Framingham in patients with type 2 diabetes mellitus(T2DM).

Methods: The study included 108 patients with vitamin D insufficiency (25[OH]D?≥?10–30?ng/mL) and 100 patients with vitamin D deficiency (25[OH]D?Results: HbA1c levels were significantly higher in patients with vitamin D deficiency. Patients with vitamin D deficiency had significantly higher Framingham risk score (p?p?r?=?0.537) and a weak but statistically significant correlation between 25[OH]D levels and BNF score (r?=?0.295). 25[OH]D levels were significantly higher and HbA1c levels were significantly lower in patients with Framingham cardiovascular risk score ≤10%.

Conclusion: We found a close relationship with Framingham cardiovascular risk score in diabetic patients with very low serum vitamin D levels. Cardiovascular risk as assessed by the Framingham’s scale increases with decreasing 25[OH]D levels. BNF score was negatively correlated with 25[OH]D levels.     

Association between serum levels of testosterone and biomarkers of subclinical atherosclerosis

Objective: To investigate the association between serum levels of testosterone and biomarkers of subclinical atherosclerosis based on data from 119 middle-aged men of the general population.

Methods: Testosterone, Apolipoprotein A-1 (ApoA-1), Apolipoprotein B (ApoB), Apolipoprotein B-to-Apolipoprotein A-1 ratio (ApoB-to-ApoA-1), high-sensitive C-reactive protein (hsCRP), and fibrinogen levels were measured. Data were also gathered based on age, BMI, waist circumference, smoking, alcohol consumption, and family history of cardiovascular diseases. Men were classified into two groups based on testosterone levels: hypogonadal (testosterone ≤12?nmol/L) and eugonadal men (testosterone >12?nmol/L).

Results: When compared to eugonadal, the hypogonadal men were significantly older (56?years vs. 55?years, p?=?.03), had greater BMI (28?kg/cm² vs. 26?kg/cm², p?=?.01), and higher waist circumference (104?cm vs. 100?cm, p?=?.01). Moreover, ApoB, ApoB-to-ApoA-1 ratio, and hsCRP were significantly higher in hypogonadal men compared to eugonadal men (1.1?g/L vs. 1.0?g/L, p?=?.03), (0.8 vs. 0.7, p?=?.03), (3.3?mg/L vs. 2.0?mg/L, p?=?.01), respectively. On the other hand, ApoA-1 and fibrinogen levels did not differ significantly between groups (p?>?.05). In an adjusted multivariate regression analysis model, only ApoB showed a significant negative association with testosterone levels (β?=??0.01; 95% CI?=??0.02, ?1.50; p?=?.04).

Conclusion: Testosterone levels showed an inverse relation to ApoB, a biomarker implicated in subclinical atherosclerosis. These findings support the hypothesis that low testosterone levels play a role in atherosclerosis.     

Analysis of cardiovascular risk factors associated with serum testosterone levels according to the US 2011–2012 National Health and Nutrition Examination Survey

Objective: To investigate associations between cardiovascular disease risk factors, including fasting glucose, cholesterol, high density lipoprotein cholesterol (HDL-c), LDL-c, blood pressure, body mass index (BMI), C-peptide, creatinine kinase, smoking, alcohol use, physical activity, C-reactive protein as well as homocysteine levels and cardiovascular events.

Methods: Data from 1545 men aged ≥40?years, with testosterone deficiency (TD) (<300?ng/dL) and non-TD (≥300?ng/dL) which were extracted from the National Health and Nutrition Examination Survey database 2011–2012 and analyzed.

Results: Multivariate logistic regression analysis showed positive associations between TD and BMI (≥35 vs.?p?=?.016), HDL-c (<0.91 vs. ≥0.91: OR?=?1.60, 95% CI: 1.14–2.24, p?=?.006) and diabetes (diabetes vs. non-diabetes: OR?=?1.48, 95% CI: 1.14–1.92, p?=?.004) as well as negative associations between TD and metabolic equivalent scores (≥12 vs. <12: OR?=?0.69, 95% CI: 0.52–0.91, p?=?.009) and smoking (Ever vs. never: OR?=?0.69, 95% CI: 0.51–0.94, p?=?.018). Furthermore, total serum testosterone levels were lower in patients with heart failure (p?=?.04) and angina/angina pectoris (p?=?.001) compared with subjects without these cardiac problems.

Conclusion: Low serum testosterone was associated with multiple risk factors for CHD.     

The association between triglyceride high density lipoprotein cholesterol ratio and benign prostate hyperplasia in non-diabetic patients:a cross-sectional study

Objectives: To assess the association between triglyceride (TG)/high density lipoprotein (HDL) ratio and benign prostate hyperplasia/lower urinary tract symptoms (BPH/LUTS).

Methods: Four hundred patients who were admitted to the Urology Clinic between January and December 2014 with complaints of BPH/LUTS were enrolled in this cross-sectional study. Patients were divided into two groups according to their International Prostate Symptom Score and prostate volume (PV). They were compared in terms of age, body mass index (BMI), PV, PSA, post micturional residual volume, uroflowmetry Q max value, fasting blood sugar, TG and high density lipoprotein-cholesterol (HDL-C) level and TG/HDL ratio.

Results: Although univariate analyses reveal that age, BMI, waist circumference (WC), FBS, TG, HDL-C level, and TG/HDL ratio were correlated with PV, only age [1.125 OR (1.088–1.164), p?=?.00001], BMI [1.119 OR (1.040–1.204), p?=?.003], TG [(1.043 OR (1.016–1.071), p?=?.002], HDL-C [(0.923 OR (0.860–0.990), p?=?.025], and TG/HDL ratio [(1.224 OR (1.130–1.315), p?=?.014] were statistically significant in multivariate analysis. The calculated area under the curve (AUC) for PV of 30?ml, 40?ml, and 50?ml was 0.668 (0.608–0.727), 0.617 (0.561–0.673), and 0.592 (0.530–0.654), respectively.

Conclusions: Our results indicate that the TG/HDL ratio correlates with enhancement in PV. Further studies are warranted to better evaluate this relationship.     

Visceral adiposity index is associated with benign prostatic enlargement in non-diabetic patients: a cross-sectional study

Objective: To evaluate the association between visceral adiposity index (VAI) - a novel indicator for the assessment of visceral adipose tissue and prostate enlargement in non diabetic patients.

Material and methods: Four hundred patients who were admitted to the Urology clinic between January and December 2014 with complaints of BPH(benign prostatic hyperplasia )/LUTS(male lower urinary tract symptoms)were enrolled in this cross-sectional study. Patients were divided into two groups according to their prostate volume and international prostate symptom score (IPSS) value. They were compared in terms of age, body mass index (BMI), VAI, prostate volume, PSA, post micturional residual volume (PMRV), uroflowmetry Q max value, triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and fasting blood sugar (FBS).

Results: Although univariate analyses reveal that age, BMI, waist circumference (WC), FBS, TG, HDL-C level and TG/HDL ratio were correlated with prostate volume, only age [1.125 OR (1.088–1.164), p?=?.00001], BMI [1.119 OR (1.040–1.204), p?=?.003], TG [1.043 OR (1.016–1.071), p?=?.002], HDL-C [0.923 OR (0.860–0.990), p?=?.025] and VAI [1.194 OR (1.110–1.305), p?=?.011] were statistically significant in multivariate analysis. A positive correlation was found between VAI value and prostate volume in the Spearman correlation test (r?=?0.29, p?=?.00001). The calculated area under the curve (AUC) for prostate volumes of 30, 40 and 50?ml were 0.680 (0.621–0.738), 0.625 (0.570–0.681) and 0.590 (0.528–0.652), respectively.

Conclusion: Our study revealed a positive correlation between VAI and prostate volume. Our results are needed to be tested with well-designed randomized prospective cohort studies.     

Cystatin C as a predictor of mortality in elderly patients with chronic kidney disease

Background: The prevalence of chronic kidney disease (CKD) in the elderly is high. Serum cystatin C is an accurate marker of kidney function and it also has prognostic utility in CKD patients. The aim of our study was to determine the prediction of serum cystatin C and other markers of kidney function on long-term survival in elderly CKD patients.

Methods: Fifty eight adult Caucasian patients, older than 65 years, without known malignancy, thyroid disease and/or not on steroid therapy were enrolled in the study. In each patient, ⁵¹CrEDTA clearance, serum creatinine, serum cystatin C, and estimated glomerular filtration rate using different equations were determined on the same day and patients were then followed for 11 years or until their death.

Results: The means are as follows: ⁵¹CrEDTA clearance 53.3?±?17.4?ml/min/1.73?m², serum creatinine 1.62?±?0.5?mg/dl, serum cystatin C 1.79?±?0.5?mg/l, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation 40.1?±?14?ml/min/1.73?m², Berlin Initiative Study 2 (BIS2) equation 38.9?±?10.7?ml/min/1.73?m², full age spectrum (FAS) creatinine equation 43.8?±?13.8?ml/min/1.73?m², FAS cystatin C equation 40.1?±?11.7?ml/min/1.73?m². In the follow up period, 47 (81%) patients died. Cox regression analysis showed different hazard ratios (HRs) for death: for ⁵¹CrEDTA clearance HR 1.022 (95% CI 1.004–1.042; p?=?.015), serum creatinine HR 1.013 (95% CI 1.006–1.019; p?=?.001), serum cystatin C HR 2.028 (95% CI 1.267–3.241; p?=?.003), CKD-EPI creatinine equation HR 1.048 (95% CI 1.019–1.076; p?=?.001), BIS2 equation HR 1.055 (95% CI 1.021–1.088; p?=?.001), FAS creatinine equation HR 1.046 (95% CI 1.017–1.074; p?=?.001), FAS cystatin C equation HR 1.039 (95% CI 1.010–1.071; p?=?.009).

Conclusions: Our results showed the highest HR for serum cystatin C among kidney function markers for prediction of outcome in elderly CKD patients.     

Vitamin D Deficiency Associated with Self-Neglect in the Elderly

ABSTRACT

Background. Vitamin D deficiency is common in elders. However, little is known about the implications of vitamin D deficiency in elder self-neglect.

Specific Aims. To characterize a group of self-neglecting elders with vitamin D deficiency based on clinical, cognitive, and functional status.

Participants. Forty-four self-neglecting elders referred by the Adult Protective Services.

Methods. Vitamin D status of the self-neglecting elders was based upon serum levels of 25-hydroxyvitamin D (25-OHD). Demographics, cognitive, and functional characteristics of vitamin D deficient self-neglecting elders were described and compared to those without vitamin D deficiency.

Results. Vitamin D deficiency (25-OHD < 25 nmol/L) was detected in 16 out of 44 self-neglecting elders (36%). Self-neglecting elders with vitamin D deficiency had lower scores in the Physical Performance Test and higher scores in the Kohlman Evaluation of Living Skills, compared with those who were not vitamin D deficient (p = 0.014 and p = 0.018 respectively).

Conclusions. Vitamin D deficiency is common in elder self-neglect. Self-neglecting elders with vitamin D deficiency have impaired physical performance and inadequate living skills, which can be potentially improved by treating vitamin D deficiency.     

Cardiometabolic risks associated with work-to-family conflict: findings from the Work Family Health Network

ABSTRACT

Objective: Work and family stressors may be associated with elevated cardiovascular risk factors.

Methods: To assess the effects of work-to-family conflict (WTFC) on biomarkers of cardiometabolic risk, we examined 1524 extended care employees over 18 months and estimated multilevel linear models that accounted for the nested nature of the data.

Results: WTFC was positively associated with BMI [β?=?0.53, CI?=?(0.08, 0.98), p?=?.02 at baseline and β?=?0.59, CI?=?(0.12, 1.04), p?=?.01 across the 18-month study period] and negatively with HDL cholesterol [β?=??0.32, CI?=?(?0.57, ?0.08), p?=?.01 across the 18-month study period]. The rate of change in BMI from baseline to 18 months increased with higher levels of WTFC as well (β?=?0.08, CI?=?(0.03, 0.15), p?=?.0007). However, WTFC was not associated with other variables reflecting cardiometabolic risk, such as including blood pressure, cholesterol, glycosylated hemoglobin and cigarette smoking status.

Conclusion: Findings suggest that BMI, which is linked to potentially malleable health behaviors, is more closely related to inter-role conflict than biological markers reflecting longer-term physiologic processes. These effects are exacerbated over time and may be particularly detrimental to already overweight and obese individuals.     

The impact of testosterone replacement therapy on glycemic control,vascular function,and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes

Objective: This study set out to assess effects of testosterone replacement therapy (TRT) on parameters of metabolic syndrome and vascular function in obese hypogonadal males with type 2 diabetes mellitus (DM2).

Study design: Fifty-five obese hypogonadal diabetic males on oral hypoglycemic treatment were enrolled into this one-year, double-blind, randomized, placebo-controlled clinical study. Group T (n?=?28) was treated with testosterone undecanoate (1000?mg i.m. every 10?weeks) while group P (n?=?27) received placebo.

Methods: Anthropometrical and vascular measurements – flow-mediated dilatation (FMD) and intima media thickness (IMT) – biochemical and hormonal blood sample analyses were performed at the start of the study and after one year. Derived parameters (BMI, HOMA-IR, calculated free testosterone (cFT) and bioavailable testosterone (BT)) were calculated.

Results: TRT resulted in reduction of HOMA-IR by 4.64?±?4.25 (p?p?p?=?.005).

Conclusion: TRT normalized serum testosterone levels, improved glycemic control and endothelial function while exerting no ill effects on the study population.     

Effects of testosterone replacement therapy on hypogonadal men with osteopenia or osteoporosis: a subanalysis of a prospective randomized controlled study in Japan (EARTH study)

Objective: We investigated the effects of testosterone replacement therapy (TRT) on bone mineral density (BMD) among hypogonadal men with osteopenia/osteoporosis.

Methods: From our previous EARTH study population, 74 patients with a clinical diagnosis of osteopenia or osteoporosis and hypogonadism were included in this study, as the TRT (n?=?35) and control (n?=?34) groups. The TRT group was administered 250?mg of testosterone enanthate injection every 4 weeks for 12 months. The BMD, waist circumference, body mass index, body fat percentage, and muscle volume were measured at baseline and at 12 months. Blood biochemical data, including total cholesterol, triglycerides, HDL-cholesterol, hemoglobin A1c, and adiponectin values were also evaluated.

Results: At the 12-month visit, BMD significantly increased in both groups. However, comparisons on changes of parameter values from baseline to the 12-month visit between the TRT and control groups were significantly different in BMD (5.0?±?5.0 vs. 3.0?±?3.2; p?=?.0434) and in adiponectin value (?0.90?±?3.33 vs. 0.10?±?2.04; p?=?.0192). There were no significant changes in other parameters.

Conclusions: TRT for 12 months could improve BMD with a decrease in adiponectin levels among hypogonadal men with osteopenia/osteoporosis.     

Caffeine intake is not associated with serum testosterone levels in adult men: cross-sectional findings from the NHANES 1999–2004 and 2011–2012

Objective: The association of caffeine intake with testosterone remains unclear. We evaluated the association of caffeine intake with serum testosterone among American men and determined whether this association varied by race/ethnicity and measurements of adiposity.

Methods: Data were analyzed for 2581 men (≥20?years old) who participated in the cycles of the NHANES 1999–2004 and 2011–2012, a cross-sectional study. Testosterone (ng/mL) was measured by immunoassay among men who participated in the morning examination session. We analyzed 24-h dietary recall data to estimate caffeine intake (mg/day). Multivariable weighted linear regression models were conducted.

Results: We identified no linear relationship between caffeine intake and testosterone levels in the total population, but there was a non-linear association (p_nonlinearity?p_nonlinearity?≤?.03 both) and only among men with waist circumference <102?cm and body mass index <25?kg/m² (p_nonlinearity?Conclusion: No linear association was identified between levels of caffeine intake and testosterone in US men, but we observed a non-linear association, including among racial/ethnic groups and measurements of adiposity in this cross-sectional study. These associations are warranted to be investigated in larger prospective studies.     

Impact of metabolic status on the association of serum vitamin D with hypogonadism and lower urinary tract symptoms/benign prostatic hyperplasia

Objective: The objective of this study is to investigate the impact of metabolic status on associations of serum vitamin D with hypogonadism and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).

Patients and methods: A total of 612 men underwent physical examination, biochemical/hormonal blood testing, and transrectal prostate ultrasound. Moreover, the subjects filled out standard questionnaires for identification and grading of LUTS and hypogonadism symptoms. Parameters were statistically compared with independent t-tests and correlation analyses.

Results: Vitamin D levels positively correlated with total testosterone (TT) but not with prostate volume or International Prostate Symptom Score (IPSS). Patients with metabolic syndrome had significantly lower vitamin D levels, which were not correlated with TT, prostate volume, or IPSS. However, vitamin D was positively correlated with TT, and negatively correlated with prostate volume and quality-of-life IPSS in subjects without metabolic syndrome.

Conclusion: The clinical usefulness of vitamin D for treatment of hypogonadism or LUTS/BPH varies according to metabolic status.     

The impact of age,BMI and sex hormone on aging males’ symptoms and the international index of erectile function scores

Objective: To analyze the impact of age, BMI and sex hormone on aging males’ symptoms (AMS) and the 5-item version of the international index of erectile function (IIEF-5) scores in middle-aged and elderly Chinese men.

Methods: A population-based cross-sectional study was conducted in Jiashan County. A total of 969 men, aged between 40 and 80 years old, were admitted. Physical examination and the sex hormones were measured, and AMS and IIEF-5 scores were assessed.

Results: The oneway ANOVA analysis indicated older age groups had higher AMS total-scores, somatic and sexual sub-scores, and lower IIEF5 scores (all p?r_pairwise) analyses showed the significant associations between AMS and age or sex hormone (cFT, Bio-T, SHBG, and LH) levels, and similar for IIEF5. However, when age was adjusted, the correlation coefficients (r_partial) weakened, and correlation significance disappeared, except LH (for AMS: r_partial?=?0.096, p?=?.009; for IIEF-5: r_partial?= ?0.140, p?=?.001). Multiple linear regressions confirmed the influence of increased age and LH on the AMS and IIEF5 scores.

Conclusion: CFT, Bio-T and SHBG failed to yield any additional predicting information when age was adjusted. To improve the male reproductive health, future research should pay more attention on aging-related comorbidities and how to improve general wellness.     

Importance of Self-Forgiveness and Social Support in Potentially Reducing Loneliness in Men Who Have Sex with Men

Abstract

Higher levels of loneliness in men who have sex with men (MSM) are associated with negative outcomes such as depression, anxiety, and sexual impulsivity. By identifying what may reduce loneliness in MSM, counselors and public health professionals can alleviate the distress of their clients. A significant hierarchical multiple regression controlling for relationship status, F(9, 105)?=?16.36, p?<?0.001, R² = .62, indicated that higher levels of self-forgiveness (β?=??.19, p?=?.04) and perceived social support (β?=??.49, p?<?.001) predicted lower levels of loneliness in MSM. Implications and limitations are discussed.     

Radical prostatectomy for clinically localized prostate cancer in patients aged 75 years or older: comparison with primary androgen deprivation therapy

Objective: To determine whether radical prostatetomy (RP) is suitable for prostate cancer patients with age ≥75 years in comparison to primary androgen deprivation therapy (PADT).

Patients and methods: A cohort study was conducted in clinically localized prostate cancer patients with ≥75 years of age who underwent RP or PADT at six institutions from 2005 to 2013. Patients who had less than 12 months of follow-up, or received neoadjuvant or adjuvant therapy were excluded. We compared clinical characteristics, cancer-specific and overall survivals, and post-treatment complication rates between two groups.

Results: We included 92 and 99 patients in the RP and PADT groups, respectively. In survival analyses, there were no significant differences in cancer-specific and overall survivals (p?=?.302 and .995, respectively). The incidence of serious adverse events (cardio- or cerebrovascular event, or bone fracture) was higher in the PADT group (p?=?.001). Multivariable analysis showed that PADT had a worse effect on the serious adverse events (OR 10.12, p?=?.038).

Conclusions: In selected elderly patients, RP was safe and effective for treatment of localized prostate cancer, as compared to PADT. Surgical treatment options should be considered in elderly patients with respect to life expectancy, rather than chronological age.     

Prevalence analysis of urinary incontinence after radical prostatectomy and influential preoperative factors in a single institution

Aims: To assess prevalence of urinary incontinence (UI) after radical prostatectomy (RP) and to analyze which preoperative characteristics of the patients have influence on UI.

Methods: Between 2002 and 2012, 746 consecutive patients underwent RP for clinically localized prostate cancer. We defined UI according to International Continence Society (ICS) definition: “the complaint of any involuntary leakage of urine” after 12?months of recovery, international consultation on incontinence questionnaire (ICIQ-SF) and pads/day was collected too. Clinical features and magnetic resonance imaging measurements were assessed. A multivariable logistic regression model predicting incontinence were built-in after adjust by cofounding factors and bootstrapping.

Results: About 172 (23%) of the patients were classified as incontinent according to the ICS definition. The mean value of the ICIQ-SF was 10.87 (±4). 17.8% of patients use at least one pad/day, 11.9% use more than one pad/day. The preoperative factors independently influential in UI are: age [OR: 1.055; CI 95% (1.006–1.107), p?=?.028], urethral wall thickness [OR: 5.03; CI 95% (1.11–22.8), p?=?.036], history of transurethral resection of the prostate [OR: 6.13; CI 95% (1.86–20.18), p?=?.003] and membranous urethral length [OR: 0.173; CI 95% (0.046–0.64), p?=?.009]. The predictive accuracy of the model is 78.7% and the area under the curve (AUC) value 71.7%.

Conclusions: Urinary incontinence after radical prostatectomy has different prevalence depending on the definition. Age, prior transurethral resection of the prostate (TURP), membranous urethral length (MUL) and urethral wall thickness (UWT) were risk factors.