Interaction of low serum adiponectin levels and smoking on coronary stenosis in Japanese men

BACKGROUND: The relationship between serum adiponectin levels and coronary stenosis and the interaction of low serum adiponectin levels and smoking on coronary stenosis have not been clarified. METHODS: We conducted a hospital-based case-control study to examine serum adiponectin levels and smoking in 86 male patients with coronary stenosis and 145 male controls, using multiple logistic regression analyses. Serum adiponectin levels were grouped into quartiles for the analysis of the relationship between serum adiponectin levels and coronary stenosis, and into dichotomy for the analysis of the interaction of low serum adiponectin levels and smoking status. RESULTS: Decreasing serum adiponectin levels were significantly associated with increased risk of coronary stenosis in a dose-dependent manner. As for the interaction of low serum adiponectin levels and smoking on coronary stenosis, adjusted odds ratios were 14.00 (95% Confidence Interval 5.45-37.48) among ever-smokers with low serum adiponectin levels, 3.84 (95% CI: 1.44-10.21) among ever-smokers with high serum adiponectin levels and 3.79 (95% CI: 1.38-10.45) among never-smokers with low serum adiponectin levels, compared with the reference group of never-smokers with high serum adiponectin levels. CONCLUSIONS: The interaction of low serum adiponectin levels and smoking on coronary stenosis was likely to be a synergic effect. This study suggests that the combination of low serum adiponectin levels and smoking is the most useful predictor for coronary stenosis among Japanese men.     

Association of Japanese dietary pattern with serum adiponectin concentration in Japanese adult men

Background and aimsAlthough previous studies suggest that the traditional Japanese dietary pattern is independently associated with a low cardiovascular disease mortality risk, the mechanisms mediating or linking this association are not well understood. Adiponectin has emerged as a valuable biomarker for cardiovascular diseases. The aim of present study was to evaluate whether dietary patterns are associated with serum adiponectin concentration in Japanese adult men.Methods and resultsWe designed a cross-sectional study of 702 men (median [interquartile range] age, 44.5 [37.8–54.2] years) living in Japan. Dietary consumption was assessed via a 75-item food frequency questionnaire. We used principal-components analysis to derive 3 major dietary patterns-“Japanese”, “sweets-fruits” and, “Izakaya (Japanese Pub)”- from 39 food groups. Serum adiponectin concentration was measured by using a specific sandwich enzyme-linked immunosorbent assay. After adjustment for potential confounders, the geometric mean (95% confidence interval) for log-transformed adiponectin concentration associated with “Japanese” dietary pattern factor score tertiles were 5.24 (4.84–5.69) for the lowest tertile, 5.82 (5.39–6.29) for the middle tertile, and 5.95 (5.47–6.46) for the highest tertile (P for trend <0.01). In contrast, a significant inverse association was found between the “Izakaya” pattern factor score tertiles and adiponectin concentration (P for trend = 0.03).ConclusionsGreater adherence to the “Japanese” dietary pattern was independently associated to a higher serum adiponectin concentration in Japanese adult men. This finding supports the hypothesis that the traditional Japanese diet may have a potentially beneficial effect on adiponectin concentrations. A long-term prospective study or randomized trials are required to clarify this causality.     

Characteristics of HIV-infected men with low serum testosterone levels

Low levels of serum testosterone may have negative implications on morbidity in HIV-infected men. The purpose of this study was to determine demographic and clinical characteristics that predict low serum testosterone among men attending our HIV clinic. A cross-sectional study of 587 HIV-positive male patients who presented at the Louisiana State University HIV Outpatient (HOP) Clinic between August 1997 and January 1999 was conducted. Demographic and clinical characteristics were collected and analysed. Of the 587 men studied, 119 (20.3%) had a serum testosterone level below 400 ng/dl. Significantly more men with low serum testosterone levels had a presence of opportunistic infection (especially HIV wasting syndrome, oesophageal candidiasis, or dementia), CD4+ cell counts below 200 cells/mm3, or were taking megestrol acetate. Early detection of low serum testosterone will allow for expedient testosterone supplementation therapy, which could improve morbidity and quality of life for HIV-infected men.     

Alcohol consumption is associated with an increased risk of erosive esophagitis and Barrett's epithelium in Japanese men

Background

The precise role of capsule endoscopy in the diagnostic algorithm of obscure gastrointestinal bleeding has yet to be determined. Despite the higher diagnostic yield of capsule endoscopy, the actual impact on clinical outcome remains poorly defined. The aim of this study was to evaluate the follow-up results of patients with obscure gastrointestinal bleeding to determine which management strategies after capsule endoscopy reduced rebleeding.

Methods

All patients in whom the cause of obscure gastrointestinal bleeding was investigated between May 2004 and March 2007 were studied retrospectively. We evaluated the clinical outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy using the rebleeding rate as the primary outcome.

Results

Seventy-seven patients with obscure gastrointestinal bleeding underwent capsule endoscopy. Capsule endoscopy identified clinically significant findings that were thought to be the sources of obscure gastrointestinal bleeding in 58.4% of the patients. The overall rebleeding rate was 36.4%. The rebleeding rate was significantly higher among patients with insignificant findings than among those with significant findings (p = 0.036). Among the patients in whom capsule endoscopy produced significant findings, the rebleeding rate of the patients who underwent therapeutic interventions was significantly lower than that in those who did not undergo intervention (9.5% vs 40.0%, p = 0.046).

Conclusion

Follow-up and further aggressive interventions are necessary for patients with obscure gastrointestinal bleeding and significant capsule endoscopy findings to reduce the chance of rebleeding.     

Sensitive LH and FSH assays for monitoring low serum levels in men undergoing steroidal contraception

BACKGROUND AND OBJECTIVES: Current immunoassays for detecting serum FSH and LH are not sufficiently sensitive to detect the markedly reduced levels in men undergoing steroidal hormonal treatment for contraceptive purposes. The purpose of this study was to increase the sensitivity of available LH and FSH immunofluorometric (Delfia) assays in order to allow a better understanding of the importance of gonadotrophin suppression in achieving the optimal suppression of sperm count. DESIGN AND PATIENTS: Assay conditions were modified by increasing serum sample volume, the inclusion of either FSH- or LH-depleted serum to reduce the resulting matrix effects and extending incubation times. The microassays were applied to serum from 10 men administered testosterone enanthate with or without depot medroxyprogesterone acetate for 12 weeks as part of a contraceptive trial. RESULTS: The assay sensitivities were increased to 0.005 IU/l for LH and 0.010 IU/l for FSH, representing a five- to six-fold increase in sensitivity compared with existing assays. In the clinical trial, serum LH levels were suppressed to near or below the level of assay detection (mean 0.014 IU/l < 0.4% of pretreatment values) while in eight of 10 men, plasma FSH levels were detectable (0.04-0.07 IU/l, 1-5% of pretreatment values). These FSH levels would not have been detected by current assays. CONCLUSIONS: The increased sensitivities of the LH and FSH assays enabled the detection of gonadotrophins that were < 0.4% of pretreatment serum levels. Using these methods, serum LH was suppressed to nondetectable or near nondetectable levels while serum FSH was highly suppressed but still detectable in the majority of men undergoing steroidal treatment for contraceptive purposes.     

Association of vitamin D status with serum androgen levels in men

Objective Studies in rodents indicate a role of vitamin D in male reproduction, but the relationship between vitamin D and androgen levels in men is largely unexplored. We aimed to investigate the association of 25‐hydroxyvitamin D [25(OH)D] levels with testosterone, free androgen index (FAI) and SHBG. Moreover, we examined whether androgen levels show a similar seasonal variation to 25(OH)D. Design In this cross‐sectional study, 25(OH)D, testosterone and SHBG levels were assessed by immunoassay in 2299 men who were routinely referred for coronary angiography (1997–2000). Measurements Main outcome measures were associations of 25(OH)D levels with testosterone, SHBG and FAI. FAI was calculated as testosterone (nmol/l)/SHBG (nmol/l) × 100. Results Men with sufficient 25(OH)D levels (≥30 μg/l) had significantly higher levels of testosterone and FAI and significantly lower levels of SHBG when compared to 25(OH)D insufficient (20–29·9 μg/l) and 25(OH)D‐deficient (<20 μg/l) men (P < 0·05 for all). In linear regression analyses adjusted for possible confounders, we found significant associations of 25(OH)D levels with testosterone, FAI and SHBG levels (P < 0·05 for all). 25(OH)D, testosterone and FAI levels followed a similar seasonal pattern with a nadir in March (12·2 μg/l, 15·9 nmol/l and 40·8, respectively) and peak levels in August (23·4 μg/l, 18·7 nmol/l and 49·7, respectively) (P < 0·05 for all). Conclusion Androgen levels and 25(OH)D levels are associated in men and reveal a concordant seasonal variation. Randomized controlled trials are warranted to evaluate the effect of vitamin D supplementation on androgen levels.     

Early atherosclerosis in obese juveniles is associated with low serum levels of adiponectin

CONTEXT: There is growing evidence that adiponectin, the most abundant adipocytokine of adipose tissue cells, plays a crucial role in advanced atherosclerosis. OBJECTIVE: The objective of the study was to evaluate the role of adiponectin in early atherosclerosis. DESIGN: One hundred forty obese juveniles (mean age, 13.5 +/- 4.4 yr) and 100 age-matched, healthy, normal-weight controls from the STYrian Juvenile Obesity Study were investigated. We measured adipocytokines, inflammatory biomarkers, parameters of insulin resistance, and lipid subfractions. Intima-media thickness (IMT) of common carotid arteries was determined by ultrasonography. Furthermore, lipometric measurements were performed in obese juveniles to determine the topographic distribution of sc adipose tissue (SAT). RESULTS: Compared with controls, the group of obese juveniles exhibited a significantly increased IMT (P < 0.001) and elevated high-sensitive C-reactive protein (P < 0.001), indicating early stages of atherosclerosis. Serum levels of adiponectin were highly significantly negatively correlated with carotid IMT, even after controlling for common cardiovascular risk factors (P < 0.001; r = -0.34). Furthermore, adiponectin was positively correlated with high-density lipoprotein-free cholesterol and serum apolipoprotein-A1 and negatively with triglycerides, insulin resistance, uric acid, and serum transaminases. By a multiple regression analysis, adiponectin was shown to be the strongest predictive variable for carotid IMT. Finally, adiponectin was found positively correlated with SAT thickness of the rear and inner thigh in boys and negatively with the SAT thickness of the neck in girls. CONCLUSION: In summary, our study describes an influence of SAT topography on adiponectin serum levels and provides first evidence that incipient atherosclerosis is associated with low serum levels of this adipocytokine.     

Similar to adiponectin, serum levels of osteoprotegerin are associated with obesity in healthy subjects

An increase in serum osteoprotegerin (OPG) is associated with type 2 diabetes mellitus, the severity of vascular calcification, and coronary artery disease. Obesity is a risk factor for diabetes and cardiovascular disease, but little is known about the relationship between OPG and obesity. The purpose of this study was to determine if changes in body mass index (BMI) and insulin sensitivity influence circulating OPG in healthy subjects. A total of 100 subjects (36 lean, 41 overweight, and 23 obese) with normal glucose tolerance, blood pressure, and electrocardiogram stress test result volunteered for this study. Insulin sensitivity was estimated using a 2-hour oral glucose tolerance test with oral glucose insulin sensitivity analysis. Osteoprotegerin, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL),soluble receptor activator of nuclear factor-κβ ligand (sRANKL), and adiponectin were analyzed using commercially available enzyme-linked immunosorbent assays. Osteoprotegerin (P < .01) and adiponectin (P < .001) were significantly decreased in the obese compared with lean subjects. There was no significant difference between BMI categories for TRAIL or sRANKL. Controlling for age and sex, there was a significant correlation between OPG and adiponectin (r = 0.391, P < .001), BMI (r = −0.331, P < .001), waist circumference (r = −0.268, P < .01), homeostasis model assessment of insulin resistance (r = −0.222, P < .05), and oral glucose insulin sensitivity (r = 0.221, P < .05). Both OPG and adiponectin were negatively correlated with body weight, BMI, waist circumference, and fasting plasma insulin while being positively correlated with insulin sensitivity (P < .05). Controlling for age, sex, and BMI, TRAIL was positively related to fat mass (r = 0.373, P < .001) and waist circumference (r = 0.257, P < .05). In contrast to patients with type 2 diabetes mellitus, circulating OPG is lower in obese, but otherwise healthy subjects and is positively correlated with indices of insulin sensitivity.     

急性糜烂性食管炎56例内镜及临床分析

急性食管黏膜损伤在临床上并非少见,其病因及临床表现多样,胃镜检查是确定诊断的主要手段.在2006年6月至2009年6月我院做的24000多例患者的胃镜检查中,发现急性糜烂性食管炎56例,发病年龄以中、青年多见,损伤部位多发生于食管下段,现将其胃镜所见及临床资料分析如下.     

Effect of walking with a pedometer on serum lipid and adiponectin levels in Japanese middle-aged men

OBJECTIVE: To clarify the effects of walking with a pedometer on metabolic parameters, including adiponectin (APN). METHODS: We recruited 44 male Japanese volunteers (age, 37 +/- 9 yrs; body mass index (BMI), 24.2 +/- 2.9 kg/m2; fasting plasma glucose (FPG), 96 +/- 11 mg/dL; total cholesterol (TC) 190 +/- 26 mg/dL; triglycerides (TG) 119 +/- 80 mg/dL; HDL-C56 +/- 14 mg/dL). Subjects were instructed to walk with a pedometer and record the number of steps they walked every day for 50 days. Serum adiponectin (APN) levels were measured by enzyme immunoassay. Treatment effects were examined by Wilcoxon's rank test. RESULTS: The average number of steps was 8211 +/- 2084 per day. There were significant reductions in BMI, sBP, TG and TNF-alpha levels after 50 days, but no changes in adiponectin levels. We then divided the subjects into 2 groups according to the steps walked per day, namely, more than 8000 steps (MT group, n = 22) and less than 8000 steps (LT group, n = 22) and found that the reduction in TG and BP was observed only in the MT group. CONCLUSIONS: Walking with a pedometer is effective for improving metabolic parameters, such as TG and blood pressure, but is not sufficient to increase adiponectin levels in Japanese men.     

Very low serum adiponectin levels in patients with type 1 Gaucher disease without overt hyperglycemia

Gaucher disease (glucocerebrosidase deficiency) is characterized by massive accumulation of lipid-laden macrophages in various tissues. Patients with Gaucher disease show a hitherto unexplained increase in hepatic glucose output. Because adiponectin is thought to influence hepatic glucose output, we studied its serum concentration in a cohort of patients with Gaucher disease. Serum adiponectin was indeed found to be markedly reduced in patients (median value, 3.1 microg/mL; range, 1.4-6.3 microg/mL) as compared with healthy subjects (median value 5.6 microg/mL range, 1.9-14.0 microg/mL). Successful treatment of patients was accompanied by an increase in serum adiponectin, from 3.1 to 3.6 microg/mL (P = .002). In healthy individuals, low levels of circulating adiponectin are generally associated with obesity. In patients with Gaucher disease, however, adiponectin levels did not correlate with body mass index. The hypoadiponectinemia in Gaucher patients is most likely attributable to their low-grade chronic inflammation. The characteristic storage macrophages produce inflammatory cytokines such as tumor necrosis factor alpha that is known to suppress adiponectin production. It is of interest that the very low adiponectin levels in Gaucher patients are not accompanied by hyperglycemia, contrary to their effect in obese individuals. It is hypothesized that the excessive hepatic glucose production in these patients balances the assumed increased glucose consumption by the massive amounts of storage macrophages. Hypoadiponectemia may play a regulatory role in preventing hypoglycemia in this condition.     

Low serum adiponectin levels in subjects born small for gestational age: impact on insulin sensitivity

OBJECTIVE: Increasing evidence point to the role of the adipose tissue on the insulin resistance associated with reduced fetal growth. Since adiponectin, exclusively produced by the adipose tissue, exerts an important insulin-sensitizing activity, it appears critical to investigate the effect of being born small for gestational age (SGA) on adiponectin production in adulthood and its relationship with insulin sensitivity. SUBJECTS AND METHODS: Serum adiponectin concentrations were measured in 486 young adults born SGA, precisely selected on birth data, who were compared to 573 age-matched subjects born appropriate for gestational age (AGA). The relationship between serum adiponectin levels and insulin-resistance indices measured under OGTT were tested and compared between the two groups. RESULTS: The SGA group demonstrated significantly reduced serum adiponectin levels than controls (12.6 +/- 6.9 vs 13.2 +/- 6.4 microg/ml, P = 0.02) and the difference remained significant when the key regulatory factors were taken into account (P = 0.008). In the AGA group, fasting I/G taken as an insulin-resistance index negatively correlated with serum adiponectin concentrations (P = 0.02), while the relationship followed a U-shape with increased fasting I/G ratio despite high concentrations of serum adiponectin in the SGA group (P = 0.12). CONCLUSION: Subjects born SGA demonstrated significantly reduced serum adiponectin levels, which were not related to insulin-resistance indices in comparison to what observed in age-matched subjects born AGA. Although this defect in adiponectin production and in its insulin-sensitizing action remains to be elucidated at the molecular level, it strengthens the critical contribution of the adipose tissue in the metabolic complications associated with reduced fetal growth.     

脂联素水平及脂联素基因多态性与糖尿病视网膜病变的关系

目的研究血清脂联素（APN）水平及脂联素基因单核苷酸多态性（SNP）45T→G与2型糖尿病（T2DM）视网膜病变（DR）之问的关系。方法运用聚合酶链反应-限制性片段长度多态性方法，对76例T2DM患者[无DR（NDR）组27例、非增殖型DR（NPDR）组28例、增殖型DR（PDR）组21例]，和35例正常对照（Nc）者的APN基因SNP45多态性位点进行基因分型；用放射免疫法检测空腹血清APN浓度；比较各组基因型和等位基因频率，并分析各指标间的相关性。结果（1）T2DM组血清APN水平明显低于NC组（P＜0.01）；PDR组APN浓度明显低于NDR和NPDR组，差异有统计学意义（P均＜0.01）；（2）血清APN浓度与年龄、收缩压、空腹血糖、空腹胰岛素、HbA1C、TG、LDL-C、HO—MA—IR呈显著负相关；（3）SNP45多态性位点的基因型和等位基因频率在NDR、NPDR、PDR组和NC组三间无统计学差异（P〉O．05），三种基因型的血清APN水平无统计学差异（P＞0.05）。结论T2DM患者血清APN水平降低，APN在DR的发病机制中发挥作用且与DR的严重度相关；而APN基因SNP45多态性位点与青岛地区汉族人群中DR无明显相关性。     

Association of erosive esophagitis with Helicobacter pylori eradication: a role of salivary bicarbonate and glycoprotein secretion

In some populations, Helicobacter pylori eradication is associated with development of erosive esophagitis. The aim of this study was to evaluate the contribution of salivary bicarbonate and glycoprotein secretion to the pathogenesis of erosive esophagitis developing after H. pylori eradication. Gastroscopy and saliva collection were performed at recruitment and 12 months after completion of eradication therapy. Eighty‐eight patients with duodenal ulcer were recruited to the study. Erosive esophagitis was found in 13 patients (grade A, 8 patients; grade B, 4 patients; grade C, 1 patient). Among the 74 subjects who completed the study, erosive esophagitis was detected in 21 patients (grade A, 15 patients; grade B, 6 patients); they all were successfully eradicated. Bicarbonate and glycoprotein secretion was not found to differ significantly between the subjects with and without erosive esophagitis both before and 1 year after H. pylori eradication. However, it was lower in H. pylori‐infected (baseline) than in H. pylori‐noninfected erosive esophagitis subjects (1 year after successful eradication) (bicarbonate 2.34 [1.29–3.40)]vs. 3.64 [2.70–4.58]µmol/min and glycoprotein 0.23 [0.15–0.31]vs. 0.35 [0.28–0.43] mg/min, P= 0.04 and P= 0.04, respectively). We conclude that changes in salivary bicarbonate and glycoprotein secretion related to H. pylori eradication do not promote the development of erosive esophagitis in duodenal ulcer patients.     

Effect of pantoprazole in older patients with erosive esophagitis

Several studies suggest that older adults with gastroesophageal reflux disease (GERD) are more likely to develop complications, including erosive esophagitis, but it is unclear whether erosive esophagitis is more difficult to treat in older patients. The purpose of this study was to determine if adults > or = 65 years with erosive esophagitis are more difficult to treat than younger adults. The study was a post hoc analysis of two double-blind, randomized, multicenter trials of patients with erosive esophagitis. Patients received pantoprazole 40 mg once daily, nizatidine 150 mg twice daily or placebo. Patients were evaluated for endoscopic healing at 4 and 8 weeks. Patients recorded typical reflux symptoms using a daily diary to note presence or absence of symptoms. Results showed that 44, 13 and 11 patients > or = 65 years and 210, 69, and 71 patients < 65 received pantoprazole 40 mg daily, nizatidine 150 mg twice daily, or placebo, respectively. Eighty-six percent (86%[76%, 97% CI]) of older and 83% (78%, 88% CI) of younger pantoprazole-treated patients were healed at 8 weeks; 46% (19%, 73% CI) and 35% (24%, 46% CI) of nizatidine-treated and 27% (1%, 54% CI) and 34% (23%, 45% CI) of placebo-treated were healed at 8 weeks. Median time to persistent absence of GERD-related symptoms was similar for older and younger patients treated with pantoprazole. We conclude that older patients with erosive esophagitis do not appear to have more difficult-to-treat disease. Erosive esophagitis is effectively healed and GERD symptoms are controlled in older patients using pantoprazole 40 mg daily.     

Association of serum high molecular weight adiponectin and blood pressure among non-diabetic community-dwelling men

Adiponectin is one of the important molecules in the development of metabolic syndrome, and its concentration is decreased in obesity, type-2 diabetes, and cardiovascular disease. We aim to determine whether serum high-molecular weight (HMW) adiponectin, which is thought to represent the biological active form, was associated with a risk for the prevalence of prehypertension and hypertension. The cross-sectional study was carried out in 2002. A total of 614 men, aged 58 ± 14 (range, 20-89) years, and 779 women, aged 62 ± 12 (range, 21-88) years without medications for hypertension, diabetes, or dyslipidemia were recruited from a single community at the time of their annual health examination. In men, nonadjusted and age-adjusted mean serum HMW adiponectin were significantly lower in subjects with prehypertension and hypertension than those with normotension. In women, only nonadjusted values were higher in subjects with hypertension than those with normotension. Multiple linear regression analysis using systolic blood pressure (SBP) and diastolic blood pressure (DBP) as an objective variable, adjusted for risk factors as explanatory variables, showed that only in men, log serum HMW adiponectin were significantly and independently associated with SBP and DBP. In men, lower serum HMW adiponectin categories were positively associated with prehypertension and hypertension in an age-adjusted model, and hypertension in an age- and BMI-adjusted model. Serum HMW adiponectin concentrations were inversely associated with blood pressure (BP) in the general male population.