Negative association between trunk fat, insulin resistance and skeleton in obese women

AIM: To evaluate the potential interference of trunk fat (TF) mass on metabolic and skeletal metabolism. METHODS: In this cross-sectional study, 340 obese women (mean age: 44.8 ± 14 years; body mass index: 36.0 ± 5.9 kg/m 2 ) were included. Patients were evaluated for serum vitamin D, osteocalcin (OSCA), inflammatory markers, lipids, glucose and insulin (homeostasis model assessment of insulin resistance, HOMA-IR) levels, and hormones profile. Moreover, all patients underwent measurements of bone mineral density (BMD;at lumbar and hip site) and body composition (lean mass, total and trunk fat mass) by dual-energy X-ray absorptiometry. RESULTS: Data showed that: (1) high TF mass was inversely correlated with low BMD both at lumbar (P < 0.001) and hip (P < 0.01) sites and with serum vitamin D (P < 0.0005), OSCA (P < 0.0001) and insulin-like growth factor-1 (IGF-1; P < 0.0001) levels; (2) a positive correlation was found between TF and HOMA-IR (P < 0.01), fibrinogen (P < 0.0001) and erythrocyte sedimentation rate (P < 0.0001); (3) vitamin D levels were directly correlated with IGF-1 (P < 0.0005), lumbar (P < 0.006) and hip (P < 0.01) BMD; and (4) inversely with HOMA-IR (P < 0.001) and fibrinogen (P < 0.0005). Multivariate analysis demonstrated that only vitamin D was independent of TF variable. CONCLUSION: In obese women, TF negatively correlates with BMD independently from vitamin D levels. Reduced IGF-1 and increased inflammatory markers might be some important determinants that account for this relationship.

Validity of self-reported male sexual function scales in a young Chinese population:a comparative study with clinician-assisted evaluation

Psychometric scales,commonly used to gauge sexual function,can sometimes be influenced by response biases.In our researchfrom June 2020 to April 2021,we examined the accuracy of self-reported sexual function scales.We invited patients from theDepartment of Infertility and Sexual Medicine at the Third Affiliated Hospital of Sun Yat-sen University(Guangzhou,China),whohave male sexual dysfunction,to participate by filling out a self-reported version of a specific questionnaire.In addition,they wentthrough a clinician-assisted version of this questionnaire,encompassing tools such as the Premature Ejaculation Diagnostic Tool(PEDT),the 6-item International Index of Erectile Function(IIEF-6),the Erection Hardness Scale(EHS),and the MasturbationErection Index(MEI).Using the clinician-assisted version as a reference,we categorized patients and applied various statisticalmethods,such as the Chi-square test,intraclass correlation coefficient(ICC),logistic regression,and the Bland–Altman plot,to gauge reliability.In our study with 322 participants,we found that while there were no notable discrepancies in error ratesbased on our categorization,certain scales showed significant differences in terms of overestimation and underestimation,withthe exception of the PEDT.The positive diagnosis rate consistency between the self-reported and clinician-assisted versions wasobserved.High ICC values between the two versions across the scales were indicative of remarkable reliability.Our findings showthat the self-reported versions of tools such as EHS,IIEF-6,MEI,and PEDT are credible and hold clinical reliability.However,employing a dual-diagnosis approach might be more prudent to circumvent potential misdiagnoses.

Late-onset hypogonadism： beyond testosterone

Late-onset hypogonadism is defined as a combination of low testosterone （T） levels and typical symptoms and signs. A major area of uncertainty is whether T concentrations are always really sufficient to fully reflect Leydig cell （dys）function. Mild testicular alteration could be diagnosed only by additional biochemical markers, such as luteinizing hormone （LH） and 25-hydroxyvitamin D levels. These markers help in identifying the so-called ＂subclinical＂ hypogonadism （normal T, high LH levels）. Patients with hypogonadism have frequently low levels of 25-hydroxyvitamin D due to impairment of the hydroxylating enzyme CYP2R1 in the testis. However, no data have been published dealing with the best treatment option （cholecalciferol - the Vitamin D precursor, or calcidiol - 25-hydroxylated form of Vitamin D） in these patients. We studied 66 patients with classic hypogonadism （total T [TT] 〈12 nmol I-~, LH 〉 8 IU 1-1） （n = 26） and subclinical hypogonadism （TT 〉 12 nmol I-＊, LH 〉 8 IU I-~） （n = 40） and low 25-hydroxyvitamin D （〈50 nmol I-1）. Subjects received cholecalciferol （5000 IU per week） （n = 20） or calcidiol （4000 IU per week） （n -- 46）, and 25-hydroxyvitamin D and parathyroid hormone （PTH） were evaluated after 3 months of therapy. Supplementation with calcidiol significantly increased 25-hydroxyvitamin D and significantly decreased PI＂H levels in both groups of men with hypogonadism （primary, n = 16 and subclinical, n = 30）, whereas supplementation with cholecalciferol did not modify their levels. This study shows for the first time that the administration of the 25-hydroxylated form of Vitamin D （calcidiol）, and not the administration of the precursor cholecalciferol, restores 25-hydroxyvitamin D levels in subjects with hypogonadism.