Features and relationships of metabolic syndrome components in men with androgen deficiency. Part 1. Are body composition parameters, sex hormone levels and blood pressure interrelated?

Introduction. Currently, a shortage of studies demonstrating the relationship between body composition disorders in men with excess adipose tissue and metabolic syndrome (MS), depending on the level of testosterone, estradiol, sex hormone binding globulin (SHBG), anthropometric parameters, or blood pressure (BP) has been noted.

Aim: to examine a relationship between disturbed anthropometric parameters, level of sex hormones and BP in men with MS.

Materials and Methods. There were enrolled 64 overweight men to the study. The patients were divided into 3 groups based on the body mass index (BMI): group 1 – with overweight (n = 24), group 2 – with the first degree of obesity (n = 21), group 3 – with the second and third degree of obesity (n = 19). A correlation analysis was carried out between the data of bioimpedance analysis (BIA) and laboratory data, as well as additionally assessing the level of inter-group difference.

Results. Our study allowed to find the relationship between the parameters of body composition in men with overdeveloped adipose tissue and MS that was coupled to the level of testosterone, estradiol, SHBG, anthropometric parameters as well as blood pressure indicators. A moderate negative correlation was observed across entire patient sample between the testosterone level and several anthropometric parameters: waist circumference (WC), WC/hip circumference and BMI (p < 0.05). A weak negative correlation was found between the level of testosterone, fat mass (FM) and the proportion of FM in the general sample. A weak negative correlation between systolic BP and testosterone level throughout the patient sample was found, but a moderate negative correlation was observed solely in group 3. A positive weak correlation was found between testosterone and estradiol level in the general sample as well as in group 2, whereas in group 1 it was moderate. In contrast, in group 3 such a correlation was negative and weak. A positive correlation can be also traced between testosterone and SHBG level particularly being moderate in the entire sample as well as in groups 1 and 2, and noticeable in group 3.

Conclusion. The relationship was revealed between the parameters of body composition in men with excessive adipose tissue and MS related to testosterone, estradiol, SHBG level as well as anthropometric parameters and ВР corroborating systematic and multi-layered nature underlying obesity.

1. Saklayen M.G. The global epidemic of the metabolic syndrome. Curr Hypertens Rep. 2018;20(2):12. https://doi.org/10.1007/s11906-018-0812-z.

2. Swarup S., Goyal A., Grigorova Y., Zeltser R. Metabolic syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. 2021 Aug 1. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459248/.

3. Schwartz V.Ya. Inflammation as a factor in the pathogenesis of insulin resistance and type 2 diabetes mellitus. [Vospalenie kak faktor patogeneza insulinorezistentnosti i saharnogo diabeta 2-go tipa. Terapevticheskij arhiv. 2009;81(10):74–80. (In Russ.).

4. Shvarts V.Ya. Adipose tissue inflammation. Part 1. Morphological and functional manifestations. [Vospalenie zhirovojtkani. Chast' 1. Morfologicheskie i funkcional'nye proyavleniya]. Problemy endokrinologii. 2009;55(4):44–9. (In Russ.). https://doi.org/10.14341/probl200955444-49.

5. Shvarts V.Ya. Inflammation of adipose tissue. Part 2. Pathogenetic role in type 2 diabetes mellitus. [Vospalenie zhirovoj tkani. Chast' 2. Patogeneticheskaya rol' pri saharnom diabete 2-go tipa]. Problemy endokrinologii. 2009;55(5):43–8. (In Russ.). https://doi.org/10.14341/probl200955543-48.

6. Shvarts V. Inflammation of adipose tissue. Part 3. Pathogenetic role in the development of atherosclerosis. [Vospalenie zhirovoj tkani. Chast' 3. Patogeneticheskaya rol' v razvitii ateroskleroza]. Problemy endokrinologii. 2009;55(6):40–5. (In Russ.). https://doi.org/10.14341/probl200955640-45.

7. Pavlova Z.Sh., Golodnikov I.I. Obesity = inflammation. Pathogenesis. How does this threaten men? [Ozhirenie = vospalenie. Patogenez. Chem eto grozit muzhchinam?] Medicinskij vestnik Yuga Rossii. 2020;11(4):6–23. (In Russ.). https://doi.org/10.21886/2219-8075-2020-11-4-6-23.

8. Carruthers M., Trinick T.R., Jankowska E., Traish A.M. Are the adverse effects of glitazones linked to induced testosterone deficiency? Cardiovasc Diabetol. 2008;7:30. https://doi.org/10.1186/1475-2840-7-30.

9. Cutolo M. Estrogen metabolites: increasing evidence for their role in rheumatoid arthritis and systemic lupus erythematosus. J Rheumatol. 2004;31(3):419–21.

10. Castagnetta L.A., Carruba G., Granata O.M. et al. Increased estrogen formation and estrogen to androgen ratio in the synovial fluid of patients with rheumatoid arthritis. J Rheumatol. 2003;30(12):2597–605.

11. Gamidov S.I., Shatylko T.V., Gasanov N.G. Male health and obesity – diagnostic and therapeutic approach. [Muzhskoe zdorov'e i ozhirenie – diagnostika i terapevticheskie podhody]. Ozhirenie i metabolizm. 2019;16(3):29–36. (In Russ.). https://doi.org/https://doi.org/10.14341/omet10314.

12. Dobroch J., Cieśluk K., Sawicka-Żukowska M. et al. Metodypomiaruskładuciała w pediatrii – przegląd. Część 1. Pediatr Endocrinol Diabetes Metab. 2018;24(4):185–90. (In Polish). https://doi.org/10.5114/pedm.2018.83365.

13. Pavlova Z.Sh., Golodnikov I.I. Latent presarcopenic obesity in a patient with inflammatory bowel disease. [Skrytoe presarkopenicheskoe ozhirenie u pacienta s vospalitel'nymi zabolevaniyami kishechnika]. Endokrinologiya: novosti, mneniya, obuchenie. 2020;9(3):59–62. (In Russ.). https://doi.org/10.33029/2304-9529-2020-9-3-59-62.

14. Pavlova Z.Sh., Pyanykh O.P., Golodnikov I.I. The role of bioimpedance analysis in determining the metabolic health of a person. In: Obesity. A modern view of pathogenesis and therapy: a tutorial. Volume 2. [Rol' bioimpedansnogo analiza v opredelenii metabolicheskogo zdorov'ya cheloveka. V kn.: Ozhirenie. Sovremennyj vzglyad na patogenez i terapiyu: uchebnoe posobie. Tom 2]. Moscow: GEOTAR-Media, 2021. 264 p. (In Russ.).

15. Pavlova Z.Sh., Pyanykh O.P., Golodnikov I.I. Bioimpedance analysis: clinical examples and explanation of changes in human body composition under the influence of various factors. [Bioimpedansnyj analiz: klinicheskie primery i interpretaciya izmenenij sostava tela cheloveka pri vozdejstvii razlichnyh faktorov]. Endokrinologiya: novosti, mneniya, obuchenie. 2020;9(4):74–81. (In Russ.). https://doi.org/10.33029/2304-9529-2020-9-4-74-81.

16. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: World Health Organization, 2008. 47 p. Available at: https://apps.who.int/iris/handle/10665/44583.

17. Mancia G., Fagard R., Narkiewicz К. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357. https://doi.org/10.1097/01.hjh.0000431740.32696.cc.

18. Blenkov Yu.N., Privalova E.V., Kaplunova V.Yu. et al. Metabolic syndrome: development of the issue, main diagnostic criteria. [Metabolicheskij sindrom: istoriya razvitiya, osnovnye kriterii diagnostiki]. Racional'naya farmakoterapiya v kardiologii. 2018;14(5):757–64. (In Russ.). https://doi.org/10.20996/1819-6446-2018-14-5-757-764.

19. Metabolic syndrome. Ed. Corresponding Member of RAMS G.E. Roitberg. [Metabolicheskij sindrom. Pod red. chlen.-korr. RAMN G.E. Rojtberga]. Moscow: MEDpress-inform, 2007. 224 p. (In Russ.).

20. Alberti K.G., Eckel R.H., Grundy S.M. et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644.

21. Kassi E., Pervanidou P., Kaltsas G., Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011;9:48. https://doi.org/10.1186/1741-7015-9-48.

22. Estradiol, serum. Test Catalog. Mayo Clinic laboratories. Available at: https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/81816.

23. Jankowska E.A., Rozentryt P., Ponikowska B. et al. Circulating estradiol and mortality in men with systolic chronic heart failure. JAMA. 2009;301(18):1892–901. https://doi.org/10.1001/jama.2009.639.

24. Basu A., Seth S., Arora K. et al. Evaluating estradiol levels in male patients with colorectal carcinoma. J Clin Diagn Res: 2015;9(1):Bc08–10. https://doi.org/10.7860/jcdr/2015/10508.5397.

25. Cunningham G.R. Testosterone and metabolic syndrome. Asian J Androl. 2015;17(2):192–6. https://doi.org/10.4103/1008-682X.148068.

26. Tanabe M., Akehi Y., Nomiyama T. et al. Total testosterone is the most valuable indicator of metabolic syndrome among various testosterone values in middle-aged Japanese men. Endocr J. 2015;62(2):123–32. https://doi.org/10.1507/endocrj.EJ14-0313.

27. Meftah N., Bijani A., Hosseini S.R., Soleimani A.M. Decreased serum testosterone level was not significantly correlated with lipid indices in elderly men. Caspian J Intern Med. 2021;12(2):135–9. https://doi.org/10.22088/cjim.12.2.135.