Features and relationships of metabolic syndrome components in men with androgen deficiency. Part 2. Disorders of carbohydrate and purine metabolism. Retrospective study data

Introduction. Currently, few epidemiological data on a relation between impaired purine and carbohydrate metabolism and testosterone deficiency in overweight men due to adipose tissue and metabolic syndrome (MS) are available.

Aim: to study relationships between disturbances in carbohydrate and purine metabolism and testosterone level in men with adipose tissue excess and 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 on carbohydrate and purine metabolism related to testosterone level and body composition, as well as additionally assessing the level of inter-group difference.

Results. A relationship between the parameters of carbohydrate and purine metabolism and the level of total testosterone has been established along with overdeveloped adipose tissue. A weak negative correlation was found across the sample between testosterone and glucose, insulin, and the НОМА-IR (Homeostasis Model Assessment of Insulin Resistance) index. i.e., the higher the glucose level, the higher НОМА-IR index, and the lower the testosterone level. In addition, it was found that along with increasing BMI it was paralleled with higher insulin level. The number of patients with fasting blood glucose levels above 5.6 mmol/L and insulin resistance also increased. In the group with I degree of obesity, a negative correlation was found between the levels of total testosterone and uric acid.

Conclusion. Thus, the thesis is confirmed that the more significant the violation of carbohydrate and purine metabolism, the more profound could be androgenic deficiency. Thus, it is obvious that normalization of body composition and removal of excessive adipose tissue would provide a more effective solution in choosing a strategy to treat androgen deficiency and disorders of carbohydrate and purine metabolism in overweight men.

1. Guh D.P., Zhang W., Bansback N. et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88. https://doi.org/10.1186/1471-2458-9-88.

2. Gong M., Wen S., Nguyen T. et al. Converging relationships of obesity and hyperuricemia with special reference to metabolic disorders and plausible therapeutic implications. Diabetes Metab Syndr Obes. 2020;13:943–62. https://doi.org/10.2147/DMSO.S232377.

3. 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.

4. Wong Y., Cook P., Roderick P., Somani B.K. Metabolic syndrome and kidney stone disease: a systematic review of literature. J Endourol. 2016;30(3):246–53. https://doi.org/10.1089/end.2015.0567.

5. 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.

6. 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.

7. 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.

8. Gamidov S.I., Shatylko T.V., Hasanov N.G. Male health and obesity – diagnostis 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.

9. 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.

10. 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.

11. Tkachuk V.A., Vorotnikov A.A. Molecular mechanisms of insulin resistance. [Molekulyarnye mekhanizmy razvitiya rezistentnosti k insulin]. Saharnyj diabet. 2014;(2):29–40. (In Russ.). https://doi.org/10.14341/DM2014229-40.

12. Mishina E.E., Mayorov A.Yu., Bogomolov P.O. et al. Nonalcoholic fatty liver disease: a cause or a consequence of insulin resistance? [Nealkogol'naya zhirovaya bolezn' pecheni: prichina ili sledstvie insulinorezistentnosti?] Saharnyj diabet. (In Russ.). 2017;20(5):335–43. https://doi.org/10.14341/DM9372.

13. Pavlova Z.Sh., Golodnikov I.I., Kamalov A.A., Nizov A.N. A role of fructose in urinary stone formation. [Rol' fruktozy v geneze nefrolitiaza]. Urologiya. 2019;(1):114–8. (In Russ.). https://doi.org/10.18565/urology.2019.1.114-118.

14. Huang X., Jiang X., Wang L. et al. Visceral adipose accumulation increased the risk of hyperuricemia among middle-aged and elderly adults: a population-based study. J Transl Med. 2019;17(1):341. https://doi.org/10.1186/s12967-019-2074-1.

15. Liu F., Du G.L., Song N. et al. Hyperuricemia and its association with adiposity and dyslipidemia in Northwest China: results from cardiovascular risk survey in Xinjiang (CRS 2008-2012). Lipids Health Dis. 2020;19(1):58. https://doi.org/10.1186/s12944-020-01211-z.

16. Ni Q., Lu X., Chen C. et al. Risk factors for the development of hyperuricemia: a STROBEcompliant cross-sectional and longitudinal study. Medicine (Baltimore). 2019;98(42):e17597. https://doi.org/10.1097/MD.0000000000017597.

17. Kuwabara M., Kuwabara R., Hisatome I. et al. "Metabolically healthy" obesity and hyperuricemia increase risk for hypertension and diabetes: 5-year Japanese cohort study. Obesity (Silver Spring). 2017;25(11):1997–2008. https://doi.org/10.1002/oby.22000.

18. Qin T., Zhou X., Wang J. et al. Hyperuricemia and the prognosis of hypertensive patients: a systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2016;18(12):1268–78. https://doi.org/10.1111/jch.12855.

19. Xu J., Liu C., Fu L. et al. The association of serum uric acid with metabolic syndrome and its components – from a single-clinical centre in China. Int J Clin Pract. 2021;75(4):e13845. https://doi.org/10.1111/ijcp.13845.

20. Kuwabara M., Niwa K., Hisatome I. et al. Asymptomatic hyperuricemia without comorbidities predicts cardiometabolic diseases: five-year Japanese cohort study. Hypertension. 2017;69(6):1036–44. https://doi.org/10.1161/HYPERTENSIONAHA.116.08998.

21. Masuo K., Kawaguchi H., Mikami H. et al. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertension. 2003;42(4):474–80. https://doi.org/10.1161/01.HYP.0000091371.53502.D3.

22. Yoo T.W., Sung K.C., Shin H.S. et al. Relationship between serum uric acid concentration and insulin resistance and metabolic syndrome. Circ J. 2005;69(8):928–33. https://doi.org/10.1253/circj.69.928.

23. Pavlova Z.Sh., Grevina V.Yu. 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? [Osobennosti i vzaimosvyazi komponentov metabolicheskogo sindroma u muzhchin s androgennym deficitom. Chast' 1. Vzaimosvyazany li parametry sostava tela, uroven' polovyh gormonov i AD mezhdu soboj?]. Obstetrics, Gynecology and Reproduction. 2021;15(5):534–47. (In Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.256.

24. Mongioì L.M., Cimino L., Condorelli R.A. et al. Effectiveness of a very low calorie ketogenic diet on testicular function in overweight/obese men. Nutrients. 2020;12(10):2967. https://doi.org/10.3390/nu12102967.