title: Estradiol and metabolic syndrome in older italian men: The InCHIANTI Study.
abstract: The increasing prevalence of metabolic syndrome (MS) with age in older men has been linked with decreasing testosterone levels. Interestingly, while testosterone levels decline with age, estradiol (E2) levels remain relatively stable, resulting in a decreased testosterone:E2 ratio. Because E2 levels tend to be elevated in morbid obesity, insulin resistance, and diabetes, it is reasonable to hypothesize that high E2 levels are associated with MS in older men. We studied the relationship of total and free E2 with MS after adjustment for multiple confounders, including age, BMI, smoking, alcohol consumption, physical activity, interleukin-6 (IL-6), fasting insulin, and testosterone. Men 65 years or older (age range, 65-96; n = 452) had complete data on E2, testosterone, fasting insulin, sex hormone-binding globulin, IL-6, and albumin. Concentrations of free E2 and free testosterone were calculated using the mass action equations. MS was defined according to Adult Treatment Panel III (ATP-III). Participants with MS had significantly higher serum free and total E2 (P < .001) (P = .003). After adjusting for confounders, including age, smoking, alcohol consumption, physical activity, log(IL-6), and log(insulin), participants with higher log(total E2) (odds ratio [OR], 2.31; 95% confidence interval [95% CI], 1.39-4.70; P = .02) and higher log(free E2) (OR, 2.69; 1.38-5.24; P < .001) had an increased risk of having MS. Log(free E2) (P = .04) maintained significant correlation with MS, even after further adjustment for BMI. In older men, high E2 is independently associated with MS. Whether confirmed in other studies, assessment of E2 should be also considered in older men. Whether changes in this hormonal pattern play a role in the development of MS should be further tested in longitudinal studies.
authors.affiliation: Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, 43100 Parma, Italy. marcellomaggio2001@yahoo.it
authors.forename: Marcello
authors.initials: M
authors.lastname: Maggio
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lauretani
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ceda
authors.forename: Stefania
authors.initials: S
authors.lastname: Bandinelli
authors.forename: Shehzad
authors.initials: S
authors.lastname: Basaria
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paolisso
authors.forename: Claudio
authors.initials: C
authors.lastname: Giumelli
authors.forename: Michele
authors.initials: M
authors.lastname: Luci
authors.forename: Samer S
authors.initials: SS
authors.lastname: Najjar
authors.forename: E Jeffrey
authors.initials: EJ
authors.lastname: Metter
authors.forename: Giorgio
authors.initials: G
authors.lastname: Valenti
authors.forename: Jack
authors.initials: J
authors.lastname: Guralnik
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D004958:Estradiol / Q000097:blood*; D006801:Humans; D007328:Insulin / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007558:Italy; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism*; D012709:Serum Albumin / Q000032:analysis; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000097:blood
chemical_list: D007328:Insulin; D015850:Interleukin-6; D012709:Serum Albumin; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol