title: Interaction of sex steroid hormones and obesity on insulin resistance and type 2 diabetes in men: the Third National Health and Nutrition Examination Survey.
abstract: OBJECTIVE
  We examined interaction of sex steroid hormones and obesity with regard to insulin resistance (IR) and type 2 diabetes (T2D) by using nationally representative data from the US.
  
  
  METHODS
  Data of 1461 men aged ≥20years who participated in the Third National Health and Nutrition Examination Survey were analyzed. Multiplicative interaction was calculated by cross-product interaction terms in multivariable logistic regression models. Additive interaction was assessed by the relative excess risk due to interaction (RERI).
  
  
  RESULTS
  After adjusting for demographic and lifestyle covariates, the odds of IR were greatest among obese men with low free testosterone and high androstanediol glucuronide. Multiplicative interactions for total testosterone, free testosterone, and free estradiol index (FEI) were statistically significant with central obesity but not with overweight and obesity regarding to T2D (P<0.05). Significant additive interactions with obesity or central obesity were detected for total testosterone (RERI=2.75, 95% CI=0.92,4.59), SHBG (RERI=5.71, 95% CI=0.77,10.64), and FEI (RERI=-9.96, 95% CI=-19.18,-0.74) with regard to IR, beta-cell dysfunction, and T2D.
  
  
  CONCLUSIONS
  Our findings add to the evidence suggesting that low testosterone and high estradiol may be associated greater risks of IR and T2D by interacting with overall and central obesity in adult men.
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
authors.forename: Ji
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
authors.forename: Hong
authors.initials: H
authors.lastname: Lai
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
authors.forename: Shaoguang
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States. Electronic address: slai@jhmi.edu.
authors.forename: Shenghan
authors.initials: S
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D015113:Androstane-3,17-diol / Q000031:analogs & derivatives* / Q000097:blood; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D004958:Estradiol / Q000097:blood*; D006801:Humans; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000097:blood / Q000150:complications / Q000378:metabolism; D056128:Obesity, Abdominal / Q000097:blood / Q000150:complications / Q000378:metabolism*; D050177:Overweight / Q000097:blood / Q000150:complications / Q000378:metabolism; D015995:Prevalence; D012306:Risk; D013739:Testosterone / Q000097:blood*; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D015113:Androstane-3,17-diol; C028895:androstane-3,17-diol glucuronide; D013739:Testosterone; D004958:Estradiol
keywords: Insulin resistance; Men; NHANES; Obesity; Sex steroid hormones; Type 2 diabetes