Journal of Clinical Endocrinology & Metabolism最新文献

Context: Metabolic syndrome (MetS) risk factors emerge in childhood. The precursors may include familial association through genetic inheritance or cohabitation.

Objective: To examine cross-sectional associations of MetS components between spouses and between parents and their 5- to 19-year-old offspring.

Methods: Data were obtained from 1255 mother-father-offspring triads enrolled in a longitudinal study in an Indigenous community in Arizona (1965-2007). Parent-offspring measures of waist circumference, triglycerides, high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), diastolic blood pressure, and fasting glucose were used for MetS diagnosis. Parental MetS and its components were defined according to the modified criteria of Adult Treatment Panel III. Additional offspring measures included glycated hemoglobin, fasting insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and type 2 diabetes (T2D).

Results: Parental MetS components associated significantly with higher risk of diabetes and with higher central adiposity, triglycerides, SBP, fasting glucose and insulin, and HOMA-IR and lower HDL-C in the offspring. These associations were stronger during adolescence and more pronounced between maternal-offspring dyads. For instance, offspring of mothers with hyperglycemia had 10.3 mg/dL higher fasting glucose at ages 12 to 19 years (vs 2.61 mg/dL higher fasting glucose at ages 5-11 years) than the offspring of mothers with normal glucose levels. Parental diabetes partially explained some of these associations. We also found significant spousal concordance in metabolic risk attributes.

Conclusion: Parental MetS characteristics were significantly associated with T2D and cardiometabolic risk factors in offspring. Associations were stronger during adolescence and between maternal-offspring pairs. These findings strongly support the need for family-based interventions directed at modifying health behaviors in high-risk population groups.

Context: The biochemical diagnosis of carcinoid syndrome (CS) is established through the measurement of 24-hour urine 5-hydroxyindoleacetic acid (5-HIAA), but these measurements are prone to sampling error and may be troublesome for patients. Serum 5-HIAA measurements might constitute a more reliable and convenient alternative to diagnose CS.

Objective: To assess the diagnostic value of serum 5-HIAA measurements in patients with CS.

Design: Retrospective cohort study.

Setting: Tertiary care hospital.

Patients: 379 patients with a neuroendocrine tumor (NET), of whom 136 (35.9%) had CS; 153 control samples were included.

Intervention: Paired serum and 24-hour urine 5-HIAA measurements.

Main outcome measure(s): Performance of serum and 24-hour urine 5-HIAA for the diagnosis of CS, measured by area under the receiver operating characteristic curve (AUROC).

Results: Serum 5-HIAA performance was similar to that of 24-hour urine 5-HIAA for the diagnosis of CS in the total NET cohort (n = 379, AUROC 0.824 vs 0.843, P = .50) and in a subgroup of somatostatin analog (SSA)-naïve patients (n = 141, AUROC 0.915 vs 0.938, P = .66). Optimal cutoff value of serum 5-HIAA for the diagnosis of CS was 139.4 nmol/L (sensitivity 96.3%, specificity 87.6%) as determined in a subgroup analysis of SSA-naive patients with CS and controls. Serum 5-HIAA correlated well with 24-hour urine 5-HIAA (r = 0.892, P < .001) and the presence of flushing, diarrhea, and carcinoid heart disease (odds ratio 1.047-1.073 for every 100 nmol/L increase, P < .001).

Conclusion: Serum 5-HIAA measurements are equivalent to 24-hour urine 5-HIAA measurements for the diagnosis of CS in patients with NET and form an accessible alternative.

Objective: Type 2 diabetes risk prediction models lack the option to predict risk conditional on initiating different preventive interventions. Our objective was to develop and validate a diabetes risk prediction model with individualized preventive intervention effects among racially diverse populations.

Methods: The derivation cohort included participants in the Diabetes Prevention Program (DPP) trial randomized to placebo, metformin, or intensive lifestyle intervention (n = 2640). A risk prediction model for incident diabetes was developed using Cox proportional hazards regression using clinically available predictors: sex, glycated hemoglobin, fasting plasma glucose (FPG), body mass index (BMI), triglycerides, and intervention. To create individualized intervention effects, pairwise interactions between intervention and age, FPG, and BMI were included. The discrimination, calibration, and net benefit of the model's 3-year predictions for incident diabetes were internally validated within the DPP and externally validated among participants with prediabetes in the Multi-Ethnic Study of Atherosclerosis (MESA; n = 2104).

Results: In DPP and MESA, mean (SD) age was 51 years (11) and 64 (10), and 67% and 50% of participants were women, respectively. The mean C-statistic was 0.71 [95% confidence interval (CI): 0.68, 0.74] in DPP and 0.86 (95% CI: 0.83, 0.88) in MESA. The optimal preventive intervention (lowest 3-year risk) was lifestyle for 86% and 97% of DPP and MESA participants, respectively, and metformin for the remaining. Model performance was similar across race/ethnicity groups.

Conclusion: This is the first study to develop and validate a diabetes risk prediction model with individualized preventive intervention effects that may improve clinical decision-making and diabetes prevention.

Context: 47,XXY/Klinefelter syndrome (XXY) is associated with impaired testicular function and differences in physical growth, metabolism, and neurodevelopment. Clinical features of XXY may be influenced by testosterone during the minipuberty period of infancy.

Objective: We tested the hypothesis that exogenous testosterone treatment positively affects short-term physical, hormonal, and neurodevelopmental outcomes in infants with XXY.

Design: Double-blind randomized controlled trial, 2017-2021.

Setting: US tertiary care pediatric hospital.

Patients: Infants 30 to 90 days of age with prenatally identified, nonmosaic 47,XXY (n = 71).

Intervention: Testosterone cypionate 25 mg IM injections every 4 weeks for 3 doses.

Main outcome measures: The a priori primary outcomes were change in percent fat mass z-scores and change in the total composite percentile on Alberta Infant Motor Scales assessment from baseline to 12 weeks.

Results: The between-group difference in change in percent fat mass z-scores was -0.57 (95% CI, -1.1 to -0.06; P = .03), secondary to greater increases in lean mass in the testosterone-treated group (1.5 ± 0.4 kg vs 1.2 ± 0.4; P = .001). Testosterone suppressed gonadotropins and inhibin B (P < .001 for all). In contrast, there were no significant group differences in short-term motor, cognitive, or language outcomes (P > .15 for all).

Conclusions: In this double-blind randomized controlled trial in infants with XXY, testosterone injections resulted in physical effects attributable to systemic androgen exposure; however, this dose suppressed the hypothalamic-pituitary-gonadal axis. Neurodevelopment outcomes were not impacted by treatment. These results do not support routine testosterone treatment in infants with XXY; however, long-term follow-up on physical health, neurodevelopment, and testicular function is needed.

Context: A preclinical state of Graves' ophthalmopathy (pre-GO) exists during the progression from Graves' hyperthyroidism (GH) to GO.

Objective: To distinguish the pre-GO state and identify key pathways of T-cell immunity.

Methods: Twenty-four GH (without ophthalmopathy within 6-month follow-up), 10 pre-GO (ophthalmopathy occurred within 6-month follow-up), and 21 GO patients were enrolled, and the transcription and DNA methylation profiles of peripheral blood mononuclear cells were generated. The differentially expressed genes (DEGs), differentially methylated CpG sites (DMCs), and differentially methylated genes (DMGs) were identified. Cluster analysis, functional analysis, and data integration analysis using latent components (DIABLO) were performed to distinguish pre-GO and identify key pathways. Flow cytometry was performed for in vitro verification.

Results: In total, 731, 1214, and 372 DEGs and 1583, 277, and 555 DMCs were detected via pairwise comparisons of GH vs GO, pre-GO vs GO, and GH vs pre-GO, respectively. DIABLO accurately discriminated the pre-GO state via 17 DMC and 11 DEG features ( receiver operating characteristic = 0.9975 and 0.9407, respectively). The functional analysis revealed that the DMGs and DEGs were enriched in T-cell differentiation pathways and related cytokine pathways, respectively. Further cluster analysis revealed a cluster of pre-GO-specific DEGs enriched in the hypoxia pathway. Flow cytometry confirmed that hypoxia promoted Th1, Th17, and antigen-specific CD4+ cytotoxic T-cell differentiation.

Conclusion: The pre-GO state was identified from GH and GO and characterized by upregulation of the hypoxia pathway that may promote effector CD4+ T-cells differentiation. These findings provide new insight into the pathogenesis and prevention of GO.

Context: Very-low-calorie ketogenic diet (VLCKD) is used for weight loss and management of obesity-related comorbidities.

Objective: We aimed at evaluating the effects of VLCKD on body composition and energy metabolism.

Methods: This prospective outpatient study included 17 women with obesity (mean age 41.6 years; body mass index 37.5 kg/m2) who followed a 1-month VLCKD (700-800 kcal/day, carbohydrate 11%, fat 46%, protein 43%) at the University Hospital of Pisa. Measurements of 24-hour energy expenditure (24hEE) and substrate oxidation were conducted in a metabolic chamber at day 1 (V1), day 8 (V2), and day 29 (V3). Body composition was assessed by Dual energy X-ray absorptiometry. Twenty-two women with obesity fed a balanced isocaloric diet served as controls.

Results: Compared with controls, carbohydrate oxidation (CarbOx) was lower, whereas fat oxidation (FatOx) and protein oxidation (ProtOx) were higher in the VLCKD group at V1. CarbOx decreased by 65%, while FatOx increased by 11% at V3. The rate of ProtOx was already higher than in controls at V1 and remained stable throughout the study. After 1 month, body weight decreased by 7%, reflecting an 8.8% reduction in fat mass and a 5.6% reduction in lean soft tissue (LST). A 10% decrease in 24hEE and 24-hour sleeping metabolic rate was observed at V3 compared with V1.

Conclusion: VLCKD promotes weight loss in women with obesity. Our findings highlight the shift in energy metabolism towards increased FatOx accompanied by a modest increase in protein oxidation, a decrease in LST and a reduction in EE.

Context: The relationship between initial changes in estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR), and their independent association with clinical outcomes in type 2 diabetes (T2D) patients receiving sodium-glucose cotransporter 2 inhibitors (SGLT2is), remains unclear.

Objective: This study aimed to investigate the association between initial changes in eGFR and UACR with consequent cardiovascular and kidney outcomes in an Asian population with T2D following SGLT2i treatment in a real-world setting.

Methods: Using a large multicenter medical database in Taiwan, we analyzed 8222 T2D patients with baseline and 3-month follow-up eGFR and UACR measurements, receiving SGLT2is between June 1, 2016, and December 31, 2021. We assessed risks of major adverse renal events (MARE), major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), and all-cause mortality using a Cox proportional hazards model.

Results: After 3 months of SGLT2i treatment, patients were categorized based on early changes in eGFR (no decline, 0%-10% decline, > 10% decline) and UACR (no reduction, 0%-30% reduction, > 30% reduction). Among those with no initial eGFR decline (40.9%), 19.8% had no initial UACR reduction, 8.4% had 0% to 30% reduction, and 12.7% had greater than 30% reduction. For those with greater than 10% initial eGFR decline (21.5%), 6.5% had no UACR reduction, 4.3% had 0% to 30% reduction, and 10.7% had greater than 30% reduction. Patients with greater than 10% initial eGFR decline but no UACR reduction showed higher risks of MARE (adjusted HR [aHR]: 2.34; 95% CI, 1.32-4.15), MACE (aHR: 1.83; 95% CI, 1.01-3.29), and HHF/cardiovascular death (aHR: 1.93; 95% CI, 1.05-3.55) compared to those with modest early eGFR decline and UACR reduction.

Conclusion: T2D patients experiencing profound early eGFR decline without concordant UACR reduction while on SGLT2is represent a high-risk subgroup with worse clinical outcomes. These findings suggest the need for closer monitoring and potentially more aggressive therapeutic strategies for this patient population.

Context: Congenital hypogonadotropic hypogonadism (CHH) in infant boys is a rare disorder that can manifest as micropenis and/or cryptorchidism. Mini-puberty is considered a window of opportunity for CHH diagnosis and treatment. The lack of testosterone (T) elevation during this period is the gold standard for CHH diagnosis, but hormonal evaluation is not always available at this time.

Objectives: The aim was to compare inhibin B (INHB), anti-Müllerian hormone (AMH), T, LH, and FSH between infant boys (1 to 365 days) with micropenis and/or cryptorchidism due to isolated CHH (iCHH), CHH as part of combined pituitary hormone deficiency (CPHD), or of idiopathic origin (controls) and to determine discriminating cutoffs for CHH diagnosis based on sensitivity (Se) and specificity (Sp).

Methods: This multicenter study from 7 University Hospitals in France included 138 boys aged 0 to 12 months (58 with iCHH, including 28 with a positive molecular diagnosis, 32 with CPHD, and 48 controls). Four periods of interest were studied: between 1 to 4 days, 15 to 65 days (early mini-puberty, corresponding to the T peak), 66 to 179 days (late mini-puberty), and 180 to 365 days (post mini-puberty).

Results: Out of mini-puberty, the best-discriminating hormones were INHB between 1 to 4 days (Se/Sp 100%/75% at 150 pg/mL and 89%/100% at 85 pg/mL) and INHB and AMH after 180 days (INHB: Se/Sp 100%/100% at 100 pg/mL; AMH: Se/Sp 100%/92% at 600 pmol/L, and 75%/100% at 370 pmol/L). INHB and/or AMH discriminating performances were good (area under the receiver operating characteristic curve ≥ 0.95) across all 4 periods.

Conclusion: Inhibin B and/or AMH can be used to diagnose CHH in boys < 1 year of age.

Context: Epidemiological data suggest that participants with lower vs higher body mass index (BMI) resist exposure to the obesogenic environment.

Objective: To test this, we analyzed the relationship between overfeeding-induced weight and fat mass gains with baseline BMI and body fat percentage.

Methods: In this controlled intervention study, 34 men (age 26 ± 5 years; BMI 25.5 ± 2.4 kg/m2; body fat [by dual-energy x-ray absorptiometry] 19.3 ± 5.1%) consumed for 8 weeks 40% more energy than needed at weight maintenance. The energy costs of weight and fat mass gain were calculated as the 8-week excess energy consumed divided by weight or fat mass gain. Energy expenditure (baseline and after overfeeding) was determined using a metabolic chamber and doubly labeled water. Transcriptomic analysis was conducted from abdominal subcutaneous adipose tissue samples.

Results: Body weight increased 7.2 ± 2.1 kg and fat mass 4.0 ± 1.4 kg. There was no statistical association between baseline BMI and weight and fat mass gains. However, baseline body fat percentage was significantly associated with weight (r = 0.57) and fat mass (r = 0.59) gains. Body fat percentage was also statistically associated with energy cost of weight (r = -0.38) and fat mass (r = -0.40) gains. Metabolic adaptation in energy expenditure (adaptive thermogenesis) was unrelated to the energy cost of weight and fat mass gains. Transcriptomics analysis showed that high energy cost of weight gain was associated with upregulation of inflammation-related pathways.

Conclusion: Body fat percentage at baseline was inversely associated with overfeeding-induced weight and fat gain resistance. The underlying compensatory response appears unrelated to changes in energy expenditure.