Archives of Endocrinology Metabolism最新文献

Objective: The global increase in metabolic syndrome (MetS) highlights the need for effective lifestyle interventions to reduce cardiovascular disease (CVD) risk. This study aimed to identify factors associated with lifestyle behaviors for preventing CVD complications among adults aware of MetS.

Subjects and methods: A cross-sectional online survey was conducted from January to February 2023 among 1,000 South Korean adults aged 20-69 years. After excluding 212 participants unaware of MetS, 788 respondents were included, of whom 710 engaged in at least three of nine recommended lifestyle behaviors: smoking cessation, alcohol abstinence, body weight monitoring, waist circumference measurement, blood pressure monitoring, regular hospital visits, adequate sleep, adherence to a low-salt diet, and regular physical activity. Participants were categorized into those with one or more MetS risk factors (META) and those without (Non-META).

Results: participants with MetS risk factors were predominantly male and aged 50-69 years, while those without were more likely female and aged 20-39 years. Abdominal obesity was the most common risk factor, whereas waist circumference monitoring was the least practiced behavior. The META group showed higher rates of blood pressure monitoring and hospital visits, while the Non-META group reported more frequent smoking cessation and alcohol abstinence.

Conclusion: Engagement in healthy lifestyle behaviors was positively associated with female sex, older age, and higher awareness of MetS-related complications. The limited practice of waist circumference monitoring underscores the need for targeted education and personalized preventive strategies to enhance CVD risk reduction among individual aware of MetS.

Objective: Epidemiological studies have revealed that glucose variability (GV) is a predictor of stroke, cognitive impairment, and dementia in patients with type 2 diabetes mellitus (T2DM). However, evidence on the associations of GV with white matter hyperintensity (WMH) and cerebrovascular abnormalities remains scarce. This study aimed to explore the relationships of GV with WMH and cerebrovascular abnormalities using epidemiological and Mendelian randomization (MR) approaches. The MR approach was used to assess the effects of genetic proxies for GV on MRI outcomes.

Subjects and methods: This cross-sectional study was conducted at a medical center where patients with T2DM were recruited. The measures for fasting plasma glucose (FPG) and HbA1c variability included the standard deviation, coefficient of variation, average real variability (ARV), and variability independent of the mean (VIM). Brain magnetic resonance images were analyzed to assess WMHs and cerebrovascular abnormalities. For MR, instrumental variables were used to assess the causal relationships between glycemic variability and outcome based on two-stage regression analysis.

Results: This study included 2,247 subjects, of whom 1,122 had WMH and 957 had cerebrovascular abnormalities. We found 80 independent single-nucleotide polymorphisms associated with GV but not with WMH or cerebrovascular abnormalities, which were subsequently used as genetic instruments. Genetically increased, unweighted FPG-VIM was linked with WMH (odds ratio 1.17 [95% CI 1.08, 1.27] per standard deviation). All genetically increased, unweighted and weighted GV measures were associated with cerebrovascular abnormalities, except FPG-ARV.

Conclusion: Our study provided evidence that genetically predicted GV was associated with WMH and cerebrovascular abnormalities, supporting a potential causal link under MR assumptions.

Objective: To examine the associations of handgrip strength and CT-derived muscle and visceral fat indices with insulin resistance in middle-aged women with prediabetes and newly diagnosed type 2 diabetes.

Subjects and methods: This cross-sectional study included 44 women aged 40-60 years attending a tertiary endocrinology clinic. Participants were classified according to the American Diabetes Association (ADA, 2022) criteria as having prediabetes (n = 29) or newly diagnosed type 2 diabetes (n = 15). All participants underwent anthropometric assessment, biochemical testing, L3-level CT imaging for visceral adipose tissue (VAT) and psoas muscle measurements, and handgrip strength evaluation using a digital dynamometer. Insulin resistance was assessed using the homeostatic model assessment for insulin resistance (HOMA-IR). Multivariable linear regression analysis was performed to identify independent factors associated with HOMA-IR.

Results: Dominant-hand grip strength demonstrated an inverse association with HOMA-IR (β = -0.297, p = 0.033). VAT volume and BMI were not significantly associated with HOMA-IR after adjustment (p > 0.75). The overall model explained 28% of the variance in HOMA-IR (R2 = 0.28; adjusted R2 = 0.14). Psoas muscle thickness showed a borderline inverse relationship with HOMA-IR (p = 0.079).

Conclusion: In this cohort of women with early glucose dysregulation, handgrip strength was independently associated with insulin resistance, whereas visceral adiposity was not. These findings suggest that muscle performance may represent a clinically relevant correlation of early metabolic impairment. Longitudinal studies are needed to clarify the temporal relationships.

Objective: The objective of this study is to compare the miRNA expression profiles of primary tumors and matched metastatic lesions from patients who died due to progression of metastatic PTC.

Subjects and methods: We conducted an exploratory study of patients with PTC who died from disease progression and had tissue samples available from both primary tumors and distant metastases. Total RNA was extracted and analyzed to assess the expression of 64 preselected miRNAs. Expression data were normalized using endogenous controls (let-7g-5p and miR-181a-5p), and differential expression was calculated using the 2-∆Ct method. Those miRNAs detected in < 70% of samples or with cycle threshold (Ct) > 36 were excluded. Univariate analyses were performed using paired tests, and multivariate results were adjusted for multiple comparisons using the Benjamini-Hochberg false discovery rate (FDR) method.

Results: Out of 3,555 patients treated for PTC between 1986 and 2015, eight patients were included. Univariate analysis identified five miRNAs differentially expressed in metastatic lesions: let-7e-5p, miR-10b-5p, miR-30e-3p, miR-423-5p, and miR-483-3p. After multivariate adjustment, miR-10b-5p and miR-30e-3p remained independently overexpressed in metastatic tissues.

Conclusion: This study is one of the first to demonstrate distinct miRNA expression profiles in metastatic versus primary tumors in fatal PTC cases. The identified miRNAs are known to regulate processes such as cell migration, invasion, and apoptosis in other cancers, suggesting their potential contribution to PTC metastasis.

Objective: Insulin resistance (IR) is central to cardiometabolic risk in obesity, but the clinical utility of IR indices may vary by age. We compared homeostasis model assessment for insulin resistance (HOMA-IR) and metabolic score for insulin resistance (METS-IR) across age groups in obese adults and examined comorbidity burden and discriminatory performance for type 2 diabetes mellitus (T2DM) and hypertension (HT).

Subjects and methods: This retrospective, single-center study included adults with a BMI ≥ 30 kg/m2 (n = 481) across four age strata (18-40, 40-65, 65-75, and ≥75 years). Spearman correlation assessed the association between HOMA-IR and METS-IR. Comorbidity burden (0-3 chronic conditions) was modeled using ordinal logistic regression per 1-SD increase in z-scores, adjusted for age, sex, and BMI. Receiver operating characteristic analysis and multivariable logistic regression assessed T2DM and HT.

Results: HOMA-IR and METS-IR were moderately correlated (ρ = 0.342 and p < 0.001, respectively). METS-IR was associated with comorbidity burden (adjusted odds ratio [OR] 1.84; 95% confidence interval [CI] 1.26-2.69; p < 0.01), whereas HOMA-IR was not (OR 1.12; 95% CI 0.92-1.36; p = 0.256). Discriminatory performance was limited for T2DM (area under curve [AUC] 0.500 vs. 0.537) and HT (AUC 0.471 vs. 0.519). METS-IR remained associated with T2DM (OR 2.51; 95% CI 1.60-3.93; p < 0.001) and HT (OR 1.81; 95% CI 1.13-2.91; p < 0.05).

Conclusion: In obese adults, METS-IR demonstrated a stronger association with comorbidity burden than HOMA-IR. However, because both indices showed limited discriminatory performance for T2DM and HT, they should not be used as standalone tools for treatment guidance or diagnostic classification. Rather, they should be interpreted alongside age, clinical, and biochemical findings, as isolated use may be misleading and fail to identify disease in specific patient subgroups.

Objective: To investigate the impact of smoking on serum selenium levels, autoimmune activity, and macular microvascular density in patients with clinically inactive thyroid-associated orbitopathy (TAO), using optical coherence tomography angiography (OCTA).

Subjects and methods: This retrospective cross-sectional study included 44 patients with inactive TAO (24 smokers, 20 non-smokers) and 32 ageand sex-matched healthy controls. All participants underwent ophthalmologic evaluation and laboratory testing for thyroid hormones, selenium, and thyroid-stimulating immunoglobulin (TSI). Macular vessel density was measured using spectral-domain OCTA at the superficial capillary plexus, deep capillary plexus, outer retinal layer, and choriocapillaris. Clinical activity score (CAS) was used to assess disease activity. The collected data were analyzed statistically.

Results: Smokers with TAO exhibited significantly higher CAS (p = 0.016) and TSI levels (p = 0.027), and lower serum selenium concentrations (p = 0.042) compared to non-smokers. Central superficial and deep capillary plexus densities were significantly reduced in smokers versus healthy controls (p = 0.029 and p = 0.017, respectively). No significant differences were observed between smokers and non-smokers within the TAO group, or in the outer retinal layer and choriocapillaris layers among all groups.

Conclusion: Smoking status was associated with lower selenium levels, higher TSI levels, and increased CAS. Furthermore, retinal microvascular attenuation detected by OCTA, even in the absence of clinical activity in TAO, may serve as a significant indicator of persistent vascular deterioration.

Objective: Postoperative weight regain remains a challenge after bariatric surgery and affects long-term outcomes. This study aimed to develop a clinical model to predict weight regain within 12 months, prior to surgery by using preoperative inflammatory, metabolic, and ferritin as biomarkers.

Subjects and methods: This retrospective observational study included 394 patients with obesity who underwent bariatric surgery (2020-2023), including laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients were divided into a training set (70%, n = 276) and a validation set (30%, n = 118) using a random number table. Weight regain was defined as a ≥ 10% increase from the postoperative nadir (median time to regain: 8.2 months). Key variables included peripheral blood inflammatory markers [systemic immune-inflammation index (SII, calculated as platelet count × neutrophil count/lymphocyte count), neutrophil-to-lymphocyte ratio (NLR)], glycolipid metabolism indicators [low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)], and ferritin levels. Multivariate logistic regression was used to identify independent predictive variables, and the nomogram model was validated via calibration, area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA).

Results: The weight regain rate was 19.9% (55/276) in the training set. Independent predictive variables included elevated SII (OR=1.004; 95% CI = 1.000-1.007), LDL-C (OR = 1.873; 95% CI = 1.054-3.329), ferritin (OR = 1.005; 95% CI = 1.003-1.008), and reduced HDL-C (OR = 0.103; 95% CI = 0.013-0.844) (all P < 0.05). The model showed strong discrimination (training AUC = 0.852, 95% CI = 0.795-0.910; validation AUC = 0.812, 95% CI = 0.709-0.915) and good calibration (Hosmer-Lemeshow P > 0.05). DCA confirmed the model's clinical utility across threshold probabilities.

Conclusion: Preoperative SII, LDL-C, ferritin, and HDL-C levels effectively predict postoperative weight regain. Early monitoring of these biomarkers may guide personalized interventions to improve long-term outcomes.

Cushing'sdisease (CD), caused by an adrenocorticotropin-secreting pituitary adenoma, is a rare but severe endocrine disorder associated with high cardiometabolic morbidity and mortality. Diagnosis is challenging as many symptoms are nonspecific, and biochemical or imaging results may be inconclusive, contributing to substantial diagnostic delay. Although the core features of CD are consistent across the lifespan, certain clinical manifestations of chronic hypercortisolism vary from childhood through older age, reflecting differences in growth, puberty, metabolism, and comorbidity burden. In children, impaired growth coupled with weight gain is most prominent, whereas adolescents often present with pubertal disturbances and psychological or academic difficulties. Adults typically exhibit the classic Cushingoid features such as round face, plethora, and central obesity, along with metabolic and reproductive complications. Older individuals typically present with frailty, sarcopenia, fractures, and cognitive decline. Age also influences the interpretation of endocrine tests, the accuracy of pituitary magnetic resonance imaging, the role of inferior petrosal sinus sampling, perioperative risks, and the long-term impact of remission or persistent disease. Given this context, this narrative review used five representative clinical vignettes (pediatric, adolescent, adult female, adult male, and elderly) to illustrate how the presentation, diagnostic evaluation, and management of CD vary across the lifespan. Each case was paired with a structured synthesis of current evidence, highlighting both shared principles and age-specific nuances essential for timely diagnosis, appropriate treatment selection, and effective long-term multidisciplinary care. Understanding age-related differences is crucial to improving outcomes and reducing the substantial morbidity and mortality associated with CD throughout the lifespan.

Objective: To evaluate the association between specific/all-cause mortality and the individual's age at death.

Materials and methods: This was a retrospective study that employed STROBE guidelines to its development. Medical records of 1,367 individuals diagnosed with diabetes mellitus (DM) who died between 1981 and 2021, in Bauru, São Paulo state, Brazil, were evaluated. Demographic, clinical, and obituary data were collected from medical records and death certificates, serving as adjustment variables in the analysis. Statistics were developed by using Cox-regression models.

Results: The final model, adjusted by male sex and T2DM, revealed Hazard Ratios of 0.74 (95% CI: 0.59-0.92; p < 0.01) for infectious causes and 1.92 (95% CI: 1.12-3.37; p < 0.01) for gastrointestinal conditions. These findings suggest that infectious causes were associated with later ages at death, while gastrointestinal conditions were related to younger ages at death. The other evaluated variables and groups of death causes did not show statistical significance.

Conclusion: Our study demonstrates that sex and DM type significantly influenced age at death. These findings emphasize the importance of considering demographic and clinical factors when assessing mortality patterns in DM, contributing to improved risk stratification and clinical management strategies.