Sun P, Cameron A, Seftel A, Shabsigh R, Niederberger C, Guay A. Erectile dysfunction–an observable marker of diabetes mellitus? A large national epidemiological study.J Urol. 2006 Sep;176(3):1081-5; discussion 1085
From the study abstract

Erectile dysfunction–an observable marker of diabetes mellitus?
A large national epidemiological study.

PURPOSE: We examined whether men with erectile dysfunction are more likely to have diabetes mellitus than men without erectile dysfunction, and whether erectile dysfunction can be used as an observable early marker of diabetes mellitus.

MATERIALS AND METHODS: Using a nationally representative managed care claims database from 51 health plans and 28 million members in the United States, we conducted a retrospective cohort study to compare the prevalence rates of diabetes mellitus between men with erectile dysfunction (285,436) and men without erectile dysfunction (1,584,230) during 1995 to 2001.

Logistic regression models were used to isolate the effect of erectile dysfunction on the likelihood of having diabetes mellitus with adjustment for age, region and 7 concurrent diseases.

RESULTS: The diabetes mellitus prevalence rates were 20.0% in men with erectile dysfunction and 7.5% in men without erectile dysfunction. With adjustment for age, region and concurrent diseases, the odds ratio of having diabetes mellitus between men with erectile dysfunction and without erectile dysfunction was 1.60 (p <0.0001). With adjustment for regions and concurrent diseases, the age specific odds ratios ranged from 2.94 (p <0.0001, age 26 to 35) to 1.05 (p = 0.1717, age 76 to 85).

CONCLUSIONS: Men with erectile dysfunction were more than twice as likely to have diabetes mellitus as men without erectile dysfunction. Erectile dysfunction is an observable marker of diabetes mellitus, strongly so for men 45 years old or younger and likely for men 46 to 65 years old, but it is not a marker for men older than 66 years.

Yaffe K, Barnes D, Lindquist K, Cauley J, Simonsick EM, Penninx B, Satterfield S, Harris T, Cummings SR. Endogenous sex hormone levels and risk of cognitive decline in an older biracial cohort. Neurobiol Aging. 2007 Feb;28(2):171-8.

BACKGROUND: Older women treated with conjugated estrogens may have an increased risk of dementia, but the effect of naturally occurring sex hormones on cognition is not certain.

METHODS: Bioavailable estradiol and free testosterone level were obtained from 792 (55% men, 51% black) participants. We assessed cognition with the Modified Mini-Mental State Examination (3MS), Selective Reminding Test (SRT) and CLOX 1 at baseline and 2 years later.

RESULTS: Women in the lowest estradiol tertile were more likely than those in the highest tertile to decline (> or = 1.0 S.D. of change) on 3MS (25% versus 9%, adjusted odds ratio [OR] = 3.9; 95% confidence interval [CI] = 1.6-9.6) and on SRT (28% versus 12%, adjusted OR [95% CI] = 3.3 [1.4-7.9]) but not CLOX 1. There was a borderline association between low estradiol tertile and decline on SRT in men (22% versus 14%, adjusted OR [95% CI] = 1.9 [0.9-3.9]). Testosterone level was not associated with decline in cognition in either men or women. Findings did not differ by race.

CONCLUSIONS: Older women with low estradiol levels were more likely to experience decline in global cognitive function and verbal memory, and a similar trend was observed for verbal memory in men. This supports the hypothesis that endogenous sex hormones may play an important role in the maintenance of cognitive function in older adults.

Daley A, Macarthur C, Stokes-Lampard H, McManus R, Wilson S, Mutrie N. Exercise participation, body mass index, and health-related quality of life in women of menopausal age. Br J Gen Pract. 2007 Feb;57(535):130-5.

BACKGROUND: Menopausal symptoms can affect women’s health and wellbeing. It is important to develop interventions to alleviate symptoms, especially given recent evidence resulting in many women no longer choosing to take hormone replacement therapy. Exercise may prove useful in alleviating symptoms, although evidence on its effectiveness has been conflicting.

AIM: To examine the association between exercise participation, body mass index (BMI), and health-related quality of life in women of menopausal-age. Design of study: Survey of women of menopausal age.

SETTING: West Midlands, England.

METHOD: Women aged 46-55 years (n = 2399) registered with six general practices in the West Midlands were sent a questionnaire containing items relating to demographics, lifestyle factors, weight, height, exercise participation, menopausal bleeding patterns, and health-related quality of life (including vasomotor symptoms).

RESULTS: One thousand two hundred and six (50.3%) women replied. Women who were regularly active reported better health-related quality of life scores than women who were not regularly active (P<0.01 for all significant subscales). No difference in vasomotor symptoms was recorded for exercise status. Women who were obese reported significantly higher vasomotor symptom scores than women of normal weight (P<0.01). Women who were obese reported significantly higher somatic symptoms (P<0.001) and attractiveness concern scores (P<0.001) than women of normal weight or those who were overweight.

CONCLUSION: The data suggest a positive association between somatic and psychological dimensions of health-related quality of life and participation in regular exercise. Women with BMI scores in the normal range reported lower vasomotor symptom scores and better health-related quality of life scores than heavier women. Further evidence from high-quality randomised controlled trials is required to assess whether exercise interventions are effective for management of menopausal symptoms.

Kaplan SA, Meehan AG, Shah A. The Age Related Decrease in Testosterone is Significantly Exacerbated in Obese Men With the Metabolic Syndrome. What are the Implications for the Relatively High Incidence of Erectile Dysfunction Observed in These Men? J Urol. 2006 Oct;176(4):1524-8

From the study abstract:
PURPOSE: We examined pooled baseline data from 2 lipid treatment studies to evaluate the relationship among total serum testosterone levels, obesity and the metabolic syndrome in aging men.

MATERIALS AND METHODS: Baseline total serum testosterone, lipid, glycemic and anthropometric data were obtained from 864 men (mean age 52 years) participating in 2 lipid treatment studies. Inclusion criteria for the 2 studies included low-density lipoprotein cholesterol 130 to 160 mg/dl and triglycerides 350 mg/dl or less.

RESULTS: For all patients as well as the nonmetabolic syndrome and the metabolic syndrome cohorts, testosterone decreased with increasing body mass index (p <0.0001 for Pearson correlation coefficient in all 3 cohorts).

Mean baseline total serum testosterone levels in obese and severely obese aging men with the metabolic syndrome were around 150 and 300 ng/dl, respectively, less than that in aging, lean men with no metabolic syndrome.

…Based on these analyses the presence of diabetes or fasting serum glucose greater than 110 mg/dl, body mass index 30 kg/m or greater, and triglycerides 150 mg/dl or greater each appeared to have a clinically relevant association with low serum testosterone.

CONCLUSIONS: This study demonstrated that aging men with obesity and the metabolic syndrome have a significant decrease in total serum testosterone levels compared to aging, metabolically healthy men. These data suggest that the well established association between erectile dysfunction and pre-diabetes/diabetes (particularly in obese pre-diabetic/diabetic patients) may involve a hormonal component.

Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Waist Circumference Correlates with Metabolic Syndrome Indicators Better Than Percentage Fat.

From the article abstract
OBJECTIVE: Percent fat is often considered the reference for establishing the magnitude of adipose tissue accumulation and the risk of excess adiposity. However, the increasing recognition of a strong link between central adiposity and metabolic disturbances led us to test whether waist circumference (WC) is more highly correlated with metabolic syndrome components than percent fat and other related anthropometric measures such as BMI. (Body Mass Index)

Waist circumference had the strongest associations with health risk indicators, followed by BMI. Although percent fat is a useful measure of overall adiposity, health risks are best represented by the simply measured WC.

Derby CA, Zilber S, Brambilla D, Morales KH, McKinlay JB. Body mass index, waist circumference and waist to hip ratio and change in sex steroid hormones: the Massachusetts Male Ageing Study. Clin Endocrinol (Oxf). 2006 Jul 1;65(1):125-31.

From the study abstract:
Objective Cross-sectional data suggest that obesity, particularly central obesity, may be associated with decreased production of sex steroid hormones in men. However, longitudinal hormone data on men in relation to obesity status are limited. Previous studies have not consistently demonstrated whether sex steroids are associated specifically to body mass index or to measures of central obesity.

Our objective was to examine the relation of obesity and of central obesity to longitudinal change in sex steroid hormones in men.

Measurements Free and total testosterone (FT and TT), dehydroepiandrosterone sulphate (DHEAS), and sex hormone-binding globulin (SHBG) were assessed using standardized methods. Health behaviours and medical history were obtained by structured interview.

Repeated measures regression was used to describe trends in steroid hormones and SHBG in relation to obesity status, adjusting for age, smoking, alcohol, comorbidities, and physical activity.

Results: Obesity was associated with decreased levels of total and free testosterone, and of SHBG at follow-up relative to baseline. For any given baseline concentration of TT, FT or SHBG, follow-up levels were lowest among men who remained obese or who became obese during follow-up.

This was true for all three indices of obesity. Central adiposity was associated with lower DHEAS levels at follow-up, while elevated body mass index was not.

Conclusions: Obesity may predict greater decline in testosterone and SHBG levels with age. Central adiposity may be a more important predictor of decline in DHEAS than is body mass index.

Researchers writing in the medical journal Diabetes Care, examined the relationship between active lifestyle, diabetes, and life expectancy. From the abstract:

OBJECTIVE—Physical activity is associated with a reduced risk of developing diabetes and with reduced mortality among diabetic patients. However, the effects of physical activity on the number of years lived with and without diabetes are unclear. Our aim is to calculate the differences in life expectancy with and without type 2 diabetes associated with different levels of physical activity.

CONCLUSIONS—Moderately and highly active people have a longer total life expectancy and live more years free of diabetes than their sedentary counterparts but do not spend more years with diabetes.

Read the abstract

From the abstract:
“PURPOSE: This retrospective study evaluated the incorporation of low-glycemic index (GI) carbohydrates into daily meal planning as an effective behavioral lifestyle change to improve glycemic control and weight management in patients with type 1 and 2 diabetes.

CONCLUSIONS: Daily incorporation of low-GI carbohydrates in meal planning can be an effective diabetes self-management strategy for glycemic control and weight management. The documented responses to the subjects’ conceptual and practical knowledge of the GI confirm their acceptance of this approach as a permanent behavioral lifestyle change and not a “diet.” The positive results of this study attest to what worked for these subjects, inviting diabetes educators to consider offering low-GI dietary advice to their diabetes patients.”

Read the abstract
Burani J, Longo PJ. Low–Glycemic Index Carbohydrates. An Effective Behavioral Change for Glycemic Control and Weight Management in Patients With Type 1 and 2 Diabetes. The Diabetes Educator, Vol. 32, No. 1, 78-88 (2006)

From the study abstract: “Exercise improves glucose metabolism and delays the onset and/or reverses insulin resistance in the elderly by an unknown mechanism. In the present study we examined the effects of exercise training on glucose metabolism, abdominal adiposity and adipocytokines* in obese elderly.”

What the researchers found: “Visceral fat loss after aerobic exercise training improves glucose metabolism and is associated with the reversal of insulin resistance in older obese men and women.”

*Adipocytokines are a collective term for secretions from the fat cells that help regulate energy metabolism and food intake among other functions.

Reference: O’Leary VB, Marchetti CM, Krishnan RK, Stetzer BP, Gonzalez F, Kirwan JP. Exercise-induced reversal of Insulin Resistance in Obese Elderly is associated with reduced Visceral Fat.J Appl Physiol (December 22, 2005) Study abstract

Racette SB, Evans EM, Weiss EP, Hagberg JM, Holloszy JO. Abdominal Adiposity Is a Stronger Predictor of Insulin Resistance Than Fitness Among 50–95 Year Olds. Diabetes Care 29:673-678, 2006

Excerpts From the study abstract
OBJECTIVE—Physical inactivity and increased adiposity contribute to insulin resistance; less is known, however, about the relative contributions of these factors in older adults. The aim of this study was to determine whether cardiovascular fitness, whole-body adiposity, or abdominal adiposity is the strongest predictor of insulin resistance into old age.

CONCLUSIONS—Adiposity and fitness continue to be significant predictors of insulin sensitivity into old age, with abdominal obesity being the most important single factor. These findings support the measurement of waist circumference to assess health risk among older adults.