Niskanen L, Laaksonen D E, Punnonen K, Mustajoki P, Kaukua J, Rissanen A
Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
Diabetes Obes Metab. 2004 May;6(3):208-15. doi: 10.1111/j.1462-8902.2004.00335.x.
Mild hypoandrogenism in men, usually defined by low levels of testosterone, is a peculiar feature of abdominal obesity that independently predicts the development of insulin resistance and diabetes mellitus. Little is known about the short- and long-term effects of weight loss on sex steroids in abdominally obese men, however.
We assessed the effect of rapid weight loss and sustained weight maintenance on the plasma concentrations of testosterone and other sex hormones in 58 abdominally obese men (age, 46.3 +/- 7.5 years; body mass index, 36.1 +/- 3.8 kg/m(2); waist girth, 121 +/- 10 cm) with the metabolic syndrome.
The men lost on average 16.3 +/- 4.5 kg during a 9-week very low-calorie diet (VLCD) and maintained 14.3 +/- 9.1 kg weight loss after a 12-month maintenance period (vs. baseline, p < 0.001). Sex hormone-binding globulin (SHBG) increased from 27.6 +/- 11.9 to 48.1 +/- 23.5 nmol/l during the VLCD but decreased to 32.6 +/- 12.9 nmol/l during weight maintenance, which was still higher than at baseline (p < 0.001). Free testosterone (fT) increased from 185 +/- 66 to 208 +/- 70 pmol/l (p = 0.002) during the VLCD and remained high after 1 year of weight maintenance (212 +/- 84 pmol/l, p = 0.002). Total testosterone levels followed a pattern intermediate between fT and SHBG. Plasma estradiol and dehydroepiandrosterone sulphate concentrations changed only transiently or not at all.
Rapid weight loss with successful weight maintenance in abdominally obese men with the metabolic syndrome brings about a sustained increase in fT levels. The dramatic increase in SHBG attenuated initially during weight maintenance but remained elevated. These findings may be important with regard to prevention of progressive metabolic decompensation and cardiovascular disease associated with obesity and the metabolic syndrome.
男性轻度雄激素缺乏通常由睾酮水平低来定义，是腹型肥胖的一个特殊特征，可独立预测胰岛素抵抗和糖尿病的发生。然而，关于体重减轻对腹型肥胖男性性激素的短期和长期影响知之甚少。
我们评估了58名患有代谢综合征的腹型肥胖男性（年龄46.3±7.5岁；体重指数36.1±3.8kg/m²；腰围121±10cm）快速减重和持续维持体重对血浆睾酮和其他性激素浓度的影响。
这些男性在为期9周的极低热量饮食（VLCD）期间平均减重16.3±4.5kg，在12个月的维持期后保持了14.3±9.1kg的体重减轻（与基线相比，p<0.001）。在VLCD期间，性激素结合球蛋白（SHBG）从27.6±11.9nmol/l增加到48.1±23.5nmol/l，但在体重维持期间降至32.6±12.9nmol/l，仍高于基线水平（p<0.001）。游离睾酮（fT）在VLCD期间从185±66pmol/l增加到208±70pmol/l（p=0.002），在体重维持1年后仍保持较高水平（212±84pmol/l，p=0.002）。总睾酮水平呈现出介于fT和SHBG之间的中间模式。血浆雌二醇和硫酸脱氢表雄酮浓度仅短暂变化或根本没有变化。
患有代谢综合征的腹型肥胖男性快速减重并成功维持体重会导致fT水平持续升高。SHBG的显著升高在体重维持初期有所减弱，但仍保持升高。这些发现对于预防与肥胖和代谢综合征相关的进行性代谢失代偿和心血管疾病可能具有重要意义。
