长期减肥对睾酮的性别差异反应。
Sex-differential testosterone response to long-term weight loss.
机构信息
Garvan institute of Medical Research, Darlinghurst, NSW, Australia.
Sutherland and St George Hospitals, Caringbah, NSW, Australia.
出版信息
Int J Obes (Lond). 2024 Oct;48(10):1481-1488. doi: 10.1038/s41366-024-01591-7. Epub 2024 Jul 16.
OBJECTIVES
Obesity-associated gonadal dysfunction is a common comorbidity in patients seeking weight loss interventions. We examined the incremental effect of weight loss on gonadal axes in men and women over 3 years. Changes in sex hormones were compared between dietary intervention (Diet) and bariatric procedures: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and laparoscopic adjustable gastric banding (LAGB). Additional analysis assessed changes in corticotropic, somatotropic and thyroid axes after weight loss interventions.
METHODS
This prospective, observational study included 61 adults with Body Mass Index >30 kg/m, mean age 51 (SD = 11) years. Endocrine parameters were measured at baseline and at 6 timepoints over 36-months.
RESULTS
For each 1 kg of weight lost, between baseline and 36 months, total testosterone increased by 0.6% (95% CI: 0.2%, 1.0%, p = 0.002) in males and decreased by 0.8% (95% CI: -1.4%, -0.3%, p = 0.003) in females. These changes remained statistically significant when controlled for age and for menopausal status in females. At 36 months, in comparison with Diet, RYGB women had lower total testosterone by 54% (95% CI: -90%, -17%, p = 0.004), reduced free androgen index (FAI) by 65% (95% CI; -114%, -17%, p = 0.009) while SG had reduced FAI by 39% (95% CI; -77%, 0%, p = 0.05). No such differences between groups were noted for male subjects. Adrenocorticotropic hormone declined by 0.3% (95% CI: 0.0, -0.5%, p = 0.05), insulin-like growth factor-1 increased by 0.4% (95% CI; 0.2%, 0.7%, p = 0.005), without such thyrotrophin change for each 1 kg of weight loss, for entire cohort, over 36 months.
CONCLUSIONS
The testosterone changes observed in this study were proportional to the amount of weight loss. In females, reduction in androgens was independent of age and menopausal status and more pronounced after bariatric procedures. This study finding warrants further clinical research to explore an impact of androgen reduction on functional and cognitive status in postmenopausal women. The observed changes in pituitary hormones may contribute to the metabolic benefits of bariatric surgery.
目的
肥胖相关的性腺功能障碍是寻求减肥干预的患者的常见合并症。我们研究了体重减轻对男性和女性性腺轴的影响，时间跨度为 3 年。比较了饮食干预（Diet）和减肥手术（RYGB、SG 和 LAGB）对性激素的影响。另外的分析评估了减肥干预后促肾上腺皮质激素、生长激素和甲状腺轴的变化。
方法
这项前瞻性、观察性研究纳入了 61 名 BMI>30kg/m2、平均年龄 51（标准差=11）岁的成年人。内分泌参数在基线和 36 个月时的 6 个时间点进行测量。
结果
在 36 个月内，男性每减轻 1kg 体重，总睾酮增加 0.6%（95%CI：0.2%，1.0%，p=0.002），女性则降低 0.8%（95%CI：-1.4%，-0.3%，p=0.003）。当控制年龄和女性的绝经期状态时，这些变化仍然具有统计学意义。与 Diet 相比，36 个月时，RYGB 女性的总睾酮降低了 54%（95%CI：-90%，-17%，p=0.004），游离雄激素指数（FAI）降低了 65%（95%CI：-114%，-17%，p=0.009），而 SG 的 FAI 降低了 39%（95%CI：-77%，0%，p=0.05）。男性受试者组间无此类差异。整个队列在 36 个月内，促肾上腺皮质激素下降了 0.3%（95%CI：0.0，-0.5%，p=0.05），胰岛素样生长因子-1增加了 0.4%（95%CI：0.2%，0.7%，p=0.005），而甲状腺刺激素没有这种随体重减轻而变化。
结论
本研究中观察到的睾酮变化与体重减轻的量成正比。在女性中，雄激素的减少与年龄和绝经状态无关，减肥手术后更为明显。本研究结果需要进一步的临床研究来探索雄激素减少对绝经后女性功能和认知状态的影响。观察到的垂体激素变化可能有助于解释减肥手术的代谢益处。
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