体重减轻对2型糖尿病女性和男性性激素的影响存在差异：“展望”性激素研究

Weight Loss Differentially Impacts Sex Hormones in Women and Men With Type 2 Diabetes: Look AHEAD Sex Hormone Study.

作者信息

Bennett Wendy L, He Jiahuan Helen, Michos Erin D, Kalyani Rita R, Clark Jeanne M, Woodward Mark, Syed Nazia, Ma Jianqiao, Everett Allen D, Yang Jun, Graham David, Ellis Greg, Vaidya Dhananjay

机构信息

Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.

出版信息

J Clin Endocrinol Metab. 2025 May 19;110(6):e2001-e2007. doi: 10.1210/clinem/dgae584.

DOI:10.1210/clinem/dgae584

PMID:39219157

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12086392/

Abstract

BACKGROUND

Despite sex differences in type 2 diabetes (T2D), few studies have examined the role of sex hormones. We sought to assess the impact of weight loss, the cornerstone of T2D management, on sex hormone levels.

METHODS

This was an ancillary study to the Look AHEAD (Action for Health In Diabetes) Study [n = 850 postmenopausal females, n = 890 males, with T2D and body mass index (BMI) ≥25 kg/m2]. We measured total testosterone (T), estradiol (E2), and SHBG and calculated bioavailable T (bioT). We examined the effect of the intensive lifestyle intervention (ILI) on hormone changes and whether changes were mediated by waist circumference and sex differences in treatment effect.

RESULTS

The baseline mean age was 60 years with a higher proportion of Black females (21%) vs males (9%) and higher mean BMI in females vs males (36.3 vs 34.8 kg/m2). At year 1 in females, ILI decreased E2 by 15% and bioT by 13% and increased SHBG by 21%. At year 1 in males, ILI did not change E2 levels but increased T by 14% and increased SHBG by 18%. The effect was attenuated over 4 years; there were statistically significant sex differences in treatment effect and change in waist circumference due to ILI at year 1 was a significant mediator of sex hormone changes.

CONCLUSION

Weight loss in T2D resulted in sex hormone changes, which varied by sex and were mediated by changes in waist circumference. Changes in sex hormones due to weight loss in T2D should be considered in the context of an individual's health risks, including cardiovascular conditions, bone health, menopausal symptoms, and cognitive function.

摘要

背景

尽管2型糖尿病（T2D）存在性别差异，但很少有研究探讨性激素的作用。我们试图评估作为T2D管理基石的体重减轻对性激素水平的影响。

方法

这是Look AHEAD（糖尿病健康行动）研究的一项辅助研究[850名绝经后女性、890名男性，患有T2D且体重指数（BMI）≥25 kg/m²]。我们测量了总睾酮（T）、雌二醇（E2）和性激素结合球蛋白（SHBG），并计算了生物可利用睾酮（bioT）。我们研究了强化生活方式干预（ILI）对激素变化的影响，以及这些变化是否由腰围介导，以及治疗效果中的性别差异。

结果

基线平均年龄为60岁，黑人女性比例（21%）高于男性（9%），女性平均BMI高于男性（36.3对34.8 kg/m²）。在女性中，ILI在第1年使E2降低15%，bioT降低13%，SHBG增加21%。在男性中，ILI在第1年未改变E2水平，但使T增加14%，SHBG增加18%。这种效果在4年中逐渐减弱；治疗效果存在统计学上的显著性别差异，ILI在第1年导致的腰围变化是性激素变化的重要介导因素。