Cross-Sectional Association of Metabolic Syndrome and Its Components with Serum Testosterone Levels in a Korean-Screened Population

다국어 초록 (Multilingual Abstract)

Purpose: We evaluated the associations of metabolic syndrome (MetS) and its components with testosterone levels in the Korean population.
Materials and Methods: This cross-sectional study was performed among 6,967 adult (age≥20 years) men who attended health screening during 2006 to 2015. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Associations were evaluated using unconditional logistic regression.
Results: The estimated age-adjusted prevalence of MetS in adult and middle-aged (≥40 years) Korean men was 27.5% and 30.6%, respectively. Quartile analysis showed that high serum testosterone levels were significantly associated with a low risk of MetS (highest vs. lowest quartile, odds ratio=0.528; ptrend<0.001), with an approximately 13% reduction in MetS risk per 1 ng/mL increment of serum testosterone levels. After considering covariates such as age and body mass index (BMI), the reduction in MetS risk was attenuated but remained significant (7% reduced risk per 1 ng/mL). Testosterone levels were inversely correlated with all MetS components, including hyperglycemia (r=-0.041), increased body size (r=-0.093), increased triglyceride levels (r=-0.090), decreased high-density lipoprotein cholesterol levels (r=-0.030), and elevated blood pressure (r=-0.071, all p<0.05). Among them, elevated triglyceride levels and blood pressure were independently associated with low serum testosterone levels, even after adjustment for age and BMI.
Conclusions: Serum testosterone levels were inversely associated with MetS in Korean men. This association was attenuated after adjustment for age and BMI but remained significant. Among MetS components, increased triglyceride levels and elevated blood pressure were independently associated with testosterone levels, regardless of obesity.

참고문헌 (Reference)

1 Stellato RK, "Testosterone, sex hormone-binding globulin, and the development of type 2 diabetes in middle-aged men : prospective results from the Massachusetts male aging study" 23 : 490-494, 2000

2 Brand JS, "Testosterone, sex hormone-binding globulin and the metabolic syndrome in men : an individual participant data meta-analysis of observational studies" 9 : e100409-, 2014

3 Sorva R, "Testosterone substitution increases the activity of lipoprotein lipase and hepatic lipase in hypogonadal males" 69 : 191-197, 1988

4 Laaksonen DE, "Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men" 27 : 1036-1041, 2004

5 Laaksonen DE, "Sex hormones, inflammation and the metabolic syndrome : a population-based study" 149 : 601-608, 2003

6 Fogari R, "Serum testosterone levels and arterial blood pressure in the elderly" 28 : 625-630, 2005

7 Hall J, "Selective inhibition of L-type Ca2+ channels in A7r5 cells by physiological levels of testosterone" 147 : 2675-2680, 2006

8 Jackson RL, "Relationship between post-heparin plasma lipases, triglycerides and high density lipoproteins in normal subjects" 22 : 289-294, 1990

9 Aguilar M, "Prevalence of the metabolic syndrome in the United States, 2003-2012" 313 : 1973-1974, 2015

10 Hyuk Sang Kwon, "Prevalence and Clinical Characteristics of the Metabolic Syndrome in Middle-Aged Korean Adults; Chungju Insulin Resistance Cohort Study (CIRC Study)" 대한내과학회 20 (20): 310-316, 2005

11 Mozumdar A, "Persistent increase of prevalence of metabolic syndrome among U. S. adults : NHANES III to NHANES 1999-2006" 34 : 216-219, 2011

12 Nestel P, "Metabolic syndrome : recent prevalence in East and Southeast Asian populations" 16 : 362-367, 2007

13 Kupelian V, "Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men" 91 : 843-850, 2006

14 Agledahl I, "Low serum testosterone in men is inversely associated with non-fasting serum triglycerides : the Tromsø study" 18 : 256-262, 2008

15 KOrean Statistical Information Service (KOSIS), "Korean population census 2010" Statistics Korea

16 Tsujimura A, "Is low testosterone concentration a risk factor for metabolic syndrome in healthy middle-aged men?" 82 : 814-819, 2013

17 Torkler S, "Inverse association between total testosterone concentrations, incident hypertension and blood pressure" 14 : 176-182, 2011

18 Lim S, "Increasing prevalence of metabolic syndrome in Korea : the Korean National Health and Nutrition Examination Survey for 1998-2007" 34 : 1323-1328, 2011

19 Alberti KGMM, "Harmonizing the metabolic syndrome : a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association;World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity" 120 : 1640-1645, 2009

20 Orshal JM, "Gender, sex hormones, and vascular tone" 286 : R233-R249, 2004

21 Khaw KT, "Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men : European prospective investigation into cancer in Norfolk(EPICNorfolk)prospective population study" 116 : 2694-2701, 2007

22 Muller M, "Endogenous sex hormones and metabolic syndrome in aging men" 90 : 2618-2623, 2005

23 Rebuffé-Scrive M, "Effect of testosterone on abdominal adipose tissue in men" 15 : 791-795, 1991

24 Stern MP, "Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease?" 27 : 2676-2681, 2004

25 Grundy SM, "Diagnosis and management of the metabolic syndrome : an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement" 112 : 2735-2752, 2005

26 Kyung YS, "Changes in weight and metabolic syndrome are associated with prostate growth rate over a 5-year period" 103 : 185-190, 2017

27 Isomaa B, "Cardiovascular morbidity and mortality associated with the metabolic syndrome" 24 : 683-689, 2001

28 Tong PC, "Association of testosterone, insulin-like growth factor-I, and C-reactive protein with metabolic syndrome in Chinese middle-aged men with a family history of type 2 diabetes" 90 : 6418-6423, 2005

29 Akishita M, "Association of low testosterone with metabolic syndrome and its components in middle-aged Japanese men" 33 : 587-591, 2010

30 Tsai EC, "Association of bioavailable, free, and total testosterone with insulin resistance : influence of sex hormone-binding globulin and body fat" 27 : 861-868, 2004