Glucocorticoids and Sarcoidosis: A Longitudinal Study on the Effects on Cortical and Trabecular Bone.

BACKGROUND: Glucocorticoid induced osteoporosis is a well-known side effect of glucocorticoid treatment. In sarcoidosis the impact on bone by glucocorticoid treatment is complex due to hormonal disturbances of calcium and vitamin-D, which by itself may cause bone loss. In this study we aimed to investigate the longitudinal impact of glucocorticoids on cortical and trabecular bone in patients with mild, recently diagnosed sarcoidosis. METHODS: Ten patients (8 females; mean age 44 (±13)) were studied during one year of glucocorticoid treatment. The assessment of mainly cortical to purely trabecular bone was made by dual X-ray absorptiometry (DXA) of the spine and hip, quantitative ultrasound of the calcaneus, and magnetic resonance relaxometry of the spine and calcaneus. Bone and hormonal measurements were performed at baseline, after 3, 6, and 12 months, and baseline, 3 weeks and 3 months, respectively. RESULTS: DXA of the spine, decreased from baseline at 6 months (P=0.01). R2' of the calcaneus decreased with time (B: -3.6;P=0.03). In the females (n=8) there was a significant decrease in DXA of the spine when comparing 3 months and 6 months (P=0.03), and 3 months and 12 months (P=0.02) and a decrease in R2'of the calcaneus from baseline to 12 months (P=0.01). There was no change in hormonal levels. CONCLUSION: Treatment of initial mild sarcoidosis with dose tapered glucocorticoid therapy only mildly affects the final trabecular and cortical bone and hormone levels. Dose tapering is an important part in glucocorticoid therapy, likely contributing to the mild effects on bone observed in this study.

Increased physical activity in abdominally obese women through support for changed commuting habits: a randomized clinical trial.

BACKGROUND: Abdominally obese women can reduce their health risk through regular physical activity. There is, however, little evidence on the effectiveness of interventions that promote physical activity long-term, such as cycling and walking to and from work. METHODS: This intervention focused on physically active commuting (cycling and walking) in middle-aged (30-60 years), abdominally obese (waist circumference > or = 88 cm) women (n=120), recruited by newspaper advertisement. The intervention group was a moderate-intensity programme with physician meetings, physical activity prescriptions, group counselling and bicycles. The control group was a low-intensity group support programme with pedometers. We used a randomized, controlled, 2-armed design with 18 months duration and intention-to-treat analysis (data collection 2005-2006). Treatment success was defined as bicycling > or = 2 km/d (primary) or walking 10,000 steps per day (secondary). RESULTS: At baseline, mean (s.d.) age was 48.2 years (7.4), waist circumference 103.8 cm (7.8), walking 8471 steps per day (2646), bicycling 0 km per day. Attrition at 18 months was 10% for the intervention group and 25% in the control group (P=0.03). The intervention group was more likely to achieve treatment success for cycling than controls: 38.7 vs 8.9% (odds ratio (OR)=7.8 (95% confidence interval=4.0 to 15.0, P<0.001)), but with no difference for compliance with the walking recommendation: 45.7 vs 39.3% (OR=1.2 (95% CI=0.7 to 2.0, P=0.50)). Commuting by car and public transport were reduced by 34% (P<0.01) and 37% (P<0.001), respectively, with no differences between groups. Both groups attained similar waist reductions (-2.1 and -2.6 cm, P=0.72). CONCLUSIONS: Abdominally obese women can increase PA long-term through moderate-intensity behavioural support aimed at changing commuting habits.

Effects of glucocorticoids on leptin levels and eating behaviour in women.

OBJECTIVE: Long-term treatment with glucocorticoids induces weight gain and increased risk to develop obesity-related metabolic complications. The underlying mechanisms are not fully understood. Glucocorticoid therapy has previously been associated with increased levels of circulating leptin. In this study the eating behaviour was therefore studied in relation to leptin levels before and after short-term prednisolone treatment. DESIGN: Within-subject design. SUBJECTS: Twelve healthy postmenopausal women with a mean body mass index (BMI) of 28.9 kg m-2 (+/-0.8 SEM) volunteered after recruitment by an advertisement in the local paper. INTERVENTIONS: The subjects received 25 mg prednisolone daily for 7 days. MAIN OUTCOME MEASUREMENTS: Fasting serum samples were obtained before, during and after treatment for determination of leptin and insulin, glucose and fractionated lipoproteins in plasma. The microstructure of the eating behaviour was registered with a universal eating monitor, VIKTOR. Appetite was estimated by visual analogue rating scales and food intake by a 48-h recall. RESULTS: Serum leptin increased after 2 and 7 days of glucocorticoid administration (P < 0.01), and the food intake measured by VIKTOR after 7 days of treatment (P < 0.05). No statistically significant changes were however, found in the 48-h food- recall or in the subjective appetite registrations. Insulin levels were borderline elevated (P = 0.062) after treatment, but no significant changes of fasting glucose were seen. High density lipoprotein cholesterol (HDL) increased (P < 0.05), whilst low density lipoprotein cholesterol (LDL) decreased (P < 0.05). CONCLUSION: Food intake was elevated after glucocorticoid administration as observed with an objective, quantitative method, in spite of increased levels of circulating leptin.

Glucocorticoid-regulated adipose tissue secretion of PAI-1, but not IL-6, TNFalpha or leptin in vivo.

OBJECTIVE: Glucocorticoids are well-known regulators of adipose tissue metabolism and endocrine function. The aim of this study was to examine glucocorticoid effect on plasminogen activator inhibitor 1 (PAI-1), tumour necrosis factor alpha (TNFalpha), leptin and interleukin-6 (IL-6) adipose tissue secretion. MATERIAL AND METHODS: Twelve healthy postmenopausal women with mean BMI of 28.9 kg/m(2) (+/- 0.8 SEM) received 25 mg prednisolone daily for 7 days. Before and after glucocorticoid treatment adipose tissue secretion of PAI-1, leptin, IL-6 and TNFalpha were measured, and adipocyte PAI-1 mRNA as well as anthropometrical and bio-chemical data were obtained. RESULTS: Anthropometric measurements remained unaffected. Analyses of venous blood-samples showed a borderline increase of insulin levels (p = 0.062). PAI-1 secretion from adipose tissue increased (1.9 +/- 0.2 vs. 3.5 +/- 0.5 ng/g triglycerides, p = 0.012), but PAI-1 mRNA levels did not (0.19 +/- 0.02 vs. 0.21 +/- 0.04 arbitrary units after normalised to beta-actin, p = 0.51). There were no apparent differences in IL-6, TNFalpha or leptin secretion after glucocorticoid exposure. CONCLUSION: This study shows an increased secretion of PAI-1, but not IL-6, TNFalpha or leptin, from abdominal adipose tissue after in vivo glucocorticoid treatment, which may be a finding of pathophysiological importance given the well-known effect of glucocorticoid excess on metabolic aberrations and cardiovascular morbidity.

Downregulation of uncoupling protein 2 mRNA in women treated with glucocorticoids.

OBJECTIVE: Glucocorticoids are well-known regulators of energy turnover and adipose tissue metabolism. We investigated the effect of glucocorticoids on the expression of the human uncoupling protein 2 (UCP 2) gene, which has been implicated in energy expenditure. DESIGN: Prednisolone (25 mg) was administered orally daily for 7 days. Subcutaneous adipose tissue UCP 2 mRNA was measured before and after treatment. SUBJECTS: Eight healthy female subjects (age 52-63 y; body mass index 25-34 kg/m2). RESULTS: No differences in body weight, waist-to-hip ratio or plasma-values of FFA or glucose were found after prednisolone treatment, as compared to pre-treatment values under these conditions. In contrast, plasma insulin levels were significantly increased by glucocorticoid administration, 54+/-6 before vs 70+/-12 (mean+/-sem) pmol/l after treatment (P=0.028). Furthermore, using RT-competitive-PCR, the UCP 2 mRNA level in abdominal subcutaneous adipose tissue was found to be down-regulated by half (6.3+/-0.4 vs 3.1+/-0.8 amol/microg RNA, P=0.012) after glucocorticoid treatment. No difference in expression levels of the reference gene 18SrRNA was observed before, as compared to after prednisolone exposure (249+/-11 vs 248+/-30 amol/microg RNA, P=0.87). CONCLUSION: These data suggest that glucocorticoids may play a role in the regulation of UCP 2 mRNA expression in human adipose tissue in vivo.

["Consolatory eating" is not a myth. Stress-induced increased cortisol levels result in leptin-resistant obesity]. / "Tröstätning" ingen myt. Kortisolstegringen vid stress ger leptinresistent fetma.

Recent studies indicate that stress induces increased food intake only when stress is followed by a neuroendocrine reaction with increased cortisol concentrations. The stress of modern society may contribute to the current epidemic of abdominal obesity, which is characterised by increases in cortisol and leptin concentrations. This is a condition which carries a great risk for cardiovascular disease, type 2 diabetes mellitus and stroke.