Age-related decline in salivary dehydroepiandrosterone sulfate and associated health risks among African Americans.

OBJECTIVES: Dehydroepiandrosterone sulfate (DHEAS) declines with age and low endogenous DHEAS concentrations have been associated with obesity. In addition, DHEAS has been studied for its role in mood and wellbeing. However, limited data are available on salivary DHEAS concentrations in African Americans. Thus, we examined age-related changes in morning salivary DHEAS and the association between DHEAS and obesity risk factors among African Americans. DESIGN: Salivary DHEAS samples (n=170) were obtained from men and women divided into three age groups: 18 to 30 (young), 31 to 45 (middle) and 46 to 60 (older) years. Anthropometric, blood glucose, high sensitivity c-reactive protein (hsCRP), and blood pressure measures were obtained. Participants completed the Center for Epidemiologic Studies Depression (CESD), Beck Depression Inventory (BDI), Daily Hassles Scale (DHS), Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) scales to assess depression, daily hassles, stress and quality of sleep, respectively. RESULTS: Mean salivary DHEAS concentrations decreased significantly with increasing age: mean values were 25.8 +/- 2.4, 21.9 +/- 1.9, and 14.4 +/- .9 nmol/L for young, middle, and older groups, respectively. Like DHEAS, PSQI, DHS, CESD, MAP, WC, BMI, systolic and diastolic BP and fasting blood glucose values differed significantly in the older compared to the young and middle groups. Women had significantly lower salivary DHEAS than men (P< or =.05). CONCLUSION: The age-related decline in salivary DHEAS in African Americans is associated with cardiovascular risk factors, sleep quality, hassles and mood. Whether supplementing DHEAS levels in aging African Americans will improve health remains to be determined.

Amenorrhea: an approach to diagnosis and management.

Although amenorrhea may result from a number of different conditions, a systematic evaluation including a detailed history, physical examination, and laboratory assessment of selected serum hormone levels can usually identify the underlying cause. Primary amenorrhea, which by definition is failure to reach menarche, is often the result of chromosomal irregularities leading to primary ovarian insufficiency (e.g., Turner syndrome) or anatomic abnormalities (e.g., Müllerian agenesis). Secondary amenorrhea is defined as the cessation of regular menses for three months or the cessation of irregular menses for six months. Most cases of secondary amenorrhea can be attributed to polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency. Pregnancy should be excluded in all cases. Initial workup of primary and secondary amenorrhea includes a pregnancy test and serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone. Patients with primary ovarian insufficiency can maintain unpredictable ovarian function and should not be presumed infertile. Patients with hypothalamic amenorrhea should be evaluated for eating disorders and are at risk for decreased bone density. Patients with polycystic ovary syndrome are at risk for glucose intolerance, dyslipidemia, and other aspects of metabolic syndrome. Patients with Turner syndrome (or variant) should be treated by a physician familiar with the appropriate screening and treatment measures. Treatment goals for patients with amenorrhea may vary considerably, and depend on the patient and the specific diagnosis.

Self-reported sleep impairment and the metabolic syndrome among African Americans.

OBJECTIVES: African Americans (AA) experience a high mortality from cardiovascular disease (CVD), even without an increase in the prevalence of the metabolic syndrome (MetS). The potential role of sleep impairment in this phenomenon has not been studied. The current study examined the relationship between self-reported sleep and MetS components among AAs. Sleep variables included total sleep quality and specific symptoms: loud snoring, difficulty breathing, and sleep duration. DESIGN: Anthropometric (BMI, BP, waist circumference, body fat percent) and biologic (fasting glucose, triglycerides, total cholesterol, and HDL) measures were obtained from 248 community-recruited AA (63% female; mean age 44 years). The Pittsburgh Sleep Quality Index (PSQI), a 19-item scale with a total sleep quality score and 7 subscales, was used to assess self-reported sleep quality. Analyses were controlled for age and sex. RESULTS: PSQI total sleep quality predicted neither presence of MetS (Beta=.04, P=.29) nor individual CVD variables. However, symptomatic snoring corresponded with MetS (Beta=.38, SE=.12, P<.001; OR: 2.57), as well as with fasting glucose, BMI, body fat percentage, and waist circumference. CONCLUSIONS: Among AA, overall sleep quality as self-reported may not contribute to MetS, but symptomatic snoring appears to be important. Further work in this area should focus on sleep at the symptomatic level, and include racial and sex variables, as well as physiologic and etiologic mechanisms.

Total and acylated ghrelin levels in children with poor growth.

Ghrelin, an enteric hormone with potent appetite stimulating effects, also stimulates growth hormone release. We hypothesized that altered levels of total ghrelin (TG) or acylated ghrelin (AG) could affect growth by altering growth hormone secretion, subsequently affecting insulin-like growth factor-1 (IGF-1) generation or by altering appetite and food intake. After institutional review board approval, 52 children presenting for evaluation of chronic gastrointestinal symptoms (group 1), poor weight gain (group 2), or poor linear growth (group 3) were evaluated for fasting TG and AG levels in addition to their regular evaluation. Serum ghrelin, IGF-1, and prealbumin were compared between groups. No difference was observed for mean fasting TG between groups. However, mean fasting AG was highest in patients in group 2 (465 ± 128 pg/mL) versus group 1 (176 ± 37 pg/mL) and group 3 (190 ± 34 pg/mL). IGF-1 was lowest in patients in group 2 despite similar prealbumin levels among the three groups. We conclude that serum AG levels are highest in children with isolated poor weight gain compared with children with short stature or chronic gastrointestinal symptoms, suggesting the possibility of resistance to AG in underweight children. Additional studies are needed to further clarify ghrelin's role in growth and appetite.

Cardiovascular fitness and risk factors of healthy African Americans and Caucasians.

BACKGROUND: African Americans have a higher prevalence of and mortality rates from cardiovascular disease than Caucasians. One important risk factor for cardiovascular disease is poor cardiovascular fitness. We quantified associations between fitness and related primary risk factors for cardiovascular disease in healthy African Americans and Caucasians. METHODS AND RESULTS: Participants included African American (n = 91) and Caucasian (n = 51) men and women aged 18 to 45 years with a body mass index less than 38 kg/m2, fasting blood glucose less than 126 mg/dL, and blood pressure less than 140/90 mm Hg. Fitness, waist and hip circumference, percent body fat, fasting blood glucose, insulin, lipid profiles, and C-reactive protein (CRP) were measured. The majority of African Americans (57.1%) were low-fair fitness (Caucasians, 31.4%), and only 20.8% were good/high fitness (Caucasians, 39.2%). The number of cardiovascular disease risk factors increased with decreasing fitness, and CRP was negatively associated with fitness in both groups. CONCLUSIONS: Low fitness may characterize apparently healthy African Americans as at risk for cardiovascular disease. Including fitness as a risk factor may improve early identification of at-risk African Americans. Importantly, prescribing exercise as medicine and promoting regular physical activity to improve fitness is essential among African Americans.

Psychological and physiological correlates of insulin resistance at fasting and in response to a meal in African Americans and Whites.

BACKGROUND: African Americans are more insulin resistant than are Whites. The purpose of this study was to characterize physiologic and psychological (stress coping style) correlates of insulin resistance in African Americans and Whites. METHODS: We examined African American (n = 67) and White (n = 41) men and women aged 18-45 years with body mass index 18-35 kg/m2. We used the homeostasis model assessment (HOMA-IR) and area under the curve for insulin (AUC) after a standardized meal as measure of insulin resistance. We obtained anthropometric measures and determined maximal aerobic power (VO(2max)) by treadmill exercise. We used stress profile to assess stress and coping style. RESULTS: Postprandial insulin AUCs were higher in African Americans than in Whites. Anthropometric measures and VO(2max)) were related to HOMA-IR and AUC. Although self-reported stress level did not differ between Whites and African Americans, positive appraisal predicted reduced HOMA-IR and negative appraisal coping style predicted increased insulin AUC. CONCLUSIONS: Psychosocial factors may be determinants of health and targets of intervention for obesity-related disorders such as insulin resistance. Existing behavioral intervention programs, designed with a sole emphasis on exercise and nutrition, may fall short of optimal effectiveness.

Role of plasma adiponectin /C-reactive protein ratio in obesity and type 2 diabetes among African Americans.

BACKGROUND: Obesity is a modifiable risk factor for hypertension and T2D. Objective(s): We examined relations between fasting plasma adiponectin (ADIP), C-reactive protein (CRP) concentrations and markers of T2D in African Americans (AA). METHODS: Fasting plasma ADIP, CRP, Insulin (IN), HOMA-IR, lipid profiles, body fat percent (%BF), waist circumference (WC), body mass index (BMI) and blood pressure measures were determined in AA women (W: n=77) and men (M: n=34). Participants were classified into: 1) Normal fasting glucose (FG) and Normal %BF; 2) Normal FG and High %BF; and 3) High FG. RESULTS: Compared to men, women had significantly higher mean ADIP (W: 31.4±2.9 vs. M: 18.0±4.4 ng/L), CRP (W: 3.2±0.3 vs. M: 2.0±0.5 mg/L), %BF (W: 41.2±0.9 vs. M: 27.2±1.3), and BMI (W: 32.3±0.7 vs. M: 29.2±1.1 kg/m2). Women with normal FG and %BF had significantly higher ADIP (64.0±6.0) and lower CRP (1.3±0.6) concentrations than normal FG/ high %BF (ADIP: 37.0±5.0 and CRP: 3.1 ±0.5) and high FG (ADIP: 15.1±4.1 and CRP: 4.0 ± 0.5) groups. Women with high ADIP to CRP ratio had favorable metabolic and anthropometric profiles. CONCLUSION: Low ADIP and high CRP are associated with excessive %BF and FG in AA women. ADIP/CRP, may be useful for detecting metabolic dysregulation.

Effects of dehydroepiandrosterone and alprazolam on hypothalamic-pituitary responses to exercise.

CONTEXT: The hypothalamic-pituitary-adrenal axis (HPA) is restrained by activation of gamma-amino-butyric acid receptors. Alprazolam (APZ) and dehydroepiandrosterone (DHEA) are purported to be gamma-amino-butyric acid agonists and antagonists, respectively. OBJECTIVE: Our objective was to examine the effects of APZ and DHEA alone and in combination on HPA axis activity. DESIGN: This was a double-blind, crossover, placebo-controlled study. SETTING: The study setting was the general community. PARTICIPANTS: Subjects consisted of 15 men (age, 20-45 yr) with a body mass index of 20-25 kg/m2. INTERVENTIONS: DHEA (100 mg/d) or placebo was given for 4 wk, followed by a 2-wk washout; participants ingested 0.5 mg APZ or placebo 10 and 2 h before high-intensity exercise. OUTCOME MEASURES: We measured basal and exercise-induced ACTH, arginine vasopressin (AVP), cortisol, DHEA, and GH responses. It was hypothesized that DHEA would enhance and APZ would blunt exercise-induced ACTH and cortisol release. RESULTS: DHEA significantly increased the AVP response to exercise (P < 0.01). APZ treatment significantly increased basal GH and blunted plasma cortisol, ACTH, AVP, and DHEA responses to exercise (P < 0.05). DHEA and APZ in combination significantly increased the GH response to exercise (P < 0.01). CONCLUSIONS: DHEA may alter a subset of receptors involved in AVP release. Together DHEA and APZ may up-regulate GH during exercise by blunting a suppressive (HPA axis) and potentiating an excitatory (glutamate receptor) system.

Inadequacy of in-school support for diabetic children.

The level of blood glucose control needed to minimize complications in children with diabetes requires frequent blood sugar monitoring and appropriate responses to the information obtained. It is our impression that optimal support for good control is not available in all of the schools our patients attend. The objective of this study was to identify and quantify barriers to good control of diabetes in the school setting, and then use this information to target interventions to improve in-school support for children with diabetes. Two questionnaires were designed based on recommendations of the American Diabetes Association for appropriate in-school support for children with diabetes. Parental perception of in-school resources was addressed in one questionnaire. Forty-seven parents of children with diabetes in our clinic were surveyed. The second questionnaire was mailed to 222 randomly selected schools in our area inquiring about the in-school support available to children with diabetes and the types of educational materials that would be useful for school personnel. Thirty percent of the parents of children with diabetes indicated that the in-school support of their child was insufficient. Sixty-five of the 222 schools surveyed responded. The responses were variable and demonstrated inconsistency and, in some cases, inadequacy of support. A major deficiency noted in 13% of schools was lack of on-site personnel trained in diabetes management skills. From the schools' perspective, however, 50% of schools reported lack of parental communication. The care available for the child with diabetes is highly variable among schools. Targeted educational materials for both school personnel and parents would be useful to improve support for these children.

Allostatic load and health status of African Americans and whites.

OBJECTIVES: To compare health risks in 84 healthy African American and 45 white men and women after calculating allostatic load (AL) from biologic, psychosocial, and behavioral measures. METHODS: Participants (18-45 years) ranging in weight from normal to obese and without hypertension or diabetes. Fitness, body fat, CRP, mood, social support, blood pressure, sleep and exercise habits, coping, and insulin responses were dichotomized as low/high risk and summed for AL. RESULTS: African Americans (3.4±1.9) had significantly higher AL than that of whites (2.4±1.9; P<0.05). Significantly more African Americans had AL≥3 (67.9%) than did whites (48.9%). CONCLUSIONS: Identifying cumulative AL may help identify and address the underpinnings of health disparities in African Americans.

Plasma Proteomic Signature in Overweight Girls Closely Correlates with Homeostasis Model Assessment (HOMA), an Objective Measure of Insulin Resistance.

Obesity is known to be associated with a large number of long-term morbidities, and while in some cases the relationship of obesity and the consequences is clear (for example, excess weight and lower extremity orthopedic problems) in others the mechanism is not as clear. One common system of categorizing overweight in terms of the likelihood of negative consequences involves using the concept of "metabolic syndrome". We hypothesized that the development of a plasma protein profile of overweight adolescents with and without the metabolic syndrome might give a more precise and informative picture of the disease process than the current clinical categorization and permit early targeted intervention. For this paper, we used antibody microarrays to analyze the plasma proteome of a group of 15 overweight female adolescent patients. Upon analysis of the proteome, the overweight patients diverged from the nonoverweight female controls. Furthermore, the overweight patients were divided by the analysis into two population clusters, each with distinctive protein expression patterns. Interestingly, the clusters were characterized by differences in insulin resistance, as measured by HOMA. Categorization according to the presence or absence of the metabolic syndrome did not yield such clusters.

Diagnostic criteria for metabolic syndrome: caucasians versus African-Americans.

BACKGROUND: Metabolic syndrome is a constellation of risk factors used to identify individuals at greatest risk for developing cardiovascular disease (CVD). Early diagnosis of CVD would benefit African-Americans (AA), who have a higher prevalence of and mortality rate from CVD compared to Caucasians (CA). Two definitions for metabolic syndrome were used to classify healthy CA and AA, and evaluate how other CVD risk factors [C-reactive protein (CRP), percent body fat, fitness level, insulin resistance, and non-high-density lipoprotein cholesterol (HDL-C)] changed metabolic syndrome classification. METHODS: Healthy AA (n = 97) and CA (n = 51) ranging from normal weight to obese, 18-45 years of age, with neither hypertension nor diabetes, were evaluated for cardiorespiratory fitness, height, weight, percent body fat, hip and waist circumference, blood pressure (BP), and fasting blood glucose, insulin, triglycerides, HDL, non-HDL-C, and CRP. Participants were classified as meeting the criteria for metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III 2004 (NCEP ATP III) and the International Diabetes Federation (IDF) definitions. RESULTS: Significant ethnic differences (P < 0.01) in classification were noted for both metabolic syndrome definitions (NCEP ATP III, CA = 16.7% vs. AA = 5.7%; IDF, CA = 23.5% vs. AA = 8.2%). Ethnic differences were eliminated when fitness level or percent body fat was included as a criterion. CONCLUSIONS: If diagnosis of metabolic syndrome is intended for early recognition of CVD risk and slowing CVD development, current definitions for metabolic syndrome will not capture healthy AA. Health-care providers may consider assessing percent body fat and participation in regular exercise, because these criteria would help identify AA at risk.

Should triglycerides and the triglycerides to high-density lipoprotein cholesterol ratio be used as surrogates for insulin resistance?

The aims of the present study were to examine whether triglycerides (TG) and the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) could predict insulin resistance in healthy African Americans and whites. This cross-sectional study included 99 African American and 50 white men and women between 18 and 45 years of age with body mass indexes between 18.5 and 38.0 kg/m(2). Anthropometric measures were obtained; and overnight fasting blood was collected for TG, HDL-C, glucose, and insulin. Insulin resistance was defined by fasting insulin concentration of at least 13.13 microU/mL and homeostasis model assessment of insulin resistance (HOMA-IR) of at least 2.5. Receiver operating characteristic curves were used to analyze the data. African Americans and whites had comparable demographic and anthropometric measures. Fasting insulin was higher in African Americans (12.4 +/- 7.8 microU/mL) than whites (10.2 +/- 7.5 microU/mL), but HOMA-IR did not differ significantly (African Americans, 2.9 +/- 2.0; whites, 2.4 +/- 1.9). Triglycerides and TG/HDL-C were significantly lower in African Americans (TG, 68.2 +/- 43.3 mg/dL; TG/HDL-C, 1.8 +/- 2.1) compared with whites (TG, 105.4 +/- 55.2 mg/dL; TG/HDL-C, 2.8 +/- 1.8). Area under the receiver operating characteristic curves revealed that both TG and TG/HDL-C were acceptable markers of insulin resistance, as defined by fasting insulin concentration, in whites, 0.770 and 0.765, respectively, but poor predictors in African Americans, 0.633 and 0.651, respectively. Similarly, TG and TG/HDL-C were acceptable in predicting insulin resistance, as measured by HOMA-IR, in whites, 0.763 and 0.770, respectively, but poor in predicting HOMA-IR in African Americans, with areas of 0.625 and 0.639, respectively. In conclusion, the relationship between TG and TG/HDL-C with insulin resistance differs by ethnicity; and using TG and TG/HDL-C to predict insulin resistance in African Americans would not be appropriate.

The prevalence of overweight in participants in high school extramural sports.

This study examines the body mass index (BMI) percentiles for age of 3970 male high school athletes. Overall, boys participating in sports had BMI percentiles similar to the general population. However, the prevalence of overweight in boys playing certain sports, particularly football, but also wrestling and crew, was higher than the general population.