mens health

For men with type 2 diabetes, a cell type linked to allergic inflammation is closely linked to a key indicator of diabetic kidney disease (nephropathy), suggests a study in the November Clinical Journal of the American Society of Nephrology (CJASN). “Allergy is a common disease that is increasing worldwide, so our findings may have important implications for diabetic nephropathy,” comments Michiaki Fukui, MD (Kyoto Prefectural University of Medicine, Japan).

The researchers compared the eosinophil count with albumin excretion rate in nearly 800 patients with type 2 diabetes. Eosinophils are a type of white blood cell that contributes to inflammation in allergic diseases. The albumin excretion rate is a key indicator of kidney disease, one of the major complications of diabetes.

In men, a higher number of eosinophils in the blood correlates with higher urinealbumin a critical early sign of diabetic kidney disease. Surprisingly, the link between eosinophil count and albumin excretion rate was even stronger than for known risk factors like high blood pressure and poor diabetes control. The eosinophil count was unrelated to albumin excretion in diabetic women.

Previous studies have suggested that patients with asthma and other allergic diseases are at increased risk of heart disease. Heart disease is the main cause of death in diabetics, and nephropathy is a major risk factor for heart disease. If the results are confirmed by future studies, then the eosinophil count might help in estimating the risk of diabetesrelated kidney and heart disease in men.

Some of the antiinflammatory treatments used by patients with allergies can lower the eosinophil count, and its possible that these treatments could also benefit male patients with diabetes, Fukui believes. He adds, “The intriguing concept of a role for eosinophils in diabetic nephropathy holds great promise for the development of new preventive measures involving antiallergic agents.”

The study cant prove any causeandeffect relationship between eosinophil count and albumin excretion rate. More research will be needed to determine why the relationship was found only in men, and whether a similar link is also present in patients without diabetes.

The authors reported no financial disclosures. Other authors were Muhei Tanaka, Masahide Hamaguchi, Takafumi Senmaru, Kazumi Sakabe, Emi Shiraishi, Ichiko Harusato, Masahiro Yamazaki, Goji Hasegawa, all of Kyoto Prefectural University of Medicine.

The study entitled, “Eosinophil Count Is Positively Correlated with Albumin Excretion Rate in Men with Type 2 Diabetes,” appeared online at cjasn.asnjournals.org/ on Thursday, October 1, 2009, doi 10.2215/CJN.03330509.

Source
Shari Leventhal

Study 1 highlights Just two weeks on a highfructose diet raises blood pressure in men.

A drug used to treat gout seems to protect against that blood pressure increase and some aspects of metabolic syndrome. Study 2 highlights A study in mice finds that the time of day when fructose is consumed is linked to abnormalities in blood pressure, weight gain and behavior. Abstract P127

A highfructose diet raises blood pressure in men, while a drug used to treat gout seems to protect against the blood pressure increase, according to research reported at the American Heart Associations 63rd High Blood Pressure Research Conference.

“This is the first evidence of a role of fructose in raising blood pressure and a role for lowering uric acid to protect against that blood pressure increase in people,” said Richard Johnson, M.D., coauthor of the study and professor and head of the division of Renal Diseases and Hypertension at the University of ColoradoDenver medical campus in Aurora, Colo.

In the study, excessive fructose consumption seemed to increase new onset of metabolic syndrome, a cluster of risk factors associated with the development of cardiovascular disease and type 2 diabetes. On the other hand, the gout drug seemed to halt it most likely by lowering uric acid, which affects blood pressure.

Fructose, one of several dietary sugars, makes up about half of all the sugar molecules in table sugar and in highfructose corn syrup, a sweetener often used in packaged products because its relatively cheap and has a long shelf life. Glucose makes up the other half. Fructose is the only common sugar known to increase uric acid levels.

Patients with high blood pressure, diabetes and kidney disease often have high uric acid levels and gout. But all the ways in which those conditions might contribute to the development or worsening of the others isnt completely understood, Johnson said.

Johnson and coauthor Santos PerezPozo, M.D., a nephrologist at Mateo Orfila Hospital in Minorca, Spain who led the study, evaluated 74 adult men, average age 51, who consumed a diet that included 200 grams (g) of fructose per day in addition to their regular diet. The amount is much higher than the estimated U.S. daily intake of 50 g to 70 g of fructose consumed by most U.S. adults. Half of the men were randomly assigned to get the gout drug allopurinol and the other half acted as controls.

After only two weeks on the diet, the highfructose plus placebo group experienced significant average blood pressure increases of about 6 millimeters of mercury (mm Hg) in systolic blood pressure (the pressure when the heart beats) and about a 3 mm Hg rise in diastolic blood pressure (the pressure between heartbeats). They were measured with strapon monitors that record blood pressure periodically around the clock.

In contrast, men on the highfructose diet plus allopurinol had significantly lower uric acid levels and virtually no increase in systolic blood pressure (only 1 mm Hg). The blood pressure levels of most of the men returned to normal within two months of the studys conclusion when the participants returned to their normal dietary intake, Johnson said.

The study also found changes in the incidence of metabolic syndrome. The United States and the international community define the syndrome slightly differently, so researchers used both criteria in the study. In general, metabolic syndrome is defined as having three or more of these five risk factors Increased waist circumference;

High triglyceride levels;

Low levels of highdensity lipoprotein (HDL), a component of total cholesterol thought to have a protective effect;

High blood pressure; and

High fasting blood sugar. After just two weeks, the incidence of metabolic syndrome more than doubled in the men who consumed a heavy fructose diet and took the placebo pill. The incidence went from 19 percent at baseline to 44 percent at the studys end, according to the U.S. National Cholesterol Education ProgramATP III (NCEPATP III) definition, and from 25 percent to 58 percent under the International Diabetes Federation (IDF) definition.

Among men consuming fructose plus allopurinol, virtually no change in the rate of metabolic syndrome occurred perhaps because the gout drug prevented the blood pressure rise associated with increased fructose consumption.

The study should be viewed as a pilot and more investigations are needed before doctors consider lowering uric acid in the clinical setting, said Johnson, noting that allopurinol can have rare but serious side effects.

Men in both groups had an increase in fasting triglycerides and an indication of insulin resistance by a method called homeostatic model assessment (HOMA), while on the increased fructose diet. The HOMA method is used to quantify insulin resistance and betacell function. Allopurinol treatment appeared to lower lowdensity lipoprotein cholesterol (LDL), a component of total blood cholesterol linked to the development of cardiovascular disease, compared to placebo, the researchers reported.

“These results suggest that fructose may be a cause of metabolic syndrome,” Johnson said. “They also suggest that excessive fructose intake may have a role in the worldwide epidemic of obesity and diabetes.”

Fruit, which has just 4 g to 10 g of fructose per serving, also contains many beneficial substances including antioxidants, vitamin C, potassium and fiber that are believed to counter the effects of fructose alone. The main risk for excessive fructose consumption in the Western diet comes from sweetened drinks and foods rich in sugar or high fructose corn syrup, he said.

“When you give fructose to animals, they absolutely develop every feature of metabolic syndrome they get abdominal fat, high triglycerides, low HDL, their blood pressure goes up and they get insulin resistance,” Johnson said. “However, you must give massive amounts of fructose to rats to raise uric acid levels, because rats and most other animals have an enzyme that breaks down uric acid. Humans lack that enzyme. It turns out humans get gout but other animals dont.”

If you inhibit the enzyme in rats that breaks down uric acid, it takes only a small amount of fructose to cause uric acid to rise and the symptoms of metabolic syndrome to appear in the animals, he said.

Johnsons other coauthors are Jesse Schold, Ph.D., and Julian Lopez Lillo, M.D. Author disclosures are on the abstract.

The National Institutes of Health funded the study.

SEE ALSO

Abstract P237

Timing of fructose intake affects weight gain, blood pressure and behavior

Researchers found that abnormalities in blood pressure and weight gain were linked to the timing of the availability of fructose, a dietary sugar, in a study conducted in mice. When sugary liquids were consumed during the day (the usual sleeping period for mice), mice showed greater weight gain and a reversal in blood pressure rhythms.

Researchers implanted small ambulatory monitors to measure blood pressure around the clock in mice. Mice were given either continuous access to fructose water (10 percent) or restricted access for 12 hours during the day (light) or 12 hours at night (dark).

“The first thing we noticed was that the mice on restricted access rushed to their drinking bottles to load up on the sweetened beverage, similar to teenagers who drink too many soft drinks,” said Mariana Morris, Ph.D., study coauthor and vice president for graduate studies and chair of the Pharmacology and Toxicology Department, in the Boonshoft School of Medicine at Wright State University in Dayton, Ohio.

Researchers reported that groups consuming fructose continuously or during the dark period, showed an increase in blood pressure with a characteristic spike during the night when mice are usually active.

However, in mice that consumed fructose during the day, the blood pressure pattern was reversed, high in the day and low in night. The blood pressure change was also associated with higher stress hormone levels.

“The reversal in the day/night rhythm is similar to the pattern seen in human diabetics, suggesting the timing of fructose intake may be important in cardiovascular pathologies,” Morris said.

Researchers also observed increased weight gain in mice given fructose during the light period. This weight gain occurred even though total calorie consumption (fructose water and solid food) was similar.”This model may be similar to the human condition of night time binging of fructose laden foods and beverages,” Morris said. “The results indicate that consideration must be given not only to the amount of calories consumed but also the timing of intake.”

Co authors are Swapnil V. Shewale, a masters degree candidate and Danielle Senador, Ph.D., a postdoctoral associate. Author disclosures are on the abstract.

Source
Karen Astle

Young heterosexual men are falling prey to eating disorders such as anorexia and bulimia just as much as women and gay men and their numbers are increasing, a leading specialist has warned.

Dr John Morgan, a consultant psychiatrist and director of the Yorkshire Centre for Eating Disorders in Leeds, told the Annual Meeting of the Royal College of Psychiatrists in Liverpool that growing numbers of young men are increasingly dissatisfied with their bodies. In addition, the gap in the numbers of gay and straight men with eating disorders is closing.

Dr Morgan told Annual Meeting delegates that men are

less likely to recognise their eating disorder
more likely to be misdiagnosed with other mental health problems such as depression and schizophrenia
less likely to be given treatment
less likely to be referred to a special eating disorder clinic.

Many men struggle to be referred to a specialist eating disorders clinic in the first instance. Furthermore, once they undergo treatment, many report being stigmatised as the only man in the clinic.

He said “By the time they go for treatment, the disorder is much further down the line. Sometimes when men overcome their reluctance, their GP is likely to say that men dont get eating disorders. So its not just their reluctance its the system putting up barriers.”

Images of skeletal models or men with sixpacks, plus a plethora of choices now open to men, is at the root of body dissatisfaction, Dr Morgan said.

“To be a young man is our society is a difficult thing. What you do and who you are is less straightforward. Women were challenged decades ago to consider which of the many different social roles they adopted. Now men are having to respond to the choices that society gives them.

“Suddenly younger straight men have similar pressures to gay men and women. There is a crisis of masculinity in our society. They are given all these roles and to simply decide to manipulate your body is a nice easy solution to all the complexities of life.”

Dr Morgans research, drawn from a range of studies, has been accepted by the European Eating Disorders Review

Reference
Annual Meeting of the Royal College of Psychiatrists, BT Convention Centre, Liverpool, 2 5 June 2009

Someone who has a low level of response (LR) to alcohol, meaning relatively little reaction to alcohol, has a higher risk for developing alcoholuse disorders (AUDs). A study that examined the influence of LR in conjunction with other characteristics like family history of AUDs and age of drinking onset has found that LR is a unique risk factor for AUDs across adulthood and is not simply a reflection of a broader range of risk factors.

Results will be published in the September issue of Alcoholism Clinical & Experimental Research and are currently available at Early View.

“If a person needs more alcohol to get a certain effect, that person tends to drink more each time they imbibe,” explained Marc A. Schuckit, director of the Alcohol Research Center, Veterans Affairs San Diego Healthcare System, professor of psychiatry at the University of California, San Diego, and corresponding author for the study.

“Other studies we have published have shown that these individuals also choose heavy drinking peers, which helps them believe that what they drink and what they expect to happen in a drinking evening are normal,” he said. “This low LR, which is perhaps a low sensitivity to alcohol, is genetically influenced.”

Schuckit and his colleagues examined 297 men participating in the San Diego Prospective Study, originally recruited and tested on their level of reaction to alcohol when they were 18 to 25 years old. Each reported on family history of AUDs, typical drinking quantity, age of drinking onset, body mass index, and initial age at recruitment for the study. AUDs were evaluated at 10, 15, 20, and 25year followups.

Results showed that a low LR to alcohol predicted AUD occurrence over the course of adulthood even after controlling for the effects of other robust risk factors. In short, LR is a unique risk factor for AUDs across adulthood, and not simply a reflection of a broader range of risk factors.

“A low LR at age 20 was not just a reflection of being a heavier drinker at age 20 when we tested these men, and it wasnt an artifact of an earlier onset of drinking,” said Schuckit. “We showed that a low LR at 20 predicts later heavy drinking and alcoholism even if you control for all these other predictors of alcohol problems at age 20.”

Schuckit added that the studys method of examination establishing multiple predictors at age 20, revisiting participants about every five years, and securing a response rate of about 94 percent strongly show that LR is consistent and powerful in predicting alcoholism.”

“Because alcoholism is genetically influenced, and because a low LR is one of the factors that adds to the risk of developing alcoholism,” said Schuckit, “if youre an alcoholic, you need to tell your kids they are at a fourfold increased risk for alcoholism. If your kid does drink, find out if they can drink others under the table, and warn them that that is a major indication they have the risk themselves. Keep in mind, however, that the absence of a low LR doesnt guarantee they wont develop alcoholism, as there are other risk factors as well.”

Its not all bad news, Schuckit added. “We are looking for ways to identify this risk early in life, and to find ways to decrease the risk even if you carry a low LR … so there is hope for the future.”

Source
Marc A. Schuckit, M.D.
Veterans Affairs San Diego Healthcare System