Determinants of low muscle strength and poor physical performance in older men – the STRAMBO Study

ISMH Congress 2011 Abstracts Abstract ID: #0129 DETERMINANTS OF LOW MUSCLE STRENGTH AND POOR PHYSICAL PERFORMANCE IN OLDER MEN – THE STRAMBO STUDY P. Szulc ∗ , C. Feyt, R. Chapurlat INSERM UMR 1033, Lyons, France Background: Aging-related loss in muscle strength (dynapenia) and decrease in physical performance are faster than loss of muscle mass (sarcopenia). Dynapenia and poor physical performance in the elderly are major public health problems in developed countries. Our aim was to analyze potential determinants of the relative deficit of muscle strength and of physical performance compared to muscle mass in older men. Materials & Methods: In a cohort of 1169 men aged 19 to 87 years, we assessed grip strength and physical performance (chair stands, tests of static and dynamic balance) as well as body composition using dual X-ray energy absorptiometry (Hologic Discovery A). We also measured serum levels of testosterone, 25-hydroxycholecalciferol (25OHD) and C-reactive protein (CRP). Results: Relative appendicular skeletal muscle mass (RASM), muscle strength and physical performance decreased with age. Relative deficit of muscle strength compared to muscle mass was calculated as the difference between T-score for grip strength and T-score for RASM (reference values obtained in 153 men aged 19–40 years). After adjustment for confounders, the relative deficit of muscle strength compared to muscle mass was greater in men >60 years with low testosterone level (P < 0.05), low 25OHD level (P < 0.05), Parkinson’s disease (P < 0.05) or diabetes (P < 0.005). Men with an apparent free testosterone concentration <142 pmol/l had greater relative deficit in muscle strength (P < 0.001). In multivariate models adjusted for confounders including RASM, prevalence of poor physical performance (lowest quartile of the composite score of physical performance) increased with decreasing 25OHD (P < 0.001) and decreasing testosterone (OR = 1.14, 95%CI = 1.06–1.23; P < 0.001). Men with poor physical performance were more often current smokers (P < 0.05) and more frequently had Parkinson’s disease (P < 0.05) and diabetes (P < 0.001) as well as a higher CRP concentration (P < 0.01). Conclusion: In older men, decreased testicular secretion and vitamin D deficiency, as well as diabetes and Parkinson’s disease, are associated with low muscle strength and poor physical performance independently of each other and independently of RASM. Thus, in older men, hypogonadism and vitamin D deficit are potentially modifiable determinants of low muscle strength and poor physical performance. doi:10.1016/j.jomh.2011.08.069

Abstract ID: #0058 Topic: Non-Urology/Complementary and Alternative Medicine in Men

BENEFICIAL EFFECT OF LOW DOSE MEDICAL OZONE IN THE TYPE 2 DIABETIC AGING MALE WITH ERECTILE DYSFUNCTION M. Tedja Pranata Medizone Clinic, Jakarta Pusat, Indonesia Background: Aging is the process of growing older and showing a progressive deterioration in bodily function over a period of time. It is the result of a series of chemical activities failing or malfunctioning. Hyperglycemia in diabetes melitus (DM) can result in the generation of reactive oxygen species (ROS) by glycoxidation. ROS can damage important cell components such as membrane lipids, proteins and DNA. The increase in lipid peroxydation is shown by an increased malon-dialdehyde (MDA) level and a decrease in anti-oxidant status. The beneficial effect of ozone therapy in type 2 DM (T2DM) in lowering blood glucose is due to an increase in the permeability of the cell membrane for glucose caused by stimulation of the pentose phosphate cycle, inhibition of the effect of anti-insulin hormones (somatotropic hormone and glucagons), reduction in the glycosylation of hemoglobin, reduction in the formation of ROS, increased production of GPx, SOD, catalase and release of NO. Also, increased production of 2,3-DPG loosens the Hb-oxygen bond and facilitates the release of oxygen to the tissues. This improvement in tissue

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oxygenation may improve endothelial function, nitric oxide production, endothelium-dependent vasodilatation and erectile function. Materials & Methods: Pre- and post-test studies evaluated the effect of ozone therapy in T2DM with ED. A total of 14 men (mean age 55 years) with DM/ED (on average suffering from DM for 6 years and ED for 6 months or more) received ozone within 10 weeks at a low dosage of 27␮g/dl. Accidental blood sugar, glycosylated hemoglobin (HbA1c), and MDA levels were evaluated and IIEF-5 questionnaires were completed before and after ozone therapy. Results: Table 1. Comparison of accidental blood glucose, HbA1c and MDA levels before and after ozone bio-oxidative therapy. IIEF – 5: Before After Acci.blood glucose: Before After HbA1c: Before After MDA: Before After

12.54 17.56 245.48 175.36 9.73 7.44 2.91 1.62

± ± ± ± ± ± ± ±

2.51 2.04 52.47 50.45 1.34 0.81 0.40 0.37

P < 0.00 P < 0.00 P < 0.00 P < 0.00

Conclusion: The beneficial effect of ozone in DM in lowering blood glucose is due to the inhibition of the effect of anti-insulin hormones (somatotropic hormone and glucagons), reduction in glycosylation of Hb, and reduction in the formation of ROS. These may, together with the improvement in tissue oxygenation, improve the endothelial function, nitric oxide production, endothelium-dependent vasodilatation and erectile function. doi:10.1016/j.jomh.2011.08.070

Abstract ID: #0010 Topic: Non-Urology/CVD

INFLUENCE OF AGE, SMOKING AND T2 DIABETES ON EXERCISE RELATED ANTIANGIOGENIC ENDOSTATIN/COLLAGEN XVIII RELEASE IN MEN M. Sponder ∗ , D. Dangl, B. Stanek, A. Kautzky-Willer, R. Marculescu, A. Sabri, S. Kampf, J. Strametz-Juranek, L. Kosi Medical University of Vienna, Vienna, Austria Background: Smoking and type 2 diabetes mellitus (T2DM) are important cardiovascular risk factors inducing endothelial dysfunction and atherosclerosis. Endostatin (Endo) inhibits endothelial cells (proliferation, migration) and stimulation of endothelial nitric oxide synthase (e-NOS) and contributes to the beneficial vasoprotective effects of physical exercise in young, healthy men. Therefore, the aim of the present study was to investigate the impact of age, smoking and diabetes on exercise-related Endo release in men. Materials & Methods: A total of 70 male patients, divided into elderly smokers (n = 17, mean age = 47.12 (range = 39–62 years)), elderly non-smokers (n = 20, mean age = 51.55 (36–70)), young healthy non-smokers (n = 19, mean age = 23.16 (18–34)] and T2DM (n = 14, mean age = 57.86 (42–70)) were investigated during a graded physical stress test. Venous blood samples were taken for deterioration of Endo, which was measured (ng/ml, using ELISA) at baseline and at peak work load. Furthermore heart rate, BMI and blood pressure were measured (data not shown). Results: Young, healthy male non-smokers showed the lowest Endobaseline levels with a significant exercise-related Endo increase. Male aging was not only associated with a profound increase in Endo-baseline levels but also higher Endo-serum levels at peak work load compared to young, healthy males. Smoking was associated with lower baseline as well as statistically significant lower peak load levels compared to elderly non-smokers. Diabetic men showed comparable baseline levels to the smoking group and a blunted exercise-related increase compared to elderly non-smokers. In all groups there was a significant exercise-related increase in Endoserum levels (P values of <0.01). However, compared to the other groups, young healthy non-smokers showed by far the highest increase in Endoserum levels (22.9%). Probands suffering from T2DM and elderly smokers showed the lowest Endo-elevations (10.5% and 14.7%, respectively). The Endo-serum levels of elderly non-smokers increased by 17.2%. Conclusion: (1) Elevated Endostatin baseline levels in diabetic, elderly and smoking individuals could be interpreted as a protective adaptive