Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men

The association of dietary antioxidants and the inflammatory potential of the diet with poor physical function and disability in older Australian men: the Concord Health and Ageing in Men Project

Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations.

Intra-generational social mobility and mortality among older men in the Concord Health and Ageing in Men Project: A cohort study

Objectives

We examined associations between intra-generational social mobility (reflected in life-course socioeconomic trajectories) and mortality, among older men.

Methods

Data came from a prospective Australian community-based cohort of older men. Social mobility was defined by socioeconomic indicators from three points in the life-course: educational attainment (late adolescence-early adulthood), occupation (mid-life), and current sources of income (older age). We defined indicators of social mobility trajectory (6 categories; reflecting the direction of social mobility) and social mobility status (2 categories; mobile or non-mobile). We used Cox regression to examine associations with mortality, adjusting for age, country of birth, and living arrangement.

Results

We followed 1568 men (mean age 76.8, SD 5.4) for a mean duration of 9.1 years, with 797 deaths recorded. Moving upward was the predominant social mobility trajectory (36.0%), followed by mixed trajectories (25.1%), downward (15.1%), stable low (12.2%), stable high (7.6%), and stable middle (4.0%). Men with downward (Hazard ratio 1.58, 95% CI 1.13 to 2.19) and stable low socioeconomic trajectories (1.77, 1.25 to 2.50) had higher mortality risks than men with stable high socioeconomic trajectories, while men with upward trajectories had similar risks to those with stable high trajectories. 76.2% of the participants were classified as having mobile status; no associations were evident between binary social mobility status and mortality.

Discussions

These findings suggest cumulative and persistent exposure to disadvantaged socioeconomic conditions across the life-course, rather than social mobility, is associated with increased mortality. For each stage of the life-course, addressing socioeconomic disadvantage may reduce inequities in mortality.

Stigmatization as a Barrier to Urologic Care: A Review

Heavy societal stigma of certain conditions has created an environment where individuals may be hesitant to seek professional care. Urology is a specialized field that focuses on many of these conditions that society has deemed taboo to discuss. In this review, we address barriers that have prevented patients from seeking urologic care in order to better understand and elucidate important concerns within development of the physician-patient relationship. Recognizing these concerns can also assist in public health outreach approaches to motivate patients for seeking urologic care. The scope of this review was limited to three highly prevalent conditions affecting both men and women, including urinary incontinence, erectile dysfunction, and genitourinary syndrome of menopause.

ATP5D Is a Potential Biomarker for Male Fertility

Background

Infertility is a global medical and social problem that affects human health and social development. At present, about 15% of couples of the right age in the world are infertile. As all we know, genetic defects are the most likely underlying cause of the pathology. ATP5D is also known as the delta subunit of mitochondrial ATP synthase. Mitochondria maintain sperm vitality, capacitation, acrosome reaction, and DNA integrity through ATP. Mitochondrial damage can trigger energy synthesis disorders, resulting in decreased sperm quality and function or even disappearance. The specific role of ATP5D in regulation of the male reproductive system remains elusive.

Methods

In this study, semen from normal and infertile males were collected and their indicators were examined by analysis of routine sperm parameters; ATP5D protein content in semen was examined by ELISA. Singer sequencing was used to detect whether there was a mutated of ATP5D in semen. Meanwhile, ATP5D knockout (KO) and knockin (KI) male mice were selected at 8-12 weeks of age and mated with adult wild-type (WT) female mice for more than two months to assess their fertility and reproductive ability. Morphological changes in tissues such as testes and epididymis were observed by HE staining; spermatozoa were taken from the epididymis of the mice; sperm counts were performed and morphological changes were observed by Diff-Quik staining.

Results

The results showed that the expression of ATP5D in infertile males was significantly lower than that in normal males (P < 0.001) and the normal morphology rate of spermatozoa was much lower than that of normal males, and the sequencing results showed no mutations. The animal reproductive experiments showed no significant changes in the number of fertility in KO/KI mice compared with WT mice, but the duration of fertility was significantly longer (P = 0.02). The testicular cells in KO mice were loosely arranged and disorganized, the lumen was larger, the interstitial cells were atrophied, and the number of spermatozoa was reduced and the malformation rate was higher in WT males. This suggests that ATP5D is an essential protein for sperm formation and fertility in male mice and may be used as a biomarker of male fertility.

Conclusion

This study found ATP5D correlated with male infertility and the expression levels were significantly reduced in the seminal plasma of all male infertile patients without gene mutations. KO male significantly prolonged fertility time and impaired testicular histomorphology. This suggests that ATP5D may be associated with spermatogenic function and fertility in male mice and may be used as a biomarker for male fertility. Future studies are required to elucidate the potential mechanisms. The trial registration number is KLL-2021-266.

The role of testosterone in male sexual function

Sexual function, and testosterone (T) levels, progressively decline in aging men. Associated morbidities and metabolic disorders can accelerate the phenomenon. The specific contribution of low T to sexual function impairment in aging men has still not been completely clarified. Similarly, the role of T replacement therapy (TRT), as well as the combination of TRT with phosphodiesterase type 5 inhibitors (PDE5i) for patients with erectile dysfunction (ED), is still conflicting. Here we aim to summarize and critically discuss all available data supporting the contribution of low T to sexual impairment observed with aging as well as the possible role of TRT. Available data on men with sexual dysfunction show that reduced sexual desire is the most important correlate of male hypogonadism. Conversely, aging and associated morbidities substantially attenuate the relationship between ED and T. TRT is effective in improving sexual function in middle-aged and older subjects but its role is small and extremely variable. Lifestyle interventions can result in similar outcomes to those of TRT. In conclusion, it is our opinion that PDE5i along with lifestyle measures should be considered the first approach for treating ED even in subjects with milder T deficiency. When these interventions fail or are difficult to apply, TRT should be considered.

Guilingji Protects Against Spermatogenesis Dysfunction From Oxidative Stress via Regulation of MAPK and Apoptotic Signaling Pathways in Immp2l Mutant Mice

Male infertility is a major health issue with an estimated prevalence of 4.2% of male infertility worldwide. Oxidative stress (OS) is one of the main causes of male infertility, which is characterized by excessive reactive oxygen species (ROS) or lack of antioxidants. Meanwhile, it is reported that oxidative stress plays an important role in the spermatogenic impairment in Inner mitochondrial membrane peptidase 2-like (Immp2l) mutant mice. In this study, we focused on the potential mechanism of Guilingji in protecting the spermatogenic functions in Immp2l mutant mice. The results revealed that Immp2l mutant mice exhibit impaired spermatogenesis and histology shows seminiferous tubules with reduced spermatogenic cells. After administration of Guilingji [150 mg/kg per day intragastric gavage], however, alleviated spermatogenesis impairment and reversed testis histopathological damage and reduced apoptosis. What’s more, western blotting and the levels of redox classic markers revealed that Guilingji can markedly reduce reactive oxygen species. Moreover, Guilingji treatment led to inhibition of the phosphorylation of mitogen-activated protein kinase (MAPK), regulated apoptosis in the cells. In summary, Guilingji can improve spermatogenesis in Immp2l mutant mice by regulating oxidation-antioxidant balance and MAPK pathway. Our data suggests that Guilingji may be a promising and effective antioxidant candidate for the treatment of male infertility.

Associations between dietary intake of total protein and sources of protein (plant vs. animal) and risk of all-cause and cause-specific mortality in older Australian men: The Concord Health and Ageing in Men Project

BACKGROUND

The association between dietary protein intake and the risk of mortality is still controversial. The present study aimed to examine the associations between dietary total, animal and plant protein intake and all-cause and cause-specific mortality.

METHODS

Community-dwelling men aged ≥ 70 years were recruited from local government areas surrounding Concord Hospital in Sydney, New South Wales for the Concord Health and Ageing in Men Project (CHAMP). The research dietitian administered a standardised validated diet history questionnaire to capture baseline dietary intake. In total, 794 men participated in a detailed diet history interview at the third wave. Adequacy of protein intake was assessed by comparing participant intake with the Nutrient Reference Values. Total protein intake was categorised into quintiles. Sources of protein were also captured. Mortality was ascertained through the New South Wales death registry. Cox proportional hazard models were used to assess the association between dietary total, animal and plant protein intake and risk of mortality.

RESULTS

The mean age of the CHAMP men was 81 years. In total, 162 men died during a median follow-up of 3.7 years. Of these, 54 (33.3%) and 49 (30.2%) men died due to cancer and cardiovascular disease, respectively. There were U-shaped associations between protein intake and all-cause and cancer mortality. In multiple adjusted analysis, the second (hazard ratio [HR] = 0.38; 95% confidence interval [CI] = 0.18-0.82) and third (HR = 0.36; 95% CI = 0.16-0.82) quintiles of protein intakes were significantly associated with reduced risk of all-cause and only second quintile (HR = 0.47; 95% CI = 0.10-0.93) of protein intake was significantly associated with cancer mortality. Each serve increase in animal protein was significantly associated with 12% (HR = 1.12; 95% CI = 1.00-1.26) and 23% (HR = 1.23; 95% CI = 1.02-1.49) increased risk of all-cause mortality and cancer mortality respectively. Conversely, each serve increase in plant protein intake was significantly associated with 25% (HR = 0.75; 95% CI 0.61-0.92) and 28% (HR = 0.72; 95% CI = 0.53-0.97) reduced risk of all-cause and cancer mortality, respectively. No such associations were observed for cardiovascular disease mortality.

CONCLUSIONS

Both second and third quintiles of total protein intake were associated with reduced all-cause and cancer mortality. Plant protein was inversely associated with all-cause and cancer mortality, whereas animal protein intake was positively associated with mortality.

Adherence to Mediterranean diet and its associations with circulating cytokines, musculoskeletal health and incident falls in community-dwelling older men: The Concord Health and Ageing in Men Project

BACKGROUND & AIMS

Mediterranean dietary patterns may exert favourable effects on various health conditions. This study aimed to determine associations of adherence to Mediterranean diet as well as its components, with circulating cytokine levels, musculoskeletal health and incident falls in community-dwelling older men.

METHODS

Seven hundred ninety-four (794) community-dwelling men with mean age 81.1 ± 4.5 years, who participated in the five-year follow-up of the Concord Health and Ageing in Men Project (CHAMP) were included in the cross-sectional analysis, and 616 attended follow-up three years later. Adherence to Mediterranean diet was assessed using MEDI-LITE (literature-derived Mediterranean diet) score which was obtained using a validated diet history questionnaire. Twenty-four evaluable circulating cytokines were analyzed using Bio-Plex Pro Human Cytokine 27-plex Assay kit. Appendicular lean mass (ALM) and bone mineral density (BMD) were measured using dual-energy x-ray absorptiometry (DXA). Three-year changes in gait speed and hand grip strength were assessed by walking a 6-m course and using a dynamometer respectively and analyzed using linear mixed-effects models. Incident falls over three years were determined through telephone interviews every four months. Multivariable linear regression was utilized to determine the cross-sectional associations between MEDI-LITE scores and circulating cytokines, bone mineral density, ALM, and ALM_BMI. Linear mixed-effects models were performed to estimate associations between MEDI-LITE scores and three-year change in hand grip strength and gait speed while negative binomial regression was applied to estimate associations between MEDI-LITE scores and three-year incident falls as well as associations between each MEDI-LITE component and three-year incident falls. Adjustments for multiple comparisons were performed using Benjamini-Hochberg adjustment for multiple testing.

RESULTS

A higher MEDI-LITE score, indicating greater adherence to Mediterranean diet, was associated with higher appendicular lean mass adjusted for body mass index (ALM_BMI) (β: 0.004 kg; 95% CI: 0.000, 0.008), and lower incident falls rates (IRR: 0.94; 95% CI: 0.89, 0.99). Higher consumption of monounsaturated fatty acids (IRR: 0.76; 95% CI: 0.59, 0.98) and monounsaturated fatty acids to saturated fatty acids ratio (IRR: 0.72; 95% CI: 0.57, 0.90) were associated with 24%, and 28% lower falls risk in older men respectively. MEDI-LITE scores were not associated with BMD or physical function parameters.

CONCLUSIONS

Adherence to a Mediterranean diet is associated with higher ALM_BMI, and fewer falls in community-dwelling older men. Monounsaturated and saturated fatty acids were the most important contributors to the association between Mediterranean diet and falls risk.

Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea

BACKGROUND

Obstructive sleep apnoea syndrome (OSAS) is associated with several chronic diseases, including erectile dysfunction (ED). The association of OSAS and ED is far more common than might be found by chance; the treatment of OSAS with non-invasive positive airway pressure therapy is associated with improvement of respiratory symptoms, and may contribute to the improvement of associated conditions, such as ED.

OBJECTIVES

To assess the effectiveness and acceptability of non-invasive positive airway pressure therapy for improving erectile dysfunction in OSAS.

SEARCH METHODS

We identified studies from the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, AMED EBSCO, and LILACS, the US National Institutes of Health ongoing trials register ClinicalTrials.gov, and the World Health Organisation international clinical trials registry platform to 14 June 2021, with no restriction on date, language, or status of publication. We checked the reference lists of all primary studies, and review articles for additional references, and relevant manufacturers' websites for study information. We also searched specific conference proceedings for the British Association of Urological Surgeons; the European Association of Urology; and the American Urological Association to 14 June 2021.

SELECTION CRITERIA

We considered randomised controlled trials (RCTs) with a parallel or cross-over design, or cluster-RCTs, which included men aged 18 years or older, with OSAS and ED. We considered RCTs comparing any non-invasive positive airway pressure therapy (such as continuous positive airways pressure (CPAP), bilevel positive airway pressure (BiPAP), variable positive airway pressure (VPAP), or similar devices) versus sham, no treatment, waiting list, or pharmacological treatment for ED. The primary outcomes were remission of ED and serious adverse events; secondary outcome were sex-related quality of life, health-related quality of life, and minor adverse events.

DATA COLLECTION AND ANALYSIS

Two review authors independently conducted study selection, data extraction, and risk of bias assessment. A third review author solved any disagreement. We used the Cochrane RoB 1 tool to assess the risk of bias of the included RCTs. We used the GRADE approach to assess the certainty of the body of evidence. To measure the treatment effect on dichotomous outcomes, we used the risk ratio (RR); for continuous outcomes, we used the mean difference (MD). We calculated 95% confidence intervals (CI) for these measures. When possible (data availability and homogeneous studies), we used a random-effect model to pool data with a meta-analysis.

MAIN RESULTS

We included six RCTs (all assessing CPAP as the non-invasive positive airway pressure therapy device), with a total of 315 men with OSAS and ED. All RCTs presented some important risk of bias related to selection, performance, assessment, or reporting bias. None of included RCTs assessed the ED remission rate, and we used the provided ED mean scores as a proxy. CPAP versus no CPAP There is uncertainty about the effect of CPAP on mean ED scores after 4 weeks, using the International index of erectile function (IIEF-5, higher = better; MD 7.50, 95% CI 4.05 to 10.95; 1 RCT; 27 participants; very low-certainty evidence), and after 12 weeks (IIEF-ED, ED domain; MD 2.50, 95% CI -1.10 to 6.10; 1 RCT; 57 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). There is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks, using the Self-esteem and relationship test (SEAR, higher = better; MD 1.00, 95% CI -8.09 to 10.09; 1 RCT; 57 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision); no serious adverse events were reported after 4 weeks (1 RCT; 27 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). CPAP versus sham CPAP One RCT assessed this comparison (61 participants), but we were unable to extract outcomes for this comparison due to the factorial design and reporting of this trial. CPAP versus sildenafil (phosphodiesterase type 5 inhibitors) Sildenafil may slightly improve erectile function at 12 weeks when compared to CPAP, measured with the IIEF-ED (MD -4.78, 95% CI -6.98 to -2.58; 3 RCTs; 152 participants; I² = 59%; low-certainty evidence, downgraded due to methodological limitations). There is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks, measured with the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire (EDITS, higher = better; MD -1.24, 95% CI -1.80 to -0.67; 2 RCTs; 122 participants; I² = 0%; very low-certainty evidence, downgraded due to methodological limitations). No serious adverse events were reported for either group (2 RCTs; 70 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). There is uncertainty about the effects of CPAP when compared to sildenafil for the incidence of minor adverse events (RR 1.33, 95% CI 0.34 to 5.21; 1 RCT; 40 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). The confidence interval was wide and neither a significant increase nor reduction in the risk of minor adverse events can be ruled out with the use of CPAP (4/20 men complained of nasal dryness in the CPAP group, and 3/20 men complained of transient flushing and mild headache in the sildenafil group).

AUTHORS' CONCLUSIONS

When compared with no CPAP, we are uncertain about the effectiveness and acceptability of CPAP for improving erectile dysfunction in men with obstructive sleep apnoea. When compared with sildenafil, there is some evidence that sildenafil may slightly improve erectile function at 12 weeks.

The Prospective Association Between Socioeconomic Status and Falls Among Community-Dwelling Older Men

BACKGROUND

Socioeconomic status (SES) has been suggested as a risk factor for falls but the few prospective studies to test this have had mixed results. We evaluated the prospective association between SES and falls in the Concord Health and Ageing in Men Project (CHAMP).

METHODS

CHAMP is a population-based prospective cohort study of men aged ≥70 years in Sydney, Australia. Incident falls were ascertained by triannual telephone calls for up to 4 years. SES was assessed with 4 indicators (education, occupation, source of income, home ownership) and cumulative SES score. We tested for interaction between SES indicators and country of birth and conducted stratified analyses.

RESULTS

We evaluated 1624 men (mean age: 77.3 ± 5.4 years). During a mean ± SD follow-up of 42.6 ± 8.7 months, 766 (47%) participants reported ≥1 incident falls. In nonstratified analyses, there were no associations between SES indicators and falls. In stratified analyses, falls rates were higher among Australian-born men with less formal education (incidence rate ratio [IRR] 1.66, 95% confidence interval [CI] 1.16-2.37, compared with those with more education) and those with low occupational position (1.45; 1.09-1.93). However, among men born in non-main English-speaking countries the rate of falls was lower among those with low educational level and no associations were evident for occupational position.

CONCLUSIONS

Lower educational level and occupational position predicted a higher falls rate in Australian-born men; the opposite relationship was evident for educational level among migrants born in non-main English-speaking countries. Further studies should test these relationships in different populations and settings and evaluate targeted interventions.

Erectile dysfunction iceberg in an urology outpatient clinic: How can we encourage our patients to be more forthcoming?

The study's aim was to document the rates of declared and hidden erectile dysfunction (ED) at urology outpatient clinic while attempting to develop a method to encourage patients to talk about ED. A total of 506 patients, all of whom underwent the same procedure by the same clinician with a standard algorithm, were prospectively evaluated. The patients who declared ED as their primary or secondary symptom were grouped as 'very early treatment seekers' (VETS) and 'early treatment seekers' (ETS) respectively. The patients who hid their ED until directly questioned and the patients whose ED was diagnosed with an IIEF-5 questionnaire were grouped as 'late treatment seekers' (LTS) and 'very late treatment seekers' (VLTS) respectively. The total number of ED was 291 (57.5%), comprised of 54 (18.6%) patients in the VETS, 48 (16.5%) in the ETS, 143 (49.1%) in the LTS and 46 (15.8%) in the VLTS groups. The rate of severe ED was significantly higher in the VETS group, whereas the rate of mild ED was significantly higher in the VLTS group (p < .001). Most of the patients would not seek help for their ED until the clinician directly or indirectly questioned them. Simple manipulations uncovered the hidden ED patients.

Update of the position paper on arterial hypertension and erectile dysfunction

: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.

Quality and readability of online patient information on treatment for erectile dysfunction

Objectives

To investigate the quality and readability of online patient information on treatment for erectile dysfunction using a Google search.

Materials and methods

The results of a Google search for “erectile dysfunction treatment” were reviewed. Webpages that contained written information on erectile dysfunction except those containing scientific publications and paywall protected webpages were included in further analysis. Typographic and treatment information were recorded. Readability was assessed using the Fleisch‐Kincaid grade level, the Gunning‐Fog index, the Coleman‐Liau index, and Simple Measure of Gobbledygook. Website quality was assessed using the DISCERN instrument, Journal of the American Medical Association (JAMA) benchmark criteria, and presence of Health on the net (HON) code certification. Website typography, discussed treatment types, readability scores, and quality measures were reported. Parametric and nonparametric statistical tests were used to compare the data as appropriate dependent on the normality of data.

Results

Eighty‐one webpages were included. Urologists and hospitals were the most common producers with 15 (18%) each. Seventy‐four (91%) webpages contained specific information on treatment for erectile dysfunction and 15 (19%) contained advertisements. Seventeen (21%) webpages were HON code certified. The median DISCERN score was 35 (IQR 26.5‐44) out of 80. The mean combined readability score was 12.32 (SD 1.91). The median JAMA benchmark score was 1 (IQR 1‐2) out of 4. Google rank had a small negative correlation with DISCERN score (τ = −0.16, P = .036). HON code certified webpages had higher DISCERN scores (median of 44 [IQR 35‐58.5] vs 32.5 [IQR 25.25‐42.25], U = 832, Z = 6561, P < .001). A linear regression was used to predict DISCERN score based on meeting each JAMA benchmark criterion (F(2, 78) = 22.7, P < .001) R² = 0.368, P < .001. Within this model the effects of meeting attribution (β = 11.09) and currency (β = 8.79) criterion were significant.

Conclusions

The quality of online information on treatment for erectile dysfunction is generally poor. However, easy to identify markers of quality like HON code certification, or meeting JAMA benchmark criterion for attribution and currency may help patients to navigate to better quality online information on treatment for erectile dysfunction. Webpages are written at senior high school level, above any recommendations for patient medical information. Health professionals should use validated instruments to assess the quality of online information on treatment for erectile dysfunction prior to publication to improve their utility for patients.

Appetite, oral health and weight loss in community-dwelling older men: an observational study from the Concord Health and Ageing in Men Project (CHAMP)

Background

Unintended weight loss and the reduction in appetite are common phenomenon among older people. Reduced appetite has been linked to medication related reductions in saliva production, reduced taste ability and poor oral health. Poor appetite can result in reduced nutrient intake ensuing weight loss. It is possible that poor appetite is a mediating step on the causal pathway between oral health and weight loss. This study investigates whether poor oral health and loss of appetite are related to weight loss.

Methods

This is an observational study where data were obtained from the Concord Health and Ageing in Men Project (CHAMP). Information on socio-demographics, appetite and health related behavior was collected by self-completed questionnaire. Intraoral assessment was conducted by calibrated oral health therapists. Height and weight were measured by trained staff. Regression analysis investigated associations between oral health and appetite as risk factors for weight loss.

Results

Participants included 542 community dwelling older males. 99 older men (18.3%) experienced 5% or more weight loss over 3 years. Men who lost weight from baseline had lower BMI and lower body weight, had higher prevalence of frailty and depression, reported poorer appetite, and had fewer teeth (13.8 ± 9.5) than those who did not lose weight (16.3 ± 9.3). Before adjustment, the prevalence ratio (PR) for weight loss was 1.76 (95% Confidence Interval (CI), 1.19–2.59) for participants with 0–19 natural teeth present compared to those with 20 or more teeth. When adding appetite and other variables to the model, the PR for number of teeth and weight loss was unchanged: 1.78 (95% CI, 1.06–3.00). The mediation analysis showed that the indirect effect of appetite on the association between number of natural teeth on weight loss was not found to be significant.

Conclusion

This study found that number of natural teeth present and appetite are independently related to weight change among elderly men in Australia. Tooth loss can increase the risk of swallowing difficulty leading to change in food preference, avoidance of foods and a decrease in energy intake. Our study showed the importance of oral health interventions to encourage maintenance of 20 or more natural teeth in older people.

Dietary and supplemental antioxidant intake and risk of major adverse cardiovascular events in older men: The concord health and ageing in men project

BACKGROUND AND AIMS

The role of antioxidant intake in cardiovascular disease remains inconclusive. This study evaluates the association between antioxidant intake and the risk of major adverse cardiovascular events (MACE) among older Australian men.

METHODS AND RESULTS

794 men aged ≥75 years participated in the 3rd wave of the Concord Health and Ageing in Men Project. Dietary adequacy of antioxidant intake was assessed by comparing participants' intake of vitamins A, E, C and zinc to the Nutrient Reference Values (NRV) for Australia. Attainment of NRVs of antioxidants was categorised into a dichotomised variable 'inadequate' (meeting≤2 of 4 antioxidants) or 'adequate' (meeting≥3 of 4 antioxidants). The usage of antioxidant supplements was assessed. The outcome measure was MACE. The composite MACE endpoint was defined as having one of the following: death, myocardial infarction, ischemic stroke, congestive cardiac failure (CCF), and revascularization during the period of observation. There was no significant association between dietary (HR: 1.03, 95% CI: 0.71, 1.48) or supplemental antioxidant intake (HR: 1.10, 95% CI: 0.75, 1.63) and overall MACE. However, a significant association was observed between inadequate antioxidant intake and CCF (HR: 1.32; 95% CI: 1.16, 1.50). The lowest quartile of zinc intake (<11.00 mg/d) was significantly associated with CCF (HR 2.36; 95% CI: 1.04, 5.34). None of the other antioxidants were significantly associated with CCF or other MACE components.

CONCLUSION

Inadequate dietary antioxidant intake, particularly zinc, is associated with increased risk of CCF in older Australian men but not associated with overall MACE.

Sleep and the Testis

Disordered sleep impairs neurocognitive performance, and is now recognized to cause metabolic ill-health. This review assesses the nascent relationship between insufficient, misaligned, and disrupted sleep with andrological health. High-quality cohort studies show a reduced sperm count in men with sleep disturbances. Well-designed interventional studies show a reduction in testosterone with sleep restriction. Studies of long-term shift workers show no effect of misaligned sleep on mean testosterone concentrations. Men with obstructive sleep apnea (OSA) and more severe hypoxemia have lower testosterone levels, although it is unknown if this relationship is entirely explained by concomitant obesity, or is reversible. Nevertheless, erectile dysfunction, which is common in men with OSA, is clinically improved when OSA is properly treated. Few studies manipulating sleep have been performed in older men, in whom the accumulation of sleep disturbances over decades of life may contribute to age-related illnesses. Improving sleep could ameliorate the development of these disorders.

Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018

Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018.

METHODS

Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55-64 and 65-74 years) and two younger groups (15-24 and 25-34 years). Poisson regression examined trends for 2000-18 and 2014-18 separately.

RESULTS

Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55-64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02-1.10] and declined in those aged 15-24 years (IRR = 0.99; 95%CI: 0.99-0.99). Gonorrhoea rates increased the most among those aged 65-74 years (IRR = 1.47; 95%CI: 1.23-1.77) and least in those aged 15-24 years (IRR = 1.12; 95%CI: 1.10-1.13). Syphilis rates increased the most among those aged 55-64 years (IRR = 1.58; 95%CI: 1.25-1.99) and least in those aged 15-24 years (IRR = 1.29; 95%CI: 1.23-1.35). Chlamydia test positivity declined among younger women but remained stable in older women.

CONCLUSIONS

In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.

Associations between nutrient intakes and dietary patterns with different sarcopenia definitions in older Australian men: the concord health and ageing in men project

Objective:

To assess the associations between nutrient intake and dietary patterns with different sarcopenia definitions in older men.

Design:

Cross-sectional study.

Setting:

Sarcopenia was defined using the Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Dietary adequacy of fourteen nutrients was assessed by comparing participants’ intakes with the Nutrient Reference Values (NRV). Attainment of NRV for nutrients was incorporated into a variable ‘poor’ (meeting ≤ 9) v. ‘good’ (meeting ≥ 10) using the cut-point method. Also, two different dietary patterns, monounsaturated:saturated fat and n-6:n-3 fatty acids ratio and individual nutrients were used as predictor variables.

Participants:

A total of 794 men aged ≥75 years participated in this study.

Results:

The prevalence of sarcopenia by the FNIH, EWGSOP and EWGSOP2 definitions was 12·9 %, 12·9 % and 19·6 %, respectively. With the adjustment, poor nutrient intake was significantly associated with FNIH-defined sarcopenia (OR: 2·07 (95 % CI 1·16, 3·67)), but not with EWGSOP and EWGSPOP2 definitions. The lowest and second-lowest quartiles of protein, Mg and Ca and the lowest quartiles of n-6 PUFA and n-3 PUFA intakes were significantly associated with FNIH-defined sarcopenia. Each unit decrease in n-6:n-3 ratio was significantly associated with a 9 % increased risk of FNIH-defined sarcopenia (OR: 1·09 (95 % CI 1·04, 1·16)).

Conclusions:

Inadequate intakes of nutrients are associated with FNIH-defined sarcopenia in older men, but not with the other two sarcopenia definitions. Further studies are required to understand these relationships.

Prospective Associations Between Dietary Antioxidant Intake and Frailty in Older Australian Men: The Concord Health and Ageing in Men Project

BACKGROUND

The objective of the study is to evaluate the prospective associations between antioxidant intake and incident frailty among older Australian men aged ≥75 years.

METHODS

Seven hundred and ninety-four men participated in a detailed diet history interview at the Concord Health and Ageing in Men Project (CHAMP) study third wave (considered baseline nutrition here) and 781 men participated at the fourth wave (considered 3-year follow-up here). The main outcome measurement was incident frailty at 3-year follow-up, using the Cardiovascular Health Study definition. Dietary adequacy of antioxidant intake was assessed by comparing participants' median intakes of four dietary antioxidants (vitamin A, E, C, and zinc) to the nutrient reference values (NRVs). Attainment of the NRVs was incorporated into a dichotomized variable "poor" (meeting ≤2 antioxidants) or "good" (meeting ≥3 antioxidants) as the independent variable using the cut-point method. Also, intakes of each individual dietary antioxidant at baseline nutrition were categorized into quartiles. Analyses were performed using multinomial logistic regression.

RESULTS

Incidence of pre-frailty was 53.0% and frailty was 6.4% at 3-year follow-up. Poor dietary antioxidant intake (meeting ≤2) at baseline nutrition was associated with incident frailty at 3-year follow-up in unadjusted (OR: 2.59 [95% CI: 1.47, 4.59, p = .001]) and adjusted (OR: 2.46 [95% CI: 1.10, 5.51, p = .03]) analyses. The lowest quartile of vitamin E intake (<7.08 mg/d) was significantly associated with incident frailty (OR: 2.46 [95% CI: 1.01, 6.00, p = .05]).

CONCLUSIONS

Poor antioxidant intake, particularly vitamin E, is a plausible factor associated with incident frailty among older men. This supports the need for clinical trials of diets rich in antioxidants or possibly low-dose antioxidant supplements, for prevention of frailty.

Changes in micronutrient intake and factors associated with this change among older Australian men: the Concord Health and Ageing in Men Project

OBJECTIVES

To examine changes in micronutrient intake over 3 years and identify any associations between socio-economic, health, lifestyle and meal-related factors and these changes in micronutrient intakes among older men.

DESIGN

Prospective study.

SETTING

Dietary adequacy of individual micronutrient was compared to the estimated average requirement of the nutrient reference values (NRV). Attainment of the NRV for twelve micronutrients was incorporated into a dichotomised variable 'not meeting' (meeting ≤ 6) or 'meeting' (meeting ≥ 7) and categorised into four categories to assess change in micronutrient intake over 3 years. The multinomial logistic regression analyses were conducted to model predictors of changes in micronutrient intake.

PARTICIPANTS

Seven hundred and ninety-four men participated in a detailed diet history interview at the third wave (baseline nutrition) and 718 men participated at the fourth wave (3-year follow-up).

RESULTS

The mean age was 81 years (range 75-99 years). Median intakes of the majority of micronutrients decreased significantly over a 3-year follow-up. Inadequacy of the NRV for thiamine, dietary folate, Zn, Mg, Ca and I were significantly increased at a 3-year follow-up than baseline nutrition. The incidence of inadequate micronutrient intake was 21 % and remained inadequate micronutrient intake was 16·4 % at 3-year follow-up. Changes in micronutrient intakes were significantly associated with participants born in the UK and Italy, low levels of physical activity, having ≥2 medical conditions and used meal services.

CONCLUSIONS

Micronutrient intake decreases with age in older men. Our results suggest that strategies to improve some of the suboptimal micronutrient intakes might need to be developed and implemented for older men.

Designing and psychometric of reproductive health related behaviors assessment tool in Iranian males: an exploratory mixed method study protocol

BACKGROUND

Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior.

METHODS/DESIGN

This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted.

DISCUSSION

Discovering men's perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior.

ETHICAL CODE

IR.TUMS.FNM.REC.1397.157.

Socioeconomic status, health-related behaviours, and death among older people: the Concord health and aging in men project prospective cohort study

Background

Conflicting evidence exists regarding the association of socioeconomic status (SES) with mortality among older people and little is known about the mechanisms underlying this association. We investigated the association of SES with mortality among older Australian men. We also investigated potential mediating effects of health-related behaviours in SES-mortality associations.

Methods

We used data from a prospective population-based cohort (the Concord Health and Aging in Men Project), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score were assessed at baseline. Longitudinally assessed alcohol consumption, smoking, physical activity, and body mass index were investigated as potential mediators. Associations were quantified using Cox regression.

Results

We evaluated 1527 men (mean age: 77.4 ± 5.5 years). During a mean follow-up time of 9.0 years, 783 deaths occurred. For deaths from all causes, the adjusted hazard ratio (HR) for the lowest tertile of cumulative SES score versus the highest tertile was 1.44 (95% CI 1.21 to 1.70); the corresponding sub-HRs were 1.35 (0.96 to 1.89) for cardiovascular disease (CVD) mortality; 1.58 (1.15 to 2.18) for cancer mortality, and 1.86 (1.36 to 2.56) for non-CVD, non-cancer mortality. SES-mortality associations were attenuated by 11–25% after adjustment for mediating health-related behaviours.

Conclusion

Low SES is associated with increased mortality in older Australian men and health-related behaviours accounted for less than one-fourth of these associations. Further research is needed to fully understand the mechanisms underlying SES inequalities in mortality among older people.

Associations between lifestyle, erectile dysfunction and healthcare seeking: a population-based study

Objective: To investigate associations between age, lifestyle and erectile dysfunction (ED) in the general population and to explore associations between age, lifestyle and contact with a general practitioner (GP) regarding ED.Design: Cross-sectional web-based questionnaire study.Setting: The general Danish population.Subjects: A randomly selected sample of 48,910 men aged 20 years and older.Main outcome measures: Prevalence of ED and probability of contacting a GP regarding ED. In logistic regression models we analysed associations between age, smoking status, alcohol consumption, body mass index (BMI), and self-rated physical fitness on both ED and GP contact.Results: A total of 22,198 men (47.6%) completed the question regarding ED. The overall prevalence of ED was 19.3%, varying from 2.3% among men aged 20-29 years to 55.3% among men aged 80 years and above. 31.8% of men reporting ED had contacted a GP regarding ED. Increasing age, current or former smoking, complete alcohol abstinence or alcohol consumption above seven units per week, high BMI, and poor self-rated physical fitness were significantly associated with reporting ED. The proportion of GP contacts was significantly associated with age. Overall, no significant associations between lifestyle and healthcare seeking were observed, although lower odds of GP contact were found when physical fitness was rated as poor.Conclusion: Reporting ED and GP contact were significantly associated with age. Furthermore, lifestyle was significantly associated with reporting ED, but largely not associated with healthcare seeking. These findings are important for future interventions aiming to improve diagnosis and treatment of ED.Key pointsExperiencing erectile dysfunction is frequent in the general population, especially among older men.  • In this large-scale national survey, age and lifestyle were significantly associated with reporting erectile dysfunction.  • Healthcare seeking with erectile dysfunction was significantly associated with age, but not with lifestyle.  • Diagnosis and treatment of erectile dysfunction might be challenged when erectile dysfunction does not lead to healthcare seeking.

The association between antioxidant intake, dietary pattern and depressive symptoms in older Australian men: the Concord Health and Ageing in Men Project

PURPOSE

The objectives of the study were to evaluate the associations between antioxidant intake, dietary patterns and depressive symptoms among older men.

METHOD

794 men participated in a detailed diet history interview at the Concord Health and Ageing in Men Project 3rd wave (considered baseline nutrition) and 781 men participated at the 4th wave (considered 3-year follow-up). Depressive symptoms were measured using the Geriatric Depression Scale (GDS ≥ 5). Dietary adequacy of antioxidant intake was assessed by comparing participants' median intake of vitamin A, E, C and zinc to the Nutrient Reference Values for Australia. Attainment of NRVs of antioxidant was categorised into a dichotomised variable 'poor' (meeting ≤ 2) or 'good' (meeting ≥ 3). Individual antioxidant nutrient was categorised into quartiles. The Australian and Mediterranean diet scores were assessed as predictor variables.

RESULTS

The prevalence of GDS ≥ 5 was 12.8% at baseline nutrition and 13.2% of men developed GDS ≥ 5 at a 3-year follow-up. There was a significant cross-sectional association between poor antioxidant intake and GDS ≥ 5 in adjusted analyses [OR: 1.95 (95% CI 1.03, 3.70)]. Poor antioxidant intake at baseline nutrition remained prospectively associated with incident GDS ≥ 5 [OR: 2.46 (95% CI 1.24, 4.88)] in adjusted analyses. This association was also found for the lowest quartile of zinc [OR 2.72 (95% CI 1.37, 5.42)] and vitamin E intake [OR 2.18 (95% CI 1.05, 4.51)]. None of the other antioxidants and dietary patterns had a significant association with incident depressive symptoms.

CONCLUSION

Inadequacy of antioxidant intake, particularly zinc and vitamin E, is associated with increased risk of clinically significant depressive symptoms in older men.

Cross-Sectional and Longitudinal Relationships Between Inflammatory Biomarkers and Frailty in Community-dwelling Older Men: The Concord Health and Ageing in Men Project

BACKGROUND

Previous studies demonstrated associations between IL-6 and frailty, but associations between a wide range of cytokines, chemokines, and growth factors with prevalent and incident frailty has not been studied.

METHODS

Community-dwelling men aged more than 75 enrolled in the 5-year and 8-year follow-up of the CHAMP study were assessed. Twenty-seven inflammatory biomarkers were measured using the Bio-Plex Pro Human Cytokine 27-plex Assay kit at 5-year follow-up. Frailty was determined using the Fried frailty phenotype (FP) and Rockwood frailty index (FI) at both time-points. Age, body mass index, smoking, alcohol, and comorbidity were also assessed.

RESULTS

In cross-sectional analysis of the 5-year follow-up, the unadjusted odds ratio (OR) for frail versus robust evaluated by the FP showed significant associations for IL-6 (OR: 1.56, 95% confidence interval [CI]: 1.23-1.98) and IL-8 (OR: 1.28, 95% CI: 1.00-1.63). IL-6 remained significantly associated in the age-adjusted (OR: 1.58, 95% CI: 1.21-2.05) and multivariable-adjusted model (OR: 1.54, 95% CI: 1.16-2.05). No associations were observed between pre-frail versus robust. In longitudinal unadjusted analysis, IL-8 (OR: 1.32, 95% CI: 1.03-1.70) and IP-10 (OR: 1.32, 95% CI: 1.03-1.70) at 5-year predicted incident frailty at 8-year follow-up. IL-8 remained longitudinally associated with incident frailty after age (OR: 1.34, 95% CI: 1.03-1.75) but not multivariable (OR: 1.20, 95% CI: 0.98-1.70) adjustment. Similar results were seen using the FI. None of the other biomarkers had significant associations with incident frailty.

CONCLUSIONS

Our findings suggest that IL-6 and IL-8 may be cross-sectionally associated with frailty and that all measured inflammatory biomarkers were not causally related to frailty. Together with previous studies, the results suggest that frailty is specifically linked to IL-6 and IL-8 rather than simply representing a nonspecific pan-inflammatory condition.

Proinflammatory Diet Increases Circulating Inflammatory Biomarkers and Falls Risk in Community-Dwelling Older Men

BACKGROUND

The relations between diet, chronic inflammation, and musculoskeletal health are unclear, especially among older men.

OBJECTIVE

This study aimed to determine associations of the Dietary Inflammatory Index (DII) with inflammatory biomarkers, musculoskeletal health, and falls risk in community-dwelling older men.

METHODS

The cross-sectional analysis included 794 community-dwelling men, mean age 81.1 ± 4.5 y, who participated in the 5-y follow-up of the Concord Health and Aging in Men Project. Of these, 616 were seen again 3 y later for the longitudinal analysis. Energy-adjusted DII (E-DII) was calculated from a validated diet history questionnaire. Bone mineral density (BMD) was measured using DXA. Twenty-four inflammatory biomarkers were analyzed. Incident falls over 3 y were determined through telephone interviews every 4 mo. Multiple regression, linear mixed effects models, negative binomial regression, and mediation analysis were utilized in this study.

RESULTS

A higher E-DII score (indicating a more proinflammatory diet) was associated with higher concentrations of IL-6 (β: 0.028 pg/mL; 95% CI: 0.003, 0.053), IL-7 (β: 0.020 pg/mL; 95% CI: 0.002, 0.037), and TNF-α (β: 0.027 pg/mL; 95% CI: 0.003, 0.051). A higher E-DII score was also associated with lower appendicular lean mass adjusted for BMI (ALMBMI) (β: -0.006 kg/m2; 95% CI: -0.010, -0.001). For every unit increase in E-DII (range: -4.91 to +3.66 units), incident falls rates increased by 13% (incidence rate ratio: 1.13; 95% CI: 1.05, 1.21) over 3 y. Mediation analysis showed that the association between E-DII and 3-y incident falls was influenced by the concentrations of IL-7 by 24%. There was no association between E-DII and BMD.

CONCLUSIONS

Consumption of a proinflammatory diet was associated with increased concentrations of IL-6, IL-7, and TNF-α; increased falls risk; and lower ALMBMI in community-dwelling older men. The association between incident falls and E-DII was partly mediated by concentrations of IL-7.

Frailty and Cause-Specific Hospitalizations in Community-Dwelling Older Men

OBJECTIVES

The types of medical conditions leading to hospitalization in frail older people have not been investigated. The objectives were to evaluate associations between frailty and (a) risk of all-cause and cause-specific hospitalization, and (b) rate of all-cause and cause-specific hospitalizations.

DESIGN, SETTING AND PARTICIPANTS

Community-dwelling men aged 70+ years in the Concord Health and Ageing in Men Project (CHAMP) were assessed for frailty at baseline (2005-2007, n=1705).

MEASUREMENTS

Frailty was determined by both the Fried frailty phenotype (FP) and the Rockwood frailty index (FI). Non-elective and elective hospitalization data were accessed from the New South Wales (NSW) Admitted Patient Data Collection and mortality from the NSW Deaths Registry for the period 2005-2017. Causes of hospitalization were categorized using ICD-10 classification of principal diagnoses based on organ system involved into 14 major categories.

RESULTS

Nearly 80% of CHAMP men had at least one non-elective hospitalization and 63% had an elective hospitalization over a 9-year follow-up. Men with FP frailty were twice as likely to have a non-elective hospitalization (HR: 1.98, 95%CI: 1.61-2.44) and a greater number of non-elective hospitalizations (IRR: 1.44, 95%CI: 1.22-1.70). Similar relationships were found between FI frailty and non-elective hospitalizations. Men with frailty (either FP or FI) were more likely to have at least one non-elective hospitalization for 13 of the 14 cause-related admissions. In contrast, frailty was only associated with 3 cause-related elective hospitalizations. Men with frailty were also more likely to have an increased number of non-elective hospitalizations for all 14 causes, but only for 6 causes of elective hospitalizations.

CONCLUSIONS

Our findings suggest frailty increases the risk and number of non-elective hospitalizations in older men for a wide range of cause. Strategies on early identification of frailty, followed by appropriate preventative strategies to lower the risk of non-elective hospital admissions are warranted.

Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Objective

Low levels of total cholesterol (TC) are associated with adverse outcomes in older populations. Whether this phenomenon is independent of statin use is unknown. We investigated the association between low TC levels and long-term major adverse cardiovascular events (MACE) in a prospective study of men aged ≥70 years without ischaemic heart disease (IHD) and whether this was influenced by statin use.

Methods

The CHAMP (Concord Health and Ageing in Men Project) cohort is a prospective cohort study of community-dwelling men aged ≥70 years. The relationship between TC and long-term MACE was analysed using Cox-regression modelling adjusted for comorbidities and stratified by statin use.

Results

The study cohort comprised 1289 men (mean (±SD) age, 77.0±5.5 years; mean follow-up, 6.4±2.7 years). Decreasing TC level was associated with increased comorbidity burden, frailty and MACE (linear trend p<0.001). In men not on statin therapy (n=731), each 1 mmol/L decrease in TC was associated with increased MACE (HR 1.27, 95% CI 1.10 to 1.45, p=0.001) and mortality (HR 1.22, 95% CI 1.03 to 1.44, p=0.02) adjusted for comorbidities. In contrast, low TC in men on statins (n=558) was not associated with MACE (HR 0.91, 95% CI 0.74 to 1.11) or mortality (HR 0.86, 95% CI 0.68 to 1.09).

Conclusion

Low TC is associated with increased risk of MACE in older men without IHD who are not taking statin therapy but not in those on statins.

Duplications in 19p13.3 are associated with male infertility

PURPOSE

To identify genomic imbalances and candidate loci in idiopathic male infertility.

METHODS

Affymetrix CytoScan 750K Array was used to analyze genomic imbalances and candidate loci in 34 idiopathic infertile cases of different phenotypes (hypo-spermatogenesis, n = 8; maturation arrest, n = 7; and Sertoli cell-only syndrome, n = 13, severe oligozoospermia, n = 6, and 10 normozoospermic fertile men). Ten ethnically matched controls were screened for comparison.

RESULTS

The cytogenetic array analysis detected a genomic gain at the 19p13.3 region in 9 (26.47%) cases, with the highest frequency in patients with Sertoli cell-only syndrome (SCOS) (38%). Its complete absence in the control group suggests its likely pathogenic nature. In addition to Y-classical, micro, and partial deletions, the duplication in 19p13.3 could serve as a unique biomarker for evaluation of infertility risk. The common region across the individuals harboring the duplication identified STK11, ATP5D, MIDN, CIRBP, and EFNA2 genes which make them strong candidates for further investigations. The largest duplicated region identified in this study displayed a major network of 7 genes, viz., CIRBP, FSTL3, GPX4, GAMT, KISS1R, STK11, and PCSK4, associated with reproductive system development and function. The role of chance was ruled out by screening of ethnically matched controls.

CONCLUSION

The result clearly indicates the significance of 19p13.3 duplication in infertile men with severe testicular phenotypes. The present study underlines the utility and significance of whole genomic analysis in the cases of male infertility which goes undiagnosed due to limitations in the conventional cytogenetic techniques and for identifying genes that are essential for spermatogenesis.

Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages?

INTRODUCTION

The impact of erectile dysfunction (ED) on patients' sexual satisfaction and mood profile could differ across different ages.

AIM

To investigate the relationship between erectile function (EF), sexual satisfaction, and mood status among patients seeking medical help for ED.

METHODS

Data from 765 patients presenting at a single center for ED were analyzed. Patients were categorized as young (≤50 years), middle-aged (>50 and ≤65 years), and old (>65 years) individuals and completed the International Index of Erectile Function (IIEF) and the Beck's Inventory for Depression (BDI).

MAIN OUTCOME MEASURES

The IIEF overall satisfaction and intercourse satisfaction domain scores and the BDI score were used to investigate sexual life satisfaction and depressive symptoms (defined as BDI > 11) across ages and according to ED severity. Linear and logistic regression analyses assessed the relationship between satisfaction scores and the risk of depressive symptoms with age and EF.

RESULTS

Median (interquartile range) age at first assessment for ED was 50 (38, 59) years. Compared with older men, young and middle-aged patients showed significantly higher IIEF-OS and IIEF- Intercourse Satisfaction scores for increasing IIEF-EF scores. Older men showed no difference in terms of satisfaction scores for mild ED and normal EF status. At linear regression analysis, both IIEF-EF and age were significantly associated with sexual satisfaction (all P < .0001). The interaction term between age and EF was also significant, suggesting that the older the patients, the higher the feeling of sexual satisfaction for the same EF status (P = .004). Overall, 25% of patients reported depressive symptoms. Logistic regression analysis showed a 40% risk of depressive symptoms for patients <45 years with severe ED compared to a risk <20% for a man >65 years of age with the same EF status.

CLINICAL IMPLICATIONS

Treating older patients with mild ED may not lead to a further improvement in sexual satisfaction as compared with younger patients with the same ED severity. Younger ED patients suffer more from depressive symptoms compared with older men, regardless of ED severity, thus supporting the need for a comprehensive psychological counseling.

STRENGTH & LIMITATIONS

The single-center design and the lack of the assessment of the impact of ED treatment are the main limits.

CONCLUSIONS

The clinical management of ED should be tailored according to different ages: younger patients deserve to be investigated and eventually treated for depressive symptoms. Older patients should be counseled for treatment when a sexual satisfaction improvement is expected. Capogrosso P, Ventimiglia E, Boeri L, et al. Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages? J Sex Med 2019;16:999-1004.

Associations of Impaired Renal Function With Declines in Muscle Strength and Muscle Function in Older Men: Findings From the CHAMP Study

Background

Advanced kidney disease is associated with reduced muscle strength and physical performance. However, associations between early stages of renal impairment and physical outcomes are unclear.

Methods

The Concord Health and Ageing in Men Project is a prospective study of 1,705 community-dwelling men aged 70 years and older. Participants with estimated glomerular filtration rate (eGFR) more than 30 mL/min/1.73 m2 were included and further divided into four eGFR categories. Physical parameters including grip strength, gait speed, appendicular lean mass (ALM, a sum of skeletal mass of arms and legs), ALM adjusted for body mass index (ALMBMI), and muscle function (measured using grip strength divided by arm lean mass) were assessed at both baseline and 5-year follow-up. Associations between kidney function and changes in physical parameters were analyzed using linear and logistic regression models.

Results

Our study included 789 men with a median age of 75 years and median eGFR of 72 mL/min/1.73 m2 at baseline. Over 5 years, grip strength, gait speed, ALMBMI, and muscle function all declined in the whole cohort, compared with baseline. The multivariable analyses showed that poorer renal function was associated with more rapid declines in grip strength, gait speed, and muscle function in participants with mild-to-moderate renal impairment (GFR category stage G3, eGFR < 60 mL/min/1.73 m2) (p = .01, p < .01, p = .02, respectively) but less so in those with eGFR more than 60 mL/min/1.73 m2, whereas eGFR category did not have a significant impact on declines in ALMBMI. These results remained unchanged with or without adjustment for age.

Conclusions

In community-dwelling older men, mild-to-moderate renal impairment at baseline was associated with declines in grip strength, gait speed, and muscle function over time despite preservation of muscle mass.

Informing health promotion in rural men's sheds by examination of participant health status, concerns, interests, knowledge and behaviours

Issue addressed Despite the growth of Australian men's sheds, the body of evidence regarding the health status of members, their health concerns, interests, help- or health-seeking behaviour and their preferred format for receiving health information is limited. Methods The study involved a cross-sectional study design with data collected from 11 rural South Australian (SA) men's sheds. The survey collected information across 5 domains: demographics; health history, status, concerns and interests; health knowledge; help-seeking behaviours and health information format preferences. Results Data from 154 shed members were available for analysis. Rural SA sheds primarily cater for older, retired, lesser educated men from lower socioeconomic strata. The key health issues were age-related chronic conditions yet self-reported health status remained high. The GP was the preferred source of health advice. Key knowledge deficits were in the areas of reproductive and psychological health. The preferred mode for health education was hands-on or kinaesthetic approaches as opposed to seminars or internet based information. Conclusions Priority topics for health promotion programs should include prostate disorders, reproductive and sexual health issues, psychological health, risk factors for common chronic disease and bowel cancer. Programs should incorporate hands-on education approaches. Shed and shed member diversity should be considered when designing programs. So what? A better understanding of what ails men's shed members, what concerns and interests them in terms of health, where they go for health advice and their preferred format for receiving health information increases the likelihood of developing health promotion programs that better engage with this target group.

Temporal associations between sexual function and cognitive function in community-dwelling older men: the Concord Health and Ageing in Men Project

Background

previous cross-sectional studies have reported bidirectional associations between sexual activity and cognitive function among older people. However, the temporal associations have not been studied.

Methods

community-dwelling men aged 70+ from the Concord Health and Ageing in Men Project were assessed. This study was based on 986 men at baseline, 829 men at 2 year and 595 men at 5-year follow-up. Sexual function using a standardised questionnaire (erectile function, sexual activity, sexual satisfaction, sexual desire) was analysed by generalised estimating equations to examine associations between changes in sexual function and changes in mini-mental state examination (MMSE) across three time points over 5 years. Age, BMI, comorbidity, self-rated health, smoking, number of medications, country of birth, education, marital status, depression and reproductive hormones were also measured at all time points.

Results

in unadjusted models, declines in erectile function (β = -0.317) and sexual activity (β = -0.575) over time were statistically significantly associated with a decline in MMSE over time. The associations observed in the unadjusted models remained after adjusting for a range of covariables. Declines in sexual satisfaction and sexual desire over time were not associated with changes in MMSE.

Conclusions

our findings provide evidence of a longitudinal temporal relationship between sexual activity and cognitive function. Further studies are warranted to examine whether maintaining a healthy sexual life has a positive effect on cognitive function in older men.

Coaching to support men in making informed choices about prostate cancer screening: A qualitative study

OBJECTIVE

The objective of this study was to examine the perceptions of men, practice nurses (PNs) and general practitioners (GPs) on patient decision coaching for prostate cancer screening.

METHODS

Seven focus groups were conducted with 47 participants, representing three stakeholder groups - men, GPs and PNs. All focus group discussions were conducted by the same facilitator and guided by a semi-structured interview schedule. Transcriptions were analysed by thematic analysis.

RESULTS

Knowledge about the merits of prostate cancer screening was high amongst GPs, but limited with PNs and men. All groups saw the value in PN-led decision coaching for men considering screening for prostate cancer, but had reservations about its implementation in practice. Barriers to implementing a decision coaching system with PNs included staffing and cost of implementation.

CONCLUSION

GPs, PNs and men identified benefits for the use of a PN-led decision coaching support intervention to assist men with making an informed choice about screening for prostate cancer. Stakeholders had reservations about how a PN-led intervention would effectively work in clinical practice.

PRACTICE IMPLICATIONS

A feasibility study is required to examine barriers and enablers to implementing a PN-led decision coaching process for prostate cancer screening in the Australian primary healthcare setting.

Qilin pills alleviate oligoasthenospermia by inhibiting Bax-caspase-9 apoptosis pathway in the testes of model rats

At present, the treatment of oligoasthenospermia with western medicine is ineffective. Qilin pill (QLP) is a Chinese traditional medicine for treating male infertility. Recent multicenter clinical studies in China reported that QLPs markedly improved sperm quality. However, the mechanism of action of QLPs on oligoasthenospermia remains unknown. In this study, we investigated the mechanistic basis for improvement of semen parameters and reversal of testis damage by QLPs in a rat model of oligoasthenospermia induced by treatment with tripterygium glycosides (TGs) (40 mg/kg) once daily for 4 weeks. Rats were administered QLPs (1.62 g/kg or 3.24 g/kg) each day for 60 days, with untreated animals serving as controls. The concentration and motility of sperm extracted from rat epididymis were determined, whereas histopathological examination and immunohistochemical apoptosis analysis of rat testes was performed. Expression profiles of apoptosis-related genes were determined by microarray analysis; the results were validated by quantitative real-time PCR, western blotting, and immunohistochemistry. Sperm concentration and motility in the QLP treatment group were increased relative to those in control rats. Testis tissue and DNA damage were reversed by QLP treatment. The improvement function of QLPs on sperm and testis works mainly by suppressing mitochondrial apoptosis in the testis via modulation of B cell lymphoma (Bcl)-2, Bcl-2-associated X protein (Bax), cytochrome C, caspase-9 and caspase-3 expression. QLPs could improve sperm quality and testis damage in a rat model of oligoasthenospermia by inhibiting the Bax-Caspase-9 apoptosis pathway and exerting therapeutic effects.

Factors associated with prostate specific antigen testing in Australians: Analysis of the New South Wales 45 and Up Study

Australia has one of the highest incidence rates of prostate cancer (PC) worldwide, due in part to widespread prostate specific antigen (PSA) testing. We aimed to identify factors associated with PSA testing in Australian men without a diagnosis of prostate cancer or prior prostate disease. Participants were men joining the 45 and Up Study in 2006–2009, aged ≥45 years at recruitment. Self-completed questionnaires were linked to cancer registrations, hospitalisations, health services data and deaths. Men with a history of PC, radical prostatectomy or a “monitoring” PSA test for prostate disease were excluded. We identified Medicare reimbursed PSA tests during 2012–2014. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) for the association between having PSA tests and factors of interest. Of the 62,765 eligible men, 51.8% had at least one screening PSA test during 2012–2014. Factors strongly associated with having a PSA test included having 27+ general practitioner consultations (versus 3–9 consultations; OR = 2.00; 95%CI = 1.90–2.11), benign prostatic hyperplasia treatment (versus none; OR = 1.59(95%CI = 1.49–1.70), aged 60–69 years (versus 50–59 years; OR = 1.54; 95%CI = 1.48–1.60). These results emphasise the important role of primary care in decision making about PSA testing.

Male Sexual Quality Of Life Is Maintained Satisfactorily Throughout Life In The Amazon Rainforest

INTRODUCTION

The Amazon Rainforest is a cradle of biodiversity, where different ethnic groups have specific sexual habits.

AIMS

To define the average sexual quality of life of Amazonian men 18 to 69 years old, evaluate the influence of aging on their sexual function, and calculate the prevalence of premature ejaculation, delayed ejaculation, and hypoactive sexual desire disorder.

METHODS

A cross-sectional quantitative probability sample study was performed with a demographically representative population (N = 385), with data collected privately at participants' houses, including men who had been sexually active for a minimum of 6 months. The Male Sexual Quotient (MSQ) was used to measure sexual satisfaction and function. Statistical analysis was performed with SPSS 21.0 using the Kruskal-Wallis test (P < .05), and a multiple linear regression analysis was performed to investigate which factors could predict participants' quality of sexual life.

MAIN OUTCOME MEASURES

MSQ scores.

RESULTS

The response rate was 81.69%. The mean age was 36.00 ± 12.95 years, and most men had mixed ethnicity (63.11%), were self-employed (42.07%), had a monthly earned income of US$0 to US$460 (46.75%), and were single (36.10%). The mean MSQ score was 80.39 ± 12.14 (highly satisfied). None of the demographic characteristics showed a statistically significant influence on sexual satisfaction. The difference in quality of sexual life was statistically significant compared with age (P < .01). The domains of desire (P < .01), partner satisfaction (P = .04), and erection quality (P < .01, P = .03, P = .02) were statistically significant. Prevalences of sexual dysfunctions were 36.54% for premature ejaculation, 6.5% for delayed ejaculation, and 11.69% for hypoactive sexual desire disorder.

CONCLUSIONS

Independent of age, these men have an excellent quality of sexual life. Sexual domains such as desire, partner satisfaction, and erection quality are related to the correlation between sexual quality of life and aging. However, the prevalence of premature ejaculation seems to be slightly higher than in other parts of the world. Teixeira T, Nazima M, Hallak J. Male Sexual Quality Of Life Is Maintained Satisfactorily Throughout Life In The Amazon Rainforest. Sex Med 2018;6:90-96.

Primary goals, information-giving and men's understanding: a qualitative study of Australian and UK doctors' varied communication about PSA screening

OBJECTIVES

(1) To characterise variation in general practitioners' (GPs') accounts of communicating with men about prostate cancer screening using the prostate-specific antigen (PSA) test, (2) to characterise GPs' reasons for communicating as they do and (3) to explain why and under what conditions GP communication approaches vary.

STUDY DESIGN AND SETTING

A grounded theory study. We interviewed 69 GPs consulting in primary care practices in Australia (n=40) and the UK (n=29).

RESULTS

GPs explained their communication practices in relation to their primary goals. In Australia, three different communication goals were reported: to encourage asymptomatic men to either have a PSA test, or not test, or alternatively, to support men to make their own decision. As well as having different primary goals, GPs aimed to provide different information (from comprehensive to strongly filtered) and to support men to develop different kinds of understanding, from population-level to 'gist' understanding. Taking into account these three dimensions (goals, information, understanding) and building on Entwistle et al's Consider an Offer framework, we derived four overarching approaches to communication: Be screened, Do not be screened, Analyse and choose, and As you wish. We also describe ways in which situational and relational factors influenced GPs' preferred communication approach.

CONCLUSION

GPs' reported approach to communicating about prostate cancer screening varies according to three dimensions-their primary goal, information provision preference and understanding sought-and in response to specific practice situations. If GP communication about PSA screening is to become more standardised in Australia, it is likely that each of these dimensions will require attention in policy and practice support interventions.

Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40-70 Years

BACKGROUND

Sexual function declines with age and erectile dysfunction (ED) is a common condition worldwide; however, prevalence rates vary markedly between populations and reliable data specific to New Zealand (NZ) are lacking.

AIM

To assess the prevalence of ED in NZ men using a population-based cross-sectional survey.

METHODS

Postal questionnaires were sent, according to a modified Dillman method, to a randomly selected age-stratified population-based sample of 2,000 men 40 to 70 years old obtained from the electoral roll. Self-reported erectile function was assessed using the five-item International Index of Erectile Function (IIEF-5) and the single-question self-assessment tool.

OUTCOMES

The prevalence of ED is presented as crude, age-adjusted to the distribution of the NZ population, and standardized to the World Health Organization World Standard Population (WSP). Associations between sexual function and age were analyzed using χ² test.

RESULTS

The response rate was 30% (599) and 28% (562) were complete for analysis. The crude prevalence of ED was 42% (22% mild, 10% mild to moderate, 6% moderate, and 4% severe), the age-adjusted prevalence was 38%, and the WSP-adjusted prevalence was 37%. Among men reporting ED, 16% were medically diagnosed and 22% were treated. ED affected 24% of men in their 40s, 38% in their 50s, and 60% in their 60s (P < .001). Age was associated with a significant increase in diagnosed ED (P = .001), treated ED (P = .006), dissatisfaction with current sexual function (P < .001), associated anxiety or depression (P = .023), and a decrease in sexual activity (P < .001).

CLINICAL TRANSLATION

Approximately one in three NZ men 40 to 70 years old might have ED. Although comparable to overseas populations, this prevalence is high.

STRENGTHS AND LIMITATIONS

This study provides the most reliable, comprehensive, and current information on ED and its risk factors in NZ men. Strengths include the large sample, the use of random selection from a population-based sampling frame, established effective survey methods, and the validated IIEF-5. Limitations include the inability of cross-sectional data to determine causation, non-sampling errors associated with the population-based sampling frame, the low response rate, the inability to assess non-respondents, the possibility of men with ED who were sexually inactive not responding or not completing the IIEF-5, and the inherent inability to rule out recall bias.

CONCLUSION

ED is a marker of subclinical cardiovascular disease. The high prevalence and low levels of diagnosis and treatment indicate a lost opportunity for timely intervention to delay or prevent the progression toward clinical disease. Quilter M, Hodges L, von Hurst P, et al. Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40-70 Years. J Sex Med 2017;14:928-936.

Total Physical Activity, Exercise Intensity, and Walking Speed as Predictors of All-Cause and Cause-Specific Mortality Over 7 Years in Older Men: The Concord Health and Aging in Men Project

OBJECTIVE

The study aimed to examine the contemporaneous temporal association between changes in total physical activity, sports intensity, muscle strengthening exercise, and walking speed as predictors of all-cause, cardiovascular, cancer and other cause-specific mortality in older men.

DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS

Community-dwelling men aged 70 years and older from Concord Health and Aging in Men Project were assessed at baseline (2005-2007, n = 1705), 2 years (n = 1367), and 5 years follow-up (n = 958). At all time points, Physical Activity Scale for the Elderly questionnaire, walking speed over a 6-m walk, and potential confounders were assessed. Mortality was ascertained through the state death registry with a median follow-up of 7 years.

RESULTS

As the Physical Activity Scale for the Elderly score increased by 1 standard deviation over the follow-up period, the relative risk (RR) for mortality was 0.78 [95% confidence interval (CI) 0.69-0.88] for all-cause, 0.66 (95% CI 0.55-0.79) for cardiovascular and 0.75 (95% CI 0.61-0.94) for other cause-specific mortality, but no association was observed in cancer mortality. The RR for undertaking strenuous sports during follow-up was 0.44 (95% CI 0.26-0.72) for all-cause mortality and 0.31 (95% CI 0.13-0.70) for cancer mortality when compared with no sports participation. Increases in walking speed per standard deviation over time were also associated with a decrease in all-cause mortality (RR 0.69, 95% CI 0.61-0.78), with similar associations for cardiovascular (RR 0.60, 95% CI 0.48-0.74), but not cancer mortality.

CONCLUSIONS

Older men who engage in strenuous sports and those who increase their walking speed over time may have lower risk of all-cause and some cause-specific mortality.

Sexual Function and Mortality in Older Men: The Concord Health and Ageing in Men Project

Background

The longitudinal association between progressive temporal change in sexual (dys)function and mortality in older men.

Methods

Community-dwelling men aged 70 years and older from the Concord Health and Ageing in Men Project were assessed at baseline (2005-2007, n = 1,705), 2-years follow-up (n = 1,367), and 5-years follow-up (n = 958). Self-reported sexual function (erectile function and sexual activity) using standardized questions were analyzed by generalized estimating equations to examine the longitudinal prediction of mortality according to change in sexual function across three time-points.

Results

Men reported to have erectile dysfunction increased from 64% to 80%, and to be sexually inactive increased from 56% to 59% over the course follow-up. In univariate analyses, erectile dysfunction (hazard ratio: 2.02, 95% confidence interval [CI]: 1.45-2.81) or having no sexual activity (hazard ratio: 2.31, 95% CI: 1.82-2.93) at baseline predicted increased mortality over the subsequent 7 years. Models adjusted for multivariate and major reproductive hormones had negligible impact on mortality prediction, but neither statistically significantly predicted mortality after adjusting for depression. Similarly, change in erectile dysfunction over time was associated with mortality over 7 years in univariate (odds ratio: 1.69, 95% CI: 1.34-2.14) and multivariate analysis, including hormones, but not after adjusting for depression (odds ratio: 1.24, 95% CI: 0.95-1.62). Change in sexual activity was associated with mortality over 7 years in univariate analysis (odds ratio: 2.37, 95% CI: 1.33-4.20) but not after adjusting for age (odds ratio: 1.45, 95% CI: 0.79-2.64).

Conclusions

Our analyses suggest sexual dysfunction was not an independent risk factor of, but rather may be a biomarker for, all-cause mortality in older men.

Aging and sexual health: getting to the problem

Erectile dysfunction (ED) is one of the most common disorders in male and is often associated with other age-related comorbidities. The aging process affects the structural organization and function of penile erectile components such as smooth muscle cell and vascular architecture. These modifications affect penile hemodynamics by impairing cavernosal smooth muscle cell relaxation, reducing penile elasticity, compliance and promoting fibrosis. This review aims to identify the mechanisms of ED in the penile aging process in experimental and clinical data. It also highlights areas that are in need of more research. The search strategies yielded total records screened from PubMed. Clarification of the molecular mechanisms that accompanies corpus cavernosum aging and aging-associated ED will aid new perspectives in the development of novel mechanism-based therapeutic approaches. Age is not a limiting factor for ED medical management, and it is never too late to treat. Hypogonadism should be managed regardless of age, and synergistic effects have been found during testosterone (T) replacement therapy when used along with oral phosphodiesterase-5 (PDE-5) inhibitors. Therefore, the clinical management of ED related to aging can be done by therapeutic interventions that include PDE-5 inhibitors, and other pharmacological treatments.

Mitochondrial DNA sequencing and large-scale genotyping identifies MT-ND4 gene mutation m.11696G>A associated with idiopathic oligoasthenospermia

Genetic variants of mitochondrial DNA (mtDNA) were implicated to be associated with male infertility. Our previous whole mitochondrial genome sequencing and association study has identified two susceptibility mtDNA variants for oligoasthenospermia in Han Chinese men. In this study, we tested promising associations in an extended validation using 670 idiopathic oligoasthenospermia cases and 793 healthy controls to identify additional risk variants. We found that the genetic variant of m.11696G>A showed significantly higher frequency in the case group than that in the control group (odds ratio (OR) 2.21, 95% CI 1.21-4.04) (P=7.90×10⁻³). To elucidate the exact role of the genetic variants in spermatogenesis, two main sperm parameters (sperm count and motility) were taken into account. We found that m.11696G>A was associated with low sperm motility, with the OR of 2.38 (95 % CI 1.27-4.46) (P =5.22×10⁻³). These results advance our understanding of the genetic susceptibility to oligoasthenospermia and more functional studies are needed to provide insights into its pathogenic mechanism.

Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: The Concord Health and Ageing in Men Project

Background

to explore the longitudinal associations between body composition measures, sarcopenic obesity and outcomes of frailty, activities of daily living (ADL) and instrumental ADL (IADL) disability, institutionalisation and mortality.

Methods

men aged ≥ 70 years (2005-07) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 (n = 1,366) and 5 years (n = 954). The main outcome measures were frailty (adapted Fried criteria), ADL, including personal care and mobility and IADL disability (ability to perform tasks for independent living), institutionalisation and mortality. The Foundation for the National Institutes of Health cut-points were used for low muscle mass: appendicular lean mass (ALM):Body Mass Index (BMI) ratio (ALMBMI) <0.789 and obesity was defined as >30% fat. Generalised estimating equations were used to examine the longitudinal associations between the independent variables (obesity alone, low muscle mass and sarcopenic obesity) and frailty, ADL and IADL disability.

Results

in unadjusted, age adjusted and fully adjusted analysis, men with low muscle mass showed increased risk of frailty and IADL disability. In fully adjusted analysis, men with sarcopenic obesity had an increased risk of frailty (odds ratio (OR): 2.00 (95% confidence of interval (CI): 1.42, 2.82)) ADL disability (OR: 1.58 (95% CI: 1.12, 2.24)) and IADL disability (OR: 1.36 (95% CI: 1.05, 1.76)). Obesity alone was protective for institutionalisation (OR: 0.51 (95% CI: 0.31, 0.84)) but was not associated with any other outcomes.

Conclusions

low muscle mass and sarcopenic obesity were associated with poor functional outcomes, independent of confounders. This would suggest that future trials on frailty and disability prevention should be designed to intervene on both muscle mass and fat mass.