Alicja Szklarska

Anabolic Deficiency in Men With Chronic Heart Failure: Prevalence and Detrimental Impact on Survival

Background— The age-related decline of circulating anabolic hormones in men is associated with increased morbidity and mortality. We studied the prevalence and prognostic consequences of deficiencies in circulating total testosterone (TT) and free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor-1 (IGF-1) in men with chronic heart failure (CHF). Methods and Results— Serum levels of TT, DHEAS, and IGF-1 were measured with immunoassays in 208 men with CHF (median age 63 years; median left ventricular ejection fraction 33%; New York Heart Association class I/II/III/IV, 19/102/70/17) and in 366 healthy men. Serum levels of free testosterone were estimated (eFT) from levels of TT and sex hormone binding globulin. Deficiencies in DHEAS, TT, eFT, and IGF-1, defined as serum levels at or below the 10th percentile of healthy peers, were seen across all age categories in men with CHF. DHEAS, TT, and eFT were inversely related to New York Heart Association class irrespective of cause (all P<0.01). DHEAS correlated positively with left ventricular ejection fraction and inversely with N-terminal pro-brain natriuretic peptide (both P<0.01). Circulating TT, eFT, DHEAS, and IGF-1 levels were prognostic markers in multivariable models when adjusted for established prognostic factors (all P<0.05). Men with CHF and normal levels of all anabolic hormones had the best 3-year survival rate (83%, 95% CI 67% to 98%) compared with those with deficiencies in 1 (74% survival rate, 95% CI 65% to 84%), 2 (55% survival rate, 95% CI 45% to 66%), or all 3 (27% survival rate, 95% CI 5% to 49%) anabolic endocrine axes (P<0.0001). Conclusions— In male CHF patients, anabolic hormone depletion is common, and a deficiency of each anabolic hormone is an independent marker of poor prognosis. Deficiency of >1 anabolic hormone identifies groups with a higher mortality.

Changing patterns of social variation in stature in Poland: effects of transition from a command economy to the free-market system?

The aim of this analysis was to examine the effects on stature in two nationally representative samples of Polish 19-year-old conscripts of maternal and paternal education level, and of degree of urbanization, before and after the economic transition of 1990. Data were from two national surveys of 19-year-old Polish conscripts: 27,236 in 1986 and 28,151 in 2001. In addition to taking height measurements, each subject was asked about the socioeconomic background of their families, including paternal and maternal education, and the name of the locality of residence. The net effect of each of these social factors on stature was determined using four-factor analysis of variance. The secular trend towards increased stature of Polish conscripts has slowed down from a rate 2.1 cm per decade across the period 1965-1986 to 1.5 cm per decade between 1986 and 2001. In both cohorts, mean statures increase with increasing size of locality of residence, paternal education and maternal education. The effect of each of these three social factors on conscript height is highly significant in both cohorts. However, the effect of maternal education has increased substantially while that of size of locality of residence and paternal education diminished between 1986 and 2001. These results imply that the influence of parental education on child growth cannot be due solely to a relationship between education and income, but is also perhaps a reflection of household financial management which benefits child health and growth by better educated parents, regardless of level of income. In addition they suggest that, irrespective of whether there are one or two breadwinners in the family, it is the mother, more so than the father, who is principally responsible for the extent to which such management best favours child health and growth. The asymmetry between the importance of maternal as against paternal education for child growth, clearly seen in the 1986 cohort, became more accentuated in 2001, after the abrupt transition from a command to a free-market economy in the early 1990s.

Deficiencies in circulating testosterone and dehydroepiandrosterone sulphate, and depression in men with systolic chronic heart failure

Elderly men with androgen deficiencies are prone to develop late‐onset depression. We investigated links between circulating androgens and depression, and their combined impact on outcome in men with chronic heart failure (CHF).

Changes in the BMI of Polish conscripts between 1965 and 2001: secular and socio-occupational variation.

Objective:To describe changes in the body mass index (BMI) of nationally representative samples of young adult Polish males between 1965 and 2001, and to investigate variation in the incidence of underweight, overweight and obesity between 1965 and 2001 in the young adult males in the context of the socio-political transformation that occurred in Poland since 1989.Subjects:Four 10% nationwide random samples of 29-year-old Polish conscripts examined in 1965, 1986, 1995 and 2001. The conscripts were divided into four socio-occupational groups based on paternal education, occupation and degree of urbanization.Measurements:Height, weight and BMI (weight (kg)/height (m2)).Results:The proportion of overweight and underweight young adult males in the population increased between 1965 and 2001. The fraction of underweight decreased only among sons of farmers and entrepreneurs between 1986 and 1995 and then increased in all socio-occupational groups between 1995 and 2001. On the other hand, the proportion of overweight young adults gradually increased in all groups between 1965 and 2001.Conclusion:Socio-occupational position of the family is an important factor influencing underweight and overweight in young adult males. This factor apparently operates through a differential distribution of income, which influences components of lifestyle most likely associated with level of habitual physical activity and/or diet.

The effects of fatness and fat distribution on respiratory functions

Background: Inverse relationships between respiratory function and indices of obesity and fat distribution have been reported, but it remains unclear which measure of obesity shows the strongest relationship with lung function. Aim: The study assessed the effect of fatness and fat distribution on respiratory function. Subjects and methods: A sample of 423 males and 509 females aged 40–50 years were examined in the Silesian Centre for Preventive Medicine, DOLMED, in Wrocław in 1995. The strength of influence of height, body mass index (BMI), wait-to-hip ratio (WHR) and abdominal and subscapular skinfolds upon forced vital capacity (FVC) and forced expiratory volume in a 1-s expiration (FEV1) was assessed by multiple regression analysis. Results: In males, FVC was strongly positively associated with height and BMI, but negatively associated with subscapular and abdominal skinfolds, WHR, and smoking. FEV1 showed a positive relationship with height, BMI and WHR. In females, both FVC and FEV1 showed significant positive associations with height, negative ones with subscapular skinfold, and no association with either WHR or abdominal skinfold. In males, respiratory function is affected to a similar extent by fat in the abdominal region and by fatness of the chest. In females, fatness of the thorax has the strongest relationship with respiratory function. Conclusion: Fatness tends to impair respiratory function in both sexes but these effects show a different pattern in males and females. In males, respiratory functions are significantly, and to a similar extant, affected by fatness in the abdominal region, both subcutaneous and visceral, and by fatness on the chest. In females, it is primarily subcutaneous fat on the upper thorax that affects respiratory functions, while visceral and subcutaneous abdominal fatness play little or no role.

Independent effects of social position and parity on body mass index among polish adult women

This study evaluated the strength of the independent effects of social position (expressed by educational level) and number of childbirths on body mass index (BMI) variation of Polish adult females. The material comprised 2045 pre-menopausal women aged 35-50, who were healthy and occupationally active inhabitants of the city of Wrocław, Lower Silesia, Poland. Two-way analysis of variance (ANOVA) revealed that both educational level (F = 34.7; p = 0.0001) and parity (F = 5.6; p = 0.001) exerted independent significant effects on BMI. The mean BMI of women who had attended basic vocational or trade school at the very most (27.0 kg/m2) was greater than that of women who had completed secondary school education or had graduated from university (25.3 kg/m2). However, it is worthy of note that there were no social differences in BMI values between childless women. Nevertheless, an increasing number of childbirths was essentially related to increasing female BMI in each social group, and this tendency was most marked among women of lower social position. Regardless of educational level, the highest prevalence of obesity (BMI exceeding 30 kg/m2) was found among females with at least three children (15.6%, and 26.4% of women from higher or lower social groups, respectively).

The negative health consequences of unemployment: The case of Poland

In the 1990s Poland began to make a transition to a free-market economy: a transition accompanied by a variety of negative socio-economic developments, most notably a rise in unemployment. The aim of this study is to shed light on the relationship between occupational status (including unemployment) and the risk of cardiovascular disease (CVD), by examining the experience of 542 men and 572 women between the ages of 40 and 50 of the town of Wroclaw in 2006. The Framingham Risk Score (FRS), which uses certain health and life-style parameters to predict the risk of major coronary problems over a 10-year period, was calculated, and the effect of occupational status on the FRS was assessed. The results showed that the FRS varied according to sex and to occupational status, with the highest FRS rating among unemployed men. Thus governmental policies to counter the adverse effects of unemployment should be developed to remedy the problem.

Variation in the body mass index among young adult Polish males between 1965 and 1995.

OBJECTIVE: To investigate whether the incidence of overweight and underweight individuals among young adults showed inter-generation changes or social-class differences in Poland between the mid-1960s and mid-1990s.DESIGN: Comparisons of variation in the body mass index and in height among 19-y-old Polish males drawn from three successive birth cohorts.SUBJECTS: Three 10% nation wide random samples of 19-y-old Polish conscripts, examined in 1965, 1986 and 1995, a total of ca. 80,000 individuals.MEASUREMENTS: Body mass index (weight (kg)/height (m2) and height (m).PRINCIPAL RESULT: There has been during the three decades between the mid-1960s and mid-1990s a gradual and significant increase in the proportion of both ‘overweight’ and of ‘underweight’ young males, as well as of the very tall and very short ones in the population.CONCLUSION: The above finding seems intriguing. It may suggest that certain elements of individual lifestyles, those influencing the leanness vs fatness variation among young adults, as well as those affecting growth in height, have tended to become in Poland increasingly diversified in terms of between-family differences, irrespective of social-class differeces and of the general nationwide changes in living standards.

The stratifying force of family size, urbanization and parental education in socialist-era Poland

The strength of influence upon statural variation of: (1) the degree of urbanization of the locality of habitat, (2) family size, (3) paternal and (4) maternal educational status was analysed in three generations of 19-year-old Polish conscripts, examined in 1965, 1986 and 1995. Each of the above factors of an individuals social situation was described by a 4-level scale. Each factor was found to exert a highly significant residual effect on stature throughout the three decades considered, even after the effects of other correlated factors were partialed out by three-factor ANOVA. However, the stratifying force of each factor, as expressed by the dispersal of the level-specific main effects around the national mean, has been changing over time. For example, the growth-stunting effect of the condition of coming from a large sibship was dramatic in the 1965 cohort and considerably attenuated in 1986 but ceased to diminish thereafter. The growth-enhancing effect of the condition of being a large-city dweller, initially marked, has almost disappeared; but the growth-stunting effect of the condition of being a rural dweller has remained equally strong across all cohorts. These and other shifts in the relative importance of the social factors, as presumed determinants of family living standards, are described and some explanations attempted.

ALLOSTATIC LOAD AND SOCIOECONOMIC STATUS IN POLISH ADULT MEN

This study considers the relationship between a cumulative index of biological dysregulation (allostatic load) and several dimensions of socioeconomic status (SES) and lifestyle in adult Polish males. The extent to which lifestyle variables can explain SES variation in allostatic load was also evaluated. Participants were 3887 occupationally active men aged 25-60 years living in cities and villages in the Silesia region of Poland. The allostatic load indicator included eleven markers: % fat (adverse nutritional intake), systolic and diastolic blood pressures (cardiovascular activity), FEV1 (lung function), erythrocyte sedimentation rate (inflammatory processes), glucose and total cholesterol (cardiovascular disease risk), total plasma protein (stress-haemoconcentration), bilirubin, creatinine clearance and alkaline phosphatase activity (hepatic and renal functions). A higher level of completed education, being married and residing in an urban area were associated with lower physiological dysregulation. The association between indicators of SES and allostatic load was not eliminated or attenuated when unhealthy lifestyle variables were included in the model. Smoking status and alcohol consumption played minimal roles in explaining the association between SES and allostatic load; physical activity, however, had a generally protective effect on allostatic load.