Hoskote S. Nagraj

Effects of Human Growth Hormone in Men over 60 Years Old

BACKGROUND The declining activity of the growth hormone--insulin-like growth factor I (IGF-I) axis with advancing age may contribute to the decrease in lean body mass and the increase in mass of adipose tissue that occur with aging. METHODS To test this hypothesis, we studied 21 healthy men from 61 to 81 years old who had plasma IGF-I concentrations of less than 350 U per liter during a six-month base-line period and a six-month treatment period that followed. During the treatment period, 12 men (group 1) received approximately 0.03 mg of biosynthetic human growth hormone per kilogram of body weight subcutaneously three times a week, and 9 men (group 2) received no treatment. Plasma IGF-I levels were measured monthly. At the end of each period we measured lean body mass, the mass of adipose tissue, skin thickness (epidermis plus dermis), and bone density at nine skeletal sites. RESULTS In group 1, the mean plasma IGF-I level rose into the youthful range of 500 to 1500 U per liter during treatment, whereas in group 2 it remained below 350 U per liter. The administration of human growth hormone for six months in group 1 was accompanied by an 8.8 percent increase in lean body mass, a 14.4 percent decrease in adipose-tissue mass, and a 1.6 percent increase in average lumbar vertebral bone density (P less than 0.05 in each instance). Skin thickness increased 7.1 percent (P = 0.07). There was no significant change in the bone density of the radius or proximal femur. In group 2 there was no significant change in lean body mass, the mass of adipose tissue, skin thickness, or bone density during treatment. CONCLUSIONS Diminished secretion of growth hormone is responsible in part for the decrease of lean body mass, the expansion of adipose-tissue mass, and the thinning of the skin that occur in old age.

Prognostic significance of serum cholesterol in nursing home men

Serum cholesterol was measured in 129 men (average age 70.6; range 41-96) of a Veterans Administration Nursing Home, and was correlated with other items in an extensive clinical data base. Serum cholesterol was less than 150 mg/dl in 13% of the subjects, and was less than 160 mg/dl in 18%. Cholesterol greater than 280 mg/dl occurred in 8%. Serum cholesterol varied directly (p less than 0.02) with: body weight, serum albumin, serum total protein, serum sodium, ability to walk, and ability to feed oneself; and indirectly (p less than 0.02) with death rate, degree of functional dependence, and serum SGOT and LDH. Nursing home men with cholesterol less than 150 mg/dl had a death rate of 63% during the 14 months after the cholesterol analysis, compared to a death rate of 9% in men with cholesterol greater than 150 mg/dl (p less than 0.05). Death rate during the year after the analysis was 52% if cholesterol was below 160 mg/dl, compared to 7% if it was above this threshold (p less than 0.05).

Antecedents of Death in the Men of a Veterans Administration Nursing Home

This study aims to learn whether the annual clinical and laboratory screening of nursing home residents provides significant information about their chance of dying during the following year.

Relation of Serum Albumin Concentration to Death Rate in Nursing Home Men

Serum albumin was measured in 126 men (average age 70.6; range 40 to 96) of a Veterans Administration Nursing Home, and was correlated with other items in an extensive clinical data base, including death or survival during the year after the analysis. The reason for institutionalization was chronic neurologic disease or other disabling physical condition in 63 men (group A), and psychiatric disorder in 63 men (group B). In group A, the proportions of men with albumin less than 3.5, 3.5-4.0, and greater than 4.0 g/dl were 6%, 37%, and 57%, respectively. In this group, the serum albumin level was significantly (p less than 0.05) correlated with death rate, hemoglobin, hematocrit, serum cholesterol, and serum lactic dehydrogenase. The death rate in group A during the year after the albumin analysis was 25%. For the patients with albumin level less than 3.5, 3.5-4.0, and greater than 4.0 g/dl, the death rates were 50%, 43%, and 11% respectively (p less than 0.01 for comparison of the former two groups with the latter). The subgroup with albumin 3.5-4.0 g/dl represented only 37% of the men in group A, but accounted for 63% of the groups deaths. In group B, serum albumin level was not significantly correlated with any other clinical variable. Death rate during the year after the albumin analysis was only 2% in group B, and did not correlate with the albumin level. These data indicate that, in nonpsychiatric Nursing Home men, the desirable level for the serum albumin concentration is higher than 3.5 g/dl.

PLASMA TESTOSTERONE IN NURSING HOME MEN

Plasma testosterone (T) was measured at 8-9 a.m. in 44 men chronically institutionalized in a Veterans Administration Nursing Home, and correlated with an extensive clinical data base (including age, diagnoses, drugs, laboratory tests, anthropometric measurements, and mortality during the year after the T analysis). Age averaged 76.4 years (range 60-95). Plasma T was below the lower limit of the normal range for healthy young men (i.e. less than 300 ng/dl) in 46% of the men studied. Samples containing low T (less than 300 ng/dl) also contained subnormal unbound T, but normal concentrations of thyroxine and cortisol. Of the low T samples, 45% contained elevated LH, FSH or both (over 20 mU/ml), and the remaining 55% contained LH and FSH levels below this threshold, these two subgroups representing peripheral and central hypogonadism respectively. Plasma T was significantly (p less than 0.02) correlated in a direct relationship with hemoglobin, serum cholesterol, and the occurrence of seizures.

Hyposomatomedinemia in the Nursing Home Patient

Plasma somatomedin C (SmC) concentration was compared in three groups of men: 58 healthy independent men aged 26 to 45 years; 28 independent men aged 52 to 87 years; and 50 male nursing home residents aged 51 to 95 years. Somatomedin C (mean ± SE) was 0.73 ± .04 U/mL, 0.41 ± .03 U/mL, and 0.33 ± .03 U/mL in these three groups, respectively (P < .05 for the differences between all three groups). Somatomedin C less than 0.25 U/mL, a range consistent with severe growth hormone deficiency in children, occurred in 0% of the independent younger men, in 15% of the independent elderly, and in 37% of the nursing home men. Somatomedin C was inversely correlated with age in the independent elderly, but the excess of hyposomatomedinemia in the nursing home men was not explained by age. J Am Geriatr Soc 34:427–430, 1986

Hyposomatomedinemia in the Men of a Veterans Administration Nursing Home: Prevalence and Correlates

A previous study found hyposomatomedinemia to be common in the men of this VA Nursing Home. To gain information on the prevalence and correlates of this endocrine characteristic, we have measured plasma somatomedin C (SmC) in 69 Nursing Home men 55-95 years old (group I), and in 37 independent men 56-87 years old attending our geriatric medicine outpatient clinic (group II). In groups I and II, a clinical data base was compiled comprising: blood chemistries, measures of body composition - nutritional state and functional level, diagnoses, medications, and morbidity and mortality during the year after the SmC analysis. The mean +/- SD for SmC was significantly (p less than 0.05) lower in group I (0.35 +/- 0.21 units/ml) than in group II (0.45 +/- 0.13 units/ml). SmC less than 0.25 units/ml, a range consistent with severe growth hormone deficiency, was found almost exclusively in group I (31.8% of men in group I, 3.7% of men in group II). In either group I, or in groups I and II combined, SmC was significantly (p less than 0.05) correlated with body weight as percentage of ideal, midarm muscle circumference (MAMC) as percent of standard, diagnosis of cerebrovascular disease, and plasma testosterone level. Men with SmC values below 0.25 units/ml had significantly (p less than 0.05) lower values for body weight as percentage of ideal, and for MAMC as percentage of standard. Except for cerebrovascular disease, SmC did not correlate significantly (p greater than 0.05) with diagnosis, drugs, morbidity or mortality.

Fractures in the men of a Veterans Administration Nursing Home: relation to 1,25-dihydroxyvitamin D.

One hundred fifty-three men, age 48-96, 86% white, had resided in this Nursing Home for an average of 6.3 years (range 1.3-36) as of August 1984. At that time, we reviewed their medical charts to record the numbers and sites of fractures which had been diagnosed during the preceding 1 to 5 years of Nursing Home residence, the duration of this period depending on the duration of institutionalization. In addition, a clinical database was compiled comprising 70 attributes, including diagnoses, drugs, plasma (serum) chemistries, and measures of hematologic, nutritional, and functional status. Fractures during the studied period of Nursing Home residence had occurred in 24 of 153 men; six residents had experienced two or more fractures. Fracture rates in hip, spine, and wrist were 2564, 366, and 549 per 100,000 patient years, respectively. The total fracture rate, hip fracture rate, and limb fracture rate were five to 11 times higher than in the age-matched general population of white men in the United States; in Rochester, MN; in Dundee, England; in Oxford, England; or in Finland. Univariate statistical analysis showed that the rates for hip fracture or for fracture at any site were significantly associated with 13 attributes: directly with age, plasma somatomedin C, blood urea N, serum creatinine, serum uric acid, serum 25-hydroxyvitamin D (25-OH-D), degree of functional impairment, and chronic urinary tract infection, and inversely with serum 1,25-dihydroxyvitamin D [1,25-(OH)2-D], serum albumin, hematocrit, and hemoglobin. There was not a significant correlation with the number of falls/month which occurred during the 7 months after August 1984. After the effect of age was partialed out, somatomedin C, 25-OH-D, 1,25-(OH)2-D, and the diagnosis of urinary tract infection were still significantly related to the occurrence of fractures. The fact that Nursing Home fracture cases had significantly higher blood urea nitrogen and 25-OH-D, and significantly lower 1,25-(OH)2-D, than their non-fracture counterparts suggests that impaired renal production of the latter vitamin D metabolite contributed to the excessive rate of fractures.