Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis

Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis Amar Osmancevic, Matthew Allison, Iva Miljkovic, Chantal A Vella, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3909259/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Information on the associations of testosterone levels with abdominal muscle volume and quality in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. To investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis. A community-based sample of 907 men aged 45–84 years; 878 men with complete data were included in the analysis. CT scans of the abdomen were interrogated for muscle characteristics. Multivariable linear regressions were used to test the associations. After adjustment, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.79, 0.1–3.4, & 1.79, 0.4–3.2, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0–0.6, & -0.34, -0.6 - -0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity. Health sciences/Endocrinology/Endocrine system and metabolic diseases/Obesity Health sciences/Endocrinology/Endocrine system and metabolic diseases/Endocrine reproductive disorders Biological sciences/Developmental biology/Ageing Health sciences/Anatomy/Musculoskeletal system/Muscle/Skeletal muscle Health sciences/Medical research/Epidemiology Figures Figure 1 INTRODUCTION Abdominal obesity is linked to a higher risk of cardiometabolic disorders and mortality. 1 However, recent evidence suggests the quality and quantity of abdominal muscles may also play an important role in cardiometabolic health. 2 In this regard, abdominal muscle radiodensity, measured in Hounsfield Units (HU), reflects the quality of muscle tissue and the degree of fat infiltration/fibrosis. 3 Of note, growing evidence suggests that abdominal muscle radiodensity is inversely associated with cardiovascular events and mortality in men. 2 Earlier studies showed testosterone induces muscle fiber hypertrophy and increases the number of myonuclear cells by regulation of protein synthesis, satellite cells and stem cell proliferation, in addition to stimulation of the myogenic lineage and inhibition of the adipogenic cell line by activating androgen receptors (ARs). 4 , 5 Moreover, in men with testosterone deficiency, replacement therapy improves muscle volume, strength and quality of life. 6 However, it is unknown whether testosterone has different effects on different abdominal muscle functional groups. In addition, the effects of estradiol on muscle characteristics in men are unclear. In this regard, Russel and Colleagues reported in their review, no clear effect of estradiol on muscle mass or strength in men. 7 Yet, other studies have shown that estradiol could play a key role in regulating abdominal adiposity but is also directly associated with the volume of lean mass in men and appears to prevent expansion of adiposity. , 7 – 9 While there is some evidence to suggest that both testosterone and estradiol play an important role in the regulation of muscle function and volume, the nature of this relationship is not yet well established. Given this, we examined the cross-sectional associations between sex hormones and abdominal muscle characteristics in a large multi-ethnic sample of middle-aged and older men and hypothesized that higher estradiol and testosterone levels would be associated with greater abdominal muscle area, while testosterone would also be associated with higher abdominal muscle radiodensity. RESULTS Baseline characteristics of the study population are presented in Table 1 . The mean age was 61.6 years. The majority of participants where non-Hispanic White (42 %), followed by Hispanic/Latino (27 %), African American (17 %) and Chinese American (14 %). On average, men were overweight with a mean BMI of 27.6 kg/m 2 . The participants reported an average of 12 hours a week of physical activity. Moreover, 42% of participants were hypertensive, 13 % stated active cigarette smoking, 15 % had diabetes mellitus, and 24% were taking a cholesterol-lowering medication. The mean total testosterone level was 15 nmol/L. Association between Sex Hormones and Abdominal Muscle Area Total testosterone was significantly associated with total abdominal muscle area in the first model (B=1.39, 95 % CI 0.0 - 2.8, p = 0.05), which was accentuated with further adjustment (Model 2: 1.81, 0.2 - 3.5, p = 0.03; Model 3: 1.79, 0.1 - 3.4 p < 0.01) ( Table 2 ). No significant associations were found between total testosterone and abdominal stabilizing muscle area ( Table 3 ), while the associations were significant in all models for abdominal locomotor muscle area ( Table 4 ). Levels of estradiol were significantly associated with total abdominal muscle area in all three models: Model 1 (2.14, 0.8 - 3.6, p < 0.01), Model 2 (1.97, 0.6 - 3.4, p < 0.01), Model 3 (1.79, 0.4 - 3.2, p = 0.01) with similar results for abdominal locomotor and abdominal stabilizing muscle area ( Table 3 and Table 4 ). No significant associations were found between levels of free testosteron e and total abdominal muscle areas ( Table 2 ), as well as stabilizing. However, significant associations were presented between free testosterone and locomotor area in model 1 & model 2(0.38, 0.0 – 0.7, p = 0.04, 0.37, 0.0 – 0.7, p = 0.04) with borderline significance in model 3 (0.37, -0.0, 0.7, p = 0.05), respectively ( Table 2, 3 & 4 ). Associations between Sex Hormones and Abdominal Muscle Radiodensities Total testosterone was significantly associated with total abdominal muscle radiodensity in Models 2 and 3, but not in Model 1 (Model 1: 0.04, -0.2 - 0.3, p = 0.79; Model 2; 0.32, 0.1 - 0.7, p = 0.04; Model 3: 0.3, 0.0 - 0.6, p = 0.04) ( Table 2 ). Similar results were found for radiodensity of stabilizing muscles ( Table 3 ), but not for locomotor muscle ( Table 4 ). No significant associations were found between free testosterone and abdominal muscle radiodensities in fully adjusted models ( Table 2, 3 & 4 ). No significant associations were found between levels of estradiol and total abdominal and stabilizing muscle radiodensity ( Table 2 & 3 ), but there was a borderline significant association between estradiol and abdominal locomotor muscle radiodensity ((Model 1: -0.27, -0.0 - 0.6, p = 0.09: Model 2: 0.28, -0.0 - 0.6, p = 0.07; Model 3: 0.26, - 0.0 - 0.6, p = 0.09) ( Table 4 ). Higher SHBG levels were associated with a lower radiodensity of abdominal muscle in all models (Model 1: -0.35, -0.6 - -0.1, p = 0.02: Model 2: -0.35, -0.6 - -0.1, p = 0.02; Model 3: -0.34, -0.6 - -0.1, p = 0.02) ( Table 2 ). The results were similar for abdominal stabilizing and locomotor muscles ( Table 3 ). Associations between Sex Hormones and Abdominal Muscle Area Indexes A significant association was found in all models for total testosterone and TAMAi (Model 1: B= 0.10, 0,0 - 0.2, p < 0.01, Model 2: 0.11, 0.1 - 0.2, p < 0.01, Model 3: 0.10, 0.1 - 0.2, p <0.01) ( Table 2 ). That is, in fully adjusted models, one SD increase in testosterone levels resulted with an increase of 0.10 cm 2 /(weight/height 2 ) in abdominal muscle area index. Similar relationships were observed between total testosteron e and abdominal locomotor and stabilizing muscle area indices ( Table 3 & 4 ). Estradiol was found to be significantly associated with total abdominal muscle index (TAMAi) in model 1 (B = 0.10, 0.0 - 0.1, p= 0.03), which was borderline significant in Models 2 and 3 (Model 2: 0.05, -0.0 - 0.1, p= 0.06, Model 3: 0.05, -0.0 - 0.1, p= 0.06). Significant associations were found for estradiol and abdominal locomotor muscle area index in all three models but not for abdominal stabilizing muscle area index ( Table 3 and 4 ). Significant associations were shown for free testosterone with total, stabilizing and abdominal muscle area index in fully adjusted models (0.08, 0.0, 0.1, p = 0.008, 0.05, 0.0 – 0.1, p = 0.03, 0.02, 0.0 - 0.04, p = 0.02), respectively. Inverse non-significant associations were found between levels of SHBG and abdominal muscle areas, and muscle area indexes in both model 2 and model 3. DISCUSSION Our study presents novel findings on the associations between sex hormones and SHBG and abdominal muscles in men. First, our results indicate that increases in serum levels of total testosterone and estradiol were associated with significant increases in abdominal muscle mass in men. In fact, our data indicate that the associations were stronger for estradiol than total testosterone with abdominal muscle mass to include both stabilizing and locomotor muscles. Second, significant associations were found between higher levels of total testosterone and abdominal muscle radiodensities. Third, our study presented a significant negative association between SHBG and abdominal muscle radiodensity. A significant association was found between total testosterone and total abdominal muscle area, with similar associations presented for abdominal locomotor muscle area but not for abdominal stabilizing muscle area. A plausible explanation of these differences might be that locomotor muscle contains a greater number of types II myofibers, a more dynamic and power related muscle type. 10 Type I myofibrils, which are predominantly found in the abdominal stabilizing muscles, have shown to be rather associated with endurance and higher lipid content. 10 – 12 Even though some studies have shown that supraphysiologic levels of testosterone increase both type I and II myofibers equally, other studies have reported testosterone affects maximal voluntary strength rather than endurance. 5 , 13 Free testosterone was positively associated with total abdominal muscle area and radiodensity although, significance was found for locomotor muscle area in model 1 and 2 with borderline significance in model 3. Total testosterone was positively associated with TAMAi, abdominal stabilizing and locomotor muscle area indexes. In concurrence with our findings, Han et al. reported similar outcomes presented between total testosterone and abdominal muscle area index in men. 14 However, no adjustments were made for SHBG. In our study, total testosterone was associated with increased total and stabilizing abdominal muscle radiodensities, independent of confounding factors. Our results suggest that total testosterone is significantly associated with the degree of radiodensity of abdominal muscles, including muscle size. Total testosterone mainly includes SHBG-bound testosterone which has long been assumed to be inactive. However, recent experimental studies have shown the endocytic Megalin receptor, found in human skeletal myocytes, transports SHBG-bound testosterone and estradiol into cells. 15 , 16 This could indicate total testosterone may have an active role in cell regulation and muscle activity. Our study found that higher levels of estradiol were significantly associated with higher levels of all abdominal muscle areas. Estradiol has earlier been found to play a key role in regulation of myokines, i.e., skeletal muscle proteins, with critical functions associated with exercise-related benefits and inflammation regulation in tissues. 17 Similarly, in a study on elderly Swedish men, estradiol, and not testosterone, was associated with lean mass measured with DEXA. 8 Estradiol was positively but non-significantly associated with total and stabilizing muscle radiodensities, while a borderline-significant association was shown with locomotor muscle radiodensity. This would be in concurrence with a study by Wiik et al., reporting higher concentrations of estradiol receptors in skeletal muscles of men engaged in greater endurance training. 18 Although the role of estradiol on skeletal muscle characteristics is unclear, one study in men reported that supplementation of estradiol increased lipid utilization in skeletal muscles, increasing strength. 19 The bioactive role of SHBG is still debated. An inverse association has been shown between SHBG levels and insulin resistance and metabolic syndrome. 48 Other studies have found a positive association between SHBG and inflammatory cytokines, low protein diet and hip fractures in elderly even after adjustment for sex hormones. 20 , 21 Our study showed an inverse association between SHBG and all abdominal muscle densities. Other results have reported an inverse relationship between SHBG and lean muscles measured by DEXA. 8 Furthermore, Yuki et al. reported SHBG levels were significantly higher in the group of individuals diagnosed with sarcopenia compared to the normal group. 22 In agreement with our findings, SHBG has been reported to have a significant inverse association with muscle strength in elderly men. 23 One plausible cause of the negative associations between SHBG and abdominal muscle radiodensities could be that an increase in SHBG concentrations may influence the binding capacity and magnitude of available free testosterone and could suggest a partial explanation to some of the weaker association found for other sex hormones . 24 This study has a number of strengths, including usage of data from a large and diverse cohort, detailed sampling of information with validated instruments as well as standardized sampling of blood specimens according to guidelines. 25 Furthermore, by assessing muscle composition with CT, we were able to estimate its quality. However, our study does have some limitations. First, radioimmunoassay technique (RIA) was used to measure sex hormones and SHBG. This has been described to be less precise than mass spectrometry in the measurement of sex-hormone levels. 26 Furthermore, levels of sex hormones may be affected by the presence of several cross-reacting steroids. 27 Second, free testosterone was calculated and not directly measured which has been shown to overestimate levels compared with laboratory measured free testosterone. 28 While the Sodergard method has previously been described as one of the most common methods for calculating free testosterone in endocrinology literature, it has limitations, including higher estimates compared to other algorithms and accurate mainly when competing steroids to binding sites are limited and normal levels of SHBG are involved. 29 Furthermore, the Sodergard method presents concordant results to the Vermuelen algorithm and its association constant was validated when compared to results of calculations with a gold standard technique. 29 Third, the sex hormones were measured at visit 1 whilst CT scans were made at visit 2 and visit 3. We partially addressed this limitation by adjusting for the time from baseline to CT scan as a confounder in model 2 and model 3. In addition, measurements of physical activity and sedentary behavior were self-reported. We only evaluated abdominal muscle area and radiodensity, and therefore, our findings may not be applicable to peripheral muscles. Finally, this study design was observational and cross-sectional, which is prone to residual confounding, as well as temporal and selection biases. CONCLUSION In this analysis, we demonstrate a positive association between total testosterone levels with abdominal muscle area and radiodensity, whereas estradiol showed a similar strong association with abdominal muscle area but not radiodensity. Additionally, SHBG was significantly and inversely associated with abdominal radiodensity although a negative trend was presented for abdominal muscle index. These results suggest the relevance of sex hormone levels to maintain muscle mass and density with advancing age. MATERIAL AND METHODS Study Design and Study Population At baseline (2000 to 2002), 6814 adult men and women between 45–84 years that were free of clinical cardiovascular disease were recruited into the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were enrolled from six US communities (New York [NY], Baltimore [MD], Chicago [IL], Los Angeles [CA], Twin Cities [MI] and Winston-Salem [NC]). Approximately 38% were Non-Hispanic White, 28% African American, 23% Hispanic American, and 11% Chinese American. Data Collection Details on the MESA cohort methods have been published. 30 Briefly, trained staff performed specimen blood draws and processing of venous blood samples, blood pressure measurements and all interviews. Using standard procedures, fasting blood samples were processed and stored at − 80°C. 31 Information on lifestyle factors, medications and co-morbidities were gathered using validated questionnaires. Race/ethnicity was self-reported at baseline according to 2000 US Census criteria. All individuals treated with sex hormones at baseline were excluded from the study. Physical activity (hours/week) and sedentary behavior (hours/week) were measured by using a comprehensive, semiquantitative questionnaire. 32 Current medication use was assessed according to standardized questionnaires. 33 Hypertension was defined as a systolic blood pressure above 140 mmHg and/or a diastolic above 90 mmHg or taking a blood pressure lowering medication. Diabetes mellitus was defined as self-reported diabetes or use of glucose lowering medications. 34 , 35 Measurement of high-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, has previously been described. 31 , 36 Computed Tomography for Body Composition A random subset of 1970 participants (946 men) at visits 2 and 3 (2002 to 2005) were enrolled in an ancillary study obtaining abdominal computed tomography (CT) scans, which were then interrogated for abdominal muscle area, abdominal radiodensity, visceral adipose tissue and subcutaneous fat tissue. At three clinical sites (Northwestern University, University of California Los Angeles, and Johns Hopkins University) electron-beam CT scanner (Imatron C-150) was used while at the remaining clinical sites (Columbia University, Wake Forest University, and University of Minnesota) multi-detector CT scanners (Sensation 64 GE lightspeed, Siemens S4 Volume Zoom, and Siemens Sensation 16) were used. CT scans were set at a collimation of 3mm with a slice thickness of 6 mm. In total, six cross-sectional slices were taken at L2/L3, L3/L4 and L4/L5 intervertebral disc spaces. Approximately half of the participants underwent CT scans at visit two and the other half at visit three. Assessment of abdominal muscles and adipose tissue were obtained from these CT scans and have been described earlier. 37 Using a semi-automated method, measurement of total tissue, lean muscle, and adipose tissue were assessed using Medical Imaging Processing Analysis and Visualization (MIPAV) software version 4.1.2 (National Institutes of Health, Bethesda, Maryland). Abdominal tissue was categorized by Hounsfield units (HU) with − 190 to -30 HU assessed as adipose tissue, -30 to -0 HU defined as mixed connective tissue, while values 0 to 100 HU were set as lean muscle. 38 , 39 Abdominal muscle area and adipose tissue area were calculated by summing the number of pixels while muscle radiodensity was defined by average HU value measured within that muscle’s corresponding fascial plane. Research staff responsible for analyzing CT scans were blinded to participants’ clinical information. The inter- and intra-rater reliability of measurements for total abdominal area as well as measurements for all muscle groups was 0.99 and 0.93 to 0.98, respectively.28 Visceral adipose tissue was determined as fat tissue in the visceral cavity, excluding intermuscular fat. Four abdominal muscle groups were assessed bilaterally. Area and radiodensity of the obliques, rectus abdominus and paraspinalis muscle groups comprised the muscles of stabilization, while the psoas muscles were the locomotor group. Combined area and radiodensity of muscles of stabilization and locomotion were defined as total abdominal muscle area (TAMA) and radiodensity (TAMD), respectively. Adjustment for body mass index (BMI, kg/m 2 ) was made for abdominal muscle areas and were defined as abdominal muscle indexes (total abdominal muscle area index (TAMAi) (TAMAi = TAMA/BMI), stabilizing muscle area index (TSMA/BMI) and locomotor muscle area index (TLMA/BMI). 40 For this analysis we excluded participants with missing data from CT scans, anthropometric measurements, endogenous sex hormones, lifestyle factors, co-morbidities, and medication use. The final sample size included 878 men ( Fig. 1 ) . Assessment of endogenous sex hormones Measurement of endogenous sex hormone levels have previously been described. 41 , 42 In brief, total testosterone was measured using radioimmunoassay kits. Sex hormone binding globulin (SHBG) concentration was assessed by Chemiluminescent enzyme immunometric assay (Immulite kits, Diagnostic Products Corporation, Los Angeles, CA). A ~ 10% blind pool was obtained to assess quality control serum. The coefficients of variation for total testosterone and SHBG were 12.3% and 9.0%, respectively. 43 Estradiol was measured using an ultra-sensitive radioimmunoassay kit (Diagnostic System Laboratories, Webster, TX) with a coefficient of variation of 10.5%. 43 Free testosterone( nmol/L) was calculated according to the method of Södergård. 44 Statistical Analysis Continuous variables were reported as means and standard deviations (SD) while categorical variables were shown as frequencies and percentages. Abdominal muscle areas/radiodensities were the outcome variables. Total, locomotor and stabilizing abdominal muscles showed normal distributions. As such, multivariable linear regression models were conducted to assess the associations between levels of sex hormones and abdominal muscles. The outcome was defined as the change in HU for abdominal muscle radiodensity and square centimeters for abdominal muscle area for each 1-SD increment change in levels of testosterone, estradiol and SHBG. Model 1 adjusted for age, race/ethnicity, and visceral adipose tissue. Model 2 included variables from model 1 and SHBG (when investigating the associations of total testosterone and estradiol), CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use, and time from baseline to CT. Model 3 included variables from Model 2 with further adjustment for hypertension, diabetes mellitus, dyslipidemia, use of cholesterol/thyroid/hypertension medication. No adjustment was made for SHBG when free testosterone was the independent variable. A two-tailed p -value < 0.05 was considered as statistically significant. Analyses were conducted using IBM SPSS Statistics, version 29. Ethical Considerations The MESA study protocol was approved by the Institutional Review Board at the Johns Hopkins University Hospital, University of California Los Angeles, University of Minnesota, Wake Forest University Hospital, Northwestern University Hospital, and Columbia University. All methods were performed in accordance with the relevant guidelines and regulations as set by the approving institutions in a standardized manner. Written informed consent was given by all participants 45 . Data availability The supporting data for the conclusions drawn in this study can be obtained from the MESA committee, but access is subject to certain restrictions as they were utilized under license for the present study and are not publicly accessible. Nevertheless, interested parties can request access to the data directly from the authors, pending approval from the MESA committee. Amar Osmancevic retained unrestricted access to all data and takes accountability for both integrity of the data and the accuracy of the data analysis. Declarations ADDITIONAL INFORMATION Competing Interests The authors declare no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Funding The study was supported by The Local Research and Development Council Göteborg och Södra Bohuslän, the VGR Regional Research and Development Council Grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement ALFGBG-966255. Moreover, this research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). The sex hormone ancillary study was supported by R01 HL074406 and R01 HL074338 from the National Heart, Lung, and Blood Institute. This paper has been reviewed and approved by the MESA Publications and Presentations Committee. 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Empirical estimation of free testosterone from testosterone and sex hormone-binding globulin immunoassays. European Journal of Endocrinology eur j endocrinol 152, 471–478 (2005). https://doi.org:10.1530/eje.1.01844 Vermeulen, A., Verdonck, L. & Kaufman, J. M. A Critical Evaluation of Simple Methods for the Estimation of Free Testosterone in Serum. The Journal of Clinical Endocrinology & Metabolism 84, 3666–3672 (1999). https://doi.org:10.1210/jcem.84.10.6079 Bild, D. E. et al. Multi-Ethnic Study of Atherosclerosis: Objectives and Design. American Journal of Epidemiology 156, 871–881 (2002). https://doi.org:10.1093/aje/kwf113 Bhatraju, P. K., Zelnick, L. R., Shlipak, M., Katz, R. & Kestenbaum, B. Association of Soluble TNFR-1 Concentrations with Long-Term Decline in Kidney Function: The Multi-Ethnic Study of Atherosclerosis. J Am Soc Nephrol 29, 2713–2721 (2018). https://doi.org:10.1681/asn.2018070719 Ainsworth, B. E., Irwin, M. L., Addy, C. L., Whitt, M. C. & Stolarczyk, L. M. Moderate physical activity patterns of minority women: the Cross-Cultural Activity Participation Study. J Womens Health Gend Based Med 8, 805–813 (1999). https://doi.org:10.1089/152460999319129 Psaty, B. M. et al. Assessing the use of medications in the elderly: methods and initial experience in the Cardiovascular Health Study. The Cardiovascular Health Study Collaborative Research Group. J Clin Epidemiol 45, 683–692 (1992). https://doi.org:10.1016/0895-4356(92)90143-b Kramer, H. et al. Racial/ethnic differences in hypertension and hypertension treatment and control in the multi-ethnic study of atherosclerosis (MESA). Am J Hypertens 17, 963–970 (2004). https://doi.org:10.1016/j.amjhyper.2004.06.001 Bertoni, A. G., Kramer, H., Watson, K. & Post, W. S. Diabetes and Clinical and Subclinical CVD. Glob Heart 11, 337–342 (2016). https://doi.org:10.1016/j.gheart.2016.07.005 Harhay, M. O. et al. Relationship of CRP, IL-6, and fibrinogen with right ventricular structure and function: the MESA-Right Ventricle Study. Int J Cardiol 168, 3818–3824 (2013). https://doi.org:10.1016/j.ijcard.2013.06.028 Larsen, B. et al. Muscle area and density and risk of all-cause mortality: The Multi-Ethnic Study of Atherosclerosis. Metabolism 111, 154321 (2020). https://doi.org:10.1016/j.metabol.2020.154321 Aubrey, J. et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf) 210, 489–497 (2014). https://doi.org:10.1111/apha.12224 Goodpaster, B. H., Thaete, F. L. & Kelley, D. E. Composition of skeletal muscle evaluated with computed tomography. Ann N Y Acad Sci 904, 18–24 (2000). https://doi.org:10.1111/j.1749-6632.2000.tb06416.x Han, S. et al. Testosterone is associated with abdominal body composition derived from computed tomography: a large cross sectional study. Sci Rep 12, 22528 (2022). https://doi.org:10.1038/s41598-022-27182-y Zhao, D. et al. Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women. J Am Coll Cardiol 71, 2555–2566 (2018). https://doi.org:10.1016/j.jacc.2018.01.083 Michos, E. D. et al. Sex hormones, sex hormone binding globulin, and abdominal aortic calcification in women and men in the multi-ethnic study of atherosclerosis (MESA). Atherosclerosis 200, 432–438 (2008). https://doi.org:10.1016/j.atherosclerosis.2007.12.032 Golden, S. H. et al. Endogenous sex hormones and glucose tolerance status in postmenopausal women. J Clin Endocrinol Metab 92, 1289–1295 (2007). https://doi.org:10.1210/jc.2006-1895 Södergård, R., Bäckström, T., Shanbhag, V. & Carstensen, H. Calculation of free and bound fractions of testosterone and estradiol-17 beta to human plasma proteins at body temperature. J Steroid Biochem 16, 801–810 (1982). https://doi.org:10.1016/0022-4731(82)90038-3 Bild, D. E. et al. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol 156, 871–881 (2002). https://doi.org:10.1093/aje/kwf113 Tables Table 1. Baseline characteristics of the study population. MEN (N= 878) Mean ± SD/N (%) Age (years) 61.6 (± 10.02) SBP (mmHg) 125.7 (± 19.3) DBP (mmHg) 75.4 (± 9.3) Total Abdominal Muscle Area (cm 2 ) Total Abdominal Muscle Area Index (cm 2 /BMI) 116.3 (± 24.1) 4.26 (± 5.0) Total Abdominal Muscle Radiodensity (HU) Abdominal Stabilizing Muscle Area (cm 2 ) Abdominal Stabilizing Muscle Radiodensity (HU) Abdominal Locomotor Muscle Area (cm 2 ) Abdominal Locomotor Muscle Radiodensity (HU) 44.4 (± 5.0) 87.4 (± 20.2) 42.1 (± 5.4) 29.1 (± 6.1) 51.3 (± 5.0) Abdominal Visceral Fat Area (cm 2 ) Abdominal Subcutaneous Fat Area (cm 2 ) 163.0 (± 70.9) 209.0 (± 92.7) BMI (kg/m 2 ) WHR 27.6 (± 4.2) 0.96 (± 0.1) hsCRP (mg/L) 2.5 (± 4.35) TT (nmol/L) 15.0 (± 5.6) fT (pmol/L) 0.3 (± 0.1) SHBG (nmol/L) 43.4 (±18.2) Estradiol (nmol/L) 0.12 (± 0.0) Race/Ethnicity Non-Hispanic White 368 (42 %) Chinese American 125 (14 %) Black 153 (17%) Hispanic/Latino 229 (27 %) Time from baseline to CT (years) 2.63 (± 1.0) Total Physical activity (hours/week) Sedentary Behavior (hours/week) 11.99 (± 5.5) 24,8 (± 14.5) Current cigarette smoker 115 (13 %) Diabetes Mellitus 129 (15 %) Hypertension 368 (42%) Cholesterol medicine use 213 (24%) SBP (systolic blood pressure), DBP (diastolic blood pressure), BMI (body mass index), WHR (waist-hip-ratio), hsCRP (high sensitivity c-reactive protein), SHBG (sex-hormone binding globulin), fT (free Testosterone), TT (Total Testosterone) Table 2 (a-c). Association between levels of serum testosterone (total and free), SHBG, estradiol and abdominal muscle variables. 2a) Total Abdominal Muscle Area Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 1.39 -0.0, 2.8 1.09 -0.4, 2.5 0.24 -1.3, 1.8 2.14 0.8,3.6 model 2 1.81 0.2, 3.5 1.11 -0.3, 2.6 0.24 -1.3, 1.8 1.97 0.6, 3.4 MODEL 3 1.79 0.1, 3.4 1.14 -0.3, 2.6 0.21 -1.3, 1.8 1.79 0.4, 3.2 2b) Total Abdominal Muscle Area INDEX Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 0.1 0.0, 0.2 0.1 -0., 0.1 0.0 0.0, 0.1 0.10 0.0, 0.1 MODEL 2 0.1 0.1, 0.2 0.1 0.0, 0.1 0.0 0.0, 0.1 0.05 0.0, 0.1 MODEL 3 0.1 0.1, 0.2 0.1 0.0, 0.1 0.0 0.0, 0.1 0.05 0.0, 0.1 2C) Total Abdominal Muscle RADIOdENSITY Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 0.04 -0.2, 0.3 0.16 -0.1, 0.4 -0.35 -0.6, -0.1 0.17 -0.1, 0.4 MODEL 2 0.32 0.1, 0.7 0.19 -0.1, 0.5 -0.35 -0.6, -0.1 0.16 -0.1, 0.4 MODEL 3 0.32 0.1, 0.6 0.21 -0.1, 0.5 -0.35 -0.6, -0.1 0.16 -0.1, 0.4 Linear regressions are used to investigate the associations in three models. Model 1(adjustment for age, race/ethnicity, and visceral adipose tissue), model 2(adjustment for model 1 + SHBG, CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use and time from baseline to CT), model 3 (adjustment for model 2 + hypertension, diabetes mellitus, dyslipidemia, cholesterol medication, thyroid agents), SHBG (sex-hormone binding globulin), CRP (C-reactive protein), fT (free testosterone). Table 3(a-c). Association between testosterone (total and free), SHBG, estradiol and abdominal stabilizing muscles. 3a) Abdominal STABILIZING Muscle Area Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 0.87 -0.35, 2.1 0.71 -0.5, 1.95 0.07 -1.2, 1.38 1.45 0.2, 2.6 model 2 1.16 -0.3, 2.6 0.74 -0.5, 2.0 0.06 -1.3, 1.4 1.30 0.1, 2.5 MODEL 3 1.16 -0.3, 2.6 0.77 -0.5, 2.0 0.07 -1.3, 1.4 1.22 0.0, 2.4 3B) Abdominal Stabilizing Muscle Area INDEX Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 0.10 0.0, 0.1 0.0 -0.0, 0.1 0.3 0.0, 0.1 0.04 0.0, 0.1 model 2 0.07 0.0, 0.1 0.0 0.0, 0.1 0.03 0.0, 0.1 0.03 0.0, 0.10 MODEL 3 0.10 0.0, 0.1 0.1 0.0, 0.1 0.02 0.0, 0.1 0.03 0.0, 0.10 3C) Abdominal Stabilizing Muscle RADIODENSITY Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 0.08 -0.2, 0.4 0.20 -0.1, 0.5 -0.31 -0.6, 0.0 0.14 -0.2, 0.4 model 2 0.36 0.2, 0.7 0.23 -0.1, 0.5 -0.31 -0.6, 0.0 0.11 -0.2, 0.4 MODEL 3 0.35 0.1, 0.7 0.3 -0.0, 0.6 -0.29 -0.6, 0.0 0.11 -0.2, 0.4 Linear regressions are used to investigate the associations in three models. Model 1(adjustment for age, race/ethnicity, and visceral adipose tissue), model 2(adjustment for model 1 + SHBG, CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use and time from baseline to CT), model 3 (adjustment for model 2 + hypertension, diabetes mellitus, dyslipidemia, cholesterol medication, thyroid agents), SHBG (sex-hormone binding globulin), CRP (C-reactive protein), fT (free testosterone). Table 4 (a-c). Association between testosterone (total and free), SHBG, estradiol and abdominal locomotor muscles. 4a) Abdominal LOCOMOTOR Muscle Area Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 0.52 0.2, 0.9 0.4 0.0, 0.7 0.17 -0.2, 0.6 0.7 0.3, 1.1 model 2 0.65 0.2, 1.1 0.4 0.0, 0.7 0.18 -0.2, 0.6 0.67 0.3, 1.0 MODEL 3 0.63 0.2, 1.0 0.4 -0.0, 0.7 0.14 -0.3, 0.5 0.65 0.3, 1.0 4B) Abdominal LOCOMOTOR Muscle Area INDEX Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 0.05 0.0, 0.1 0.0 0.0, 0.0 0.02 0.0, 0.0 0.02 0.0, 0.1 model 2 0.10 0.0, 0.1 0.0 0.0, 0.0 0.02 0.0, 0.0 0.02 0.0, 0.1 MODEL 3 0.10 0.0, 0.1 0.0 0.0, 0.0 0.01 -0.0, 0.0 0.02 0.0, 0.1 4C) Abdominal LOCOMOTOR Muscle RADIODENSITY Testosterone fT SHBG ESTRADIOL B 95% CI B 95% CI B 95% CI B 95% CI MODEL 1 -0.1 -0.4, 0.2 0.52 0.2, 0.9 -0.5 -0.8, -0.2 0.27 -0.0, 0.6 model 2 0.23 -0.1, 0.6 0.1 -0.3, 0.4 -0.5 -0.8, -0.2 0.28 -0.0, 0.6 MODEL 3 0.21 -0.2, 0.6 0.1 -0.2, 0.4 -0.5 -0.8, -0.2 0.26 -0.0, 0.6 Linear regressions are used to investigate the associations in three models. Model 1(adjustment for age, race/ethnicity, and visceral adipose tissue), model 2(adjustment for model 1 + SHBG, CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use and time from baseline to CT), model 3 (adjustment for model 2 + hypertension, diabetes mellitus, dyslipidemia, cholesterol medication, thyroid agents), SHBG (sex-hormone binding globulin), CRP (C-reactive protein), fT (free testosterone). Additional Declarations No competing interests reported. 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Medicine","correspondingAuthor":false,"prefix":"","firstName":"Pamela","middleName":"","lastName":"Ouyang","suffix":""},{"id":272315428,"identity":"95434f9a-ff72-4be0-b8c3-82d24b014158","order_by":5,"name":"Penelope Trimpou","email":"","orcid":"","institution":"University of Gothenburg and Sahlgrenska University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Penelope","middleName":"","lastName":"Trimpou","suffix":""},{"id":272315429,"identity":"309e9441-fa24-4bc9-9e54-28666b6743c7","order_by":6,"name":"Bledar Daka","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Bledar","middleName":"","lastName":"Daka","suffix":""}],"badges":[],"createdAt":"2024-01-29 16:59:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3909259/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3909259/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51025399,"identity":"1e340dbb-5851-4bb5-85ad-764a75f81648","added_by":"auto","created_at":"2024-02-12 21:47:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54381,"visible":true,"origin":"","legend":"\u003cp\u003eFlow-chart showing the number of men included in the final analyses.\u003c/p\u003e","description":"","filename":"FIGURE1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3909259/v1/a115acc50b1c5dbb5c677618.jpg"},{"id":51025997,"identity":"7851b1b7-5727-45bd-bbd0-fc3246792d6f","added_by":"auto","created_at":"2024-02-12 21:55:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":464554,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3909259/v1/640ff256-3413-423a-be20-2ddc941de232.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAbdominal obesity is linked to a higher risk of cardiometabolic disorders and mortality.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e However, recent evidence suggests the quality and quantity of abdominal muscles may also play an important role in cardiometabolic health.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e In this regard, abdominal muscle radiodensity, measured in Hounsfield Units (HU), reflects the quality of muscle tissue and the degree of fat infiltration/fibrosis.\u003csup\u003e3\u003c/sup\u003e Of note, growing evidence suggests that abdominal muscle radiodensity is inversely associated with cardiovascular events and mortality in men.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEarlier studies showed testosterone induces muscle fiber hypertrophy and increases the number of myonuclear cells by regulation of protein synthesis, satellite cells and stem cell proliferation, in addition to stimulation of the myogenic lineage and inhibition of the adipogenic cell line by activating androgen receptors (ARs).\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Moreover, in men with testosterone deficiency, replacement therapy improves muscle volume, strength and quality of life.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e However, it is unknown whether testosterone has different effects on different abdominal muscle functional groups. In addition, the effects of estradiol on muscle characteristics in men are unclear. In this regard, Russel and Colleagues reported in their review, no clear effect of estradiol on muscle mass or strength in men.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Yet, other studies have shown that estradiol could play a key role in regulating abdominal adiposity but is also directly associated with the volume of lean mass in men and appears to prevent expansion of adiposity.\u003csup\u003e,\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile there is some evidence to suggest that both testosterone and estradiol play an important role in the regulation of muscle function and volume, the nature of this relationship is not yet well established. Given this, we examined the cross-sectional associations between sex hormones and abdominal muscle characteristics in a large multi-ethnic sample of middle-aged and older men and hypothesized that higher estradiol and testosterone levels would be associated with greater abdominal muscle area, while testosterone would also be associated with higher abdominal muscle radiodensity.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eBaseline characteristics of the study population are presented in \u003cem\u003eTable 1\u003c/em\u003e. The mean age was 61.6 years. The majority of participants where non-Hispanic White (42 %), followed by Hispanic/Latino (27 %), African American (17 %) and Chinese American (14 %). On average, men were overweight with a mean BMI of 27.6 kg/m\u003csup\u003e2\u003c/sup\u003e. The participants reported an average of 12 hours a week of physical activity. Moreover, 42% of participants were hypertensive, 13 % stated active cigarette smoking, 15 % had diabetes mellitus, and 24% were taking a cholesterol-lowering medication. The mean \u003cem\u003etotal testosterone\u003c/em\u003e level was 15 nmol/L. \u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAssociation between Sex Hormones and Abdominal Muscle Area\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTotal \u003c/em\u003etestosterone\u003cem\u003e \u003c/em\u003ewas significantly associated with total abdominal muscle area in the first model (B=1.39, 95 % CI 0.0 - 2.8, p = 0.05), which was accentuated with further adjustment (Model 2: 1.81, 0.2 - 3.5, p = 0.03; Model 3: 1.79, 0.1 - 3.4 p \u0026lt; 0.01) (\u003cem\u003eTable 2\u003c/em\u003e). No significant associations were found between \u003cem\u003etotal testosterone\u003c/em\u003e and abdominal \u003cem\u003estabilizing\u003c/em\u003e muscle area (\u003cem\u003eTable 3\u003c/em\u003e), while the associations were significant in all models for abdominal \u003cem\u003elocomotor\u003c/em\u003e muscle area (\u003cem\u003eTable 4\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003eLevels of estradiol were significantly associated with total abdominal muscle area in all three models: Model 1 (2.14, 0.8 - 3.6, p \u0026lt; 0.01), Model 2 (1.97, 0.6 - 3.4, p \u0026lt; 0.01), Model 3 (1.79, 0.4 - 3.2, p = 0.01) with similar results for abdominal locomotor and abdominal stabilizing muscle area (\u003cem\u003eTable 3 and Table 4\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003eNo significant associations were found between levels of \u003cem\u003efree \u003c/em\u003etestosteron\u003cem\u003ee\u003c/em\u003e and total abdominal muscle areas (\u003cem\u003eTable 2\u003c/em\u003e), as well as stabilizing. However, significant associations were presented between free testosterone and locomotor area in model 1 \u0026amp; model 2(0.38, 0.0 \u0026ndash; 0.7, p = 0.04, 0.37, 0.0 \u0026ndash; 0.7, p = 0.04) with borderline significance in model 3 (0.37, -0.0, 0.7, p = 0.05), respectively (\u003cem\u003eTable 2, 3 \u0026amp; 4\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAssociations between Sex Hormones and Abdominal Muscle Radiodensities\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTotal \u003c/em\u003etestosterone was significantly associated with total abdominal muscle radiodensity in Models 2 and 3, but not in Model 1 (Model 1: 0.04, -0.2 - 0.3, p = 0.79; Model 2; 0.32, 0.1 - 0.7, p = 0.04; Model 3: 0.3, 0.0 - 0.6, p = 0.04) (\u003cem\u003eTable 2\u003c/em\u003e). Similar results were found for radiodensity of stabilizing muscles (\u003cem\u003eTable 3\u003c/em\u003e), but not for locomotor muscle (\u003cem\u003eTable 4\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003eNo significant associations were found between \u003cem\u003efree \u003c/em\u003etestosterone and abdominal muscle radiodensities in fully adjusted models (\u003cem\u003eTable 2, 3 \u0026amp; 4\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eNo significant associations were found between levels of estradiol and total abdominal and stabilizing muscle radiodensity (\u003cem\u003eTable 2 \u0026amp; 3\u003c/em\u003e), but there was a borderline significant association between estradiol and abdominal locomotor muscle radiodensity ((Model 1: -0.27, -0.0 - 0.6, p = 0.09: Model 2: 0.28, -0.0 - 0.6, p = 0.07; Model 3: 0.26, - 0.0 - 0.6, p = 0.09) (\u003cem\u003eTable 4\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003eHigher SHBG levels were associated with a lower radiodensity of abdominal muscle in all models (Model 1: -0.35, -0.6 - -0.1, p = 0.02: Model 2: -0.35, -0.6 - -0.1, p = 0.02; Model 3: -0.34, -0.6 - -0.1, p = 0.02) (\u003cem\u003eTable 2\u003c/em\u003e). The results were similar for abdominal stabilizing and locomotor muscles (\u003cem\u003eTable 3\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAssociations between Sex Hormones and Abdominal Muscle Area Indexes\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA significant association was found in all models for \u003cem\u003etotal \u003c/em\u003etestosterone and TAMAi (Model 1: B= 0.10, 0,0 - 0.2, p \u0026lt; 0.01, Model 2: 0.11, 0.1 - 0.2, p \u0026lt; 0.01, Model 3: 0.10, 0.1 - 0.2, p \u0026lt;0.01) (\u003cem\u003eTable 2\u003c/em\u003e). That is, in fully adjusted models, one SD increase in testosterone levels resulted with an increase of 0.10 cm\u003csup\u003e2\u003c/sup\u003e/(weight/height\u003csup\u003e2\u003c/sup\u003e) in abdominal muscle area index. Similar relationships were observed between \u003cem\u003etotal \u003c/em\u003etestosteron\u003cem\u003ee\u003c/em\u003e and abdominal locomotor and stabilizing muscle area indices (\u003cem\u003eTable 3 \u0026amp; 4\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003eEstradiol was found to be significantly associated with total abdominal muscle index (TAMAi) in model 1 (B = 0.10, 0.0 - 0.1, p= 0.03), which was borderline significant in Models 2 and 3 (Model 2: 0.05, -0.0 - 0.1, p= 0.06, Model 3: 0.05, -0.0 - 0.1, p= 0.06). Significant associations were found for estradiol and abdominal locomotor muscle area index in all three models but not for abdominal stabilizing muscle area index (\u003cem\u003eTable 3 and 4\u003c/em\u003e). \u003c/p\u003e\n\u003cp\u003eSignificant associations were shown for free testosterone with total, stabilizing and abdominal muscle area index in fully adjusted models (0.08, 0.0, 0.1, p = 0.008, 0.05, 0.0 \u0026ndash; 0.1, p = 0.03, 0.02, 0.0 - 0.04, p = 0.02), respectively. Inverse non-significant associations were found between levels of SHBG and abdominal muscle areas, and muscle area indexes in both model 2 and model 3.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study presents novel findings on the associations between sex hormones and SHBG and abdominal muscles in men. First, our results indicate that increases in serum levels of total testosterone and estradiol were associated with significant increases in abdominal muscle mass in men. In fact, our data indicate that the associations were stronger for estradiol than total testosterone with abdominal muscle mass to include both stabilizing and locomotor muscles. Second, significant associations were found between higher levels of total testosterone and abdominal muscle radiodensities. Third, our study presented a significant negative association between SHBG and abdominal muscle radiodensity.\u003c/p\u003e \u003cp\u003eA significant association was found between \u003cem\u003etotal\u003c/em\u003e testosterone and total abdominal muscle area, with similar associations presented for abdominal locomotor muscle area but not for abdominal stabilizing muscle area. A plausible explanation of these differences might be that locomotor muscle contains a greater number of types II myofibers, a more dynamic and power related muscle type.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Type I myofibrils, which are predominantly found in the abdominal stabilizing muscles, have shown to be rather associated with endurance and higher lipid content.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Even though some studies have shown that supraphysiologic levels of testosterone increase both type I and II myofibers equally, other studies have reported testosterone affects maximal voluntary strength rather than endurance.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFree testosterone was positively associated with total abdominal muscle area and radiodensity although, significance was found for locomotor muscle area in model 1 and 2 with borderline significance in model 3. \u003cem\u003eTotal\u003c/em\u003e testosterone was positively associated with TAMAi, abdominal stabilizing and locomotor muscle area indexes. In concurrence with our findings, Han et al. reported similar outcomes presented between \u003cem\u003etotal\u003c/em\u003e testosterone and abdominal muscle area index in men.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e However, no adjustments were made for SHBG.\u003c/p\u003e \u003cp\u003eIn our study, \u003cem\u003etotal\u003c/em\u003e testosterone was associated with increased total and stabilizing abdominal muscle radiodensities, independent of confounding factors.\u003c/p\u003e \u003cp\u003eOur results suggest that \u003cem\u003etotal\u003c/em\u003e testosterone is significantly associated with the degree of radiodensity of abdominal muscles, including muscle size. \u003cem\u003eTotal\u003c/em\u003e testosterone mainly includes SHBG-bound testosterone which has long been assumed to be inactive. However, recent experimental studies have shown the endocytic Megalin receptor, found in human skeletal myocytes, transports SHBG-bound testosterone and estradiol into cells. \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This could indicate \u003cem\u003etotal testosterone\u003c/em\u003e may have an active role in cell regulation and muscle activity.\u003c/p\u003e \u003cp\u003eOur study found that higher levels of estradiol were significantly associated with higher levels of all abdominal muscle areas. Estradiol has earlier been found to play a key role in regulation of myokines, i.e., skeletal muscle proteins, with critical functions associated with exercise-related benefits and inflammation regulation in tissues.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Similarly, in a study on elderly Swedish men, estradiol, and not testosterone, was associated with lean mass measured with DEXA.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEstradiol was positively but non-significantly associated with total and stabilizing muscle radiodensities, while a borderline-significant association was shown with locomotor muscle radiodensity. This would be in concurrence with a study by Wiik et al., reporting higher concentrations of estradiol receptors in skeletal muscles of men engaged in greater endurance training.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Although the role of estradiol on skeletal muscle characteristics is unclear, one study in men reported that supplementation of estradiol increased lipid utilization in skeletal muscles, increasing strength.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe bioactive role of SHBG is still debated. An inverse association has been shown between SHBG levels and insulin resistance and metabolic syndrome. \u003csup\u003e48\u003c/sup\u003e Other studies have found a positive association between SHBG and inflammatory cytokines, low protein diet and hip fractures in elderly even after adjustment for sex hormones.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Our study showed an inverse association between SHBG and all abdominal muscle densities. Other results have reported an inverse relationship between SHBG and lean muscles measured by DEXA.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Furthermore, Yuki et al. reported SHBG levels were significantly higher in the group of individuals diagnosed with sarcopenia compared to the normal group.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In agreement with our findings, SHBG has been reported to have a significant inverse association with muscle strength in elderly men.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e One plausible cause of the negative associations between SHBG and abdominal muscle radiodensities could be that an increase in SHBG concentrations may influence the binding capacity and magnitude of available free testosterone and could suggest a partial explanation to some of the weaker association found for other sex hormones .\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study has a number of strengths, including usage of data from a large and diverse cohort, detailed sampling of information with validated instruments as well as standardized sampling of blood specimens according to guidelines.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Furthermore, by assessing muscle composition with CT, we were able to estimate its quality. However, our study does have some limitations. First, radioimmunoassay technique (RIA) was used to measure sex hormones and SHBG. This has been described to be less precise than mass spectrometry in the measurement of sex-hormone levels.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Furthermore, levels of sex hormones may be affected by the presence of several cross-reacting steroids.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Second, \u003cem\u003efree\u003c/em\u003e testosterone was calculated and not directly measured which has been shown to overestimate levels compared with laboratory measured free testosterone.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e While the Sodergard method has previously been described as one of the most common methods for calculating free testosterone in endocrinology literature, it has limitations, including higher estimates compared to other algorithms and accurate mainly when competing steroids to binding sites are limited and normal levels of SHBG are involved.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Furthermore, the Sodergard method presents concordant results to the Vermuelen algorithm and its association constant was validated when compared to results of calculations with a gold standard technique.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Third, the sex hormones were measured at visit 1 whilst CT scans were made at visit 2 and visit 3. We partially addressed this limitation by adjusting for the time from baseline to CT scan as a confounder in model 2 and model 3. In addition, measurements of physical activity and sedentary behavior were self-reported.\u003c/p\u003e \u003cp\u003eWe only evaluated abdominal muscle area and radiodensity, and therefore, our findings may not be applicable to peripheral muscles. Finally, this study design was observational and cross-sectional, which is prone to residual confounding, as well as temporal and selection biases.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this analysis, we demonstrate a positive association between total testosterone levels with abdominal muscle area and radiodensity, whereas estradiol showed a similar strong association with abdominal muscle area but not radiodensity. Additionally, SHBG was significantly and inversely associated with abdominal radiodensity although a negative trend was presented for abdominal muscle index. These results suggest the relevance of sex hormone levels to maintain muscle mass and density with advancing age.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Study Population\u003c/h2\u003e \u003cp\u003eAt baseline (2000 to 2002), 6814 adult men and women between 45\u0026ndash;84 years that were free of clinical cardiovascular disease were recruited into the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were enrolled from six US communities (New York [NY], Baltimore [MD], Chicago [IL], Los Angeles [CA], Twin Cities [MI] and Winston-Salem [NC]). Approximately 38% were Non-Hispanic White, 28% African American, 23% Hispanic American, and 11% Chinese American.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eDetails on the MESA cohort methods have been published.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Briefly, trained staff performed specimen blood draws and processing of venous blood samples, blood pressure measurements and all interviews. Using standard procedures, fasting blood samples were processed and stored at \u0026minus;\u0026thinsp;80\u0026deg;C.\u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eInformation on lifestyle factors, medications and co-morbidities were gathered using validated questionnaires. Race/ethnicity was self-reported at baseline according to 2000 US Census criteria. All individuals treated with sex hormones at baseline were excluded from the study. Physical activity (hours/week) and sedentary behavior (hours/week) were measured by using a comprehensive, semiquantitative questionnaire.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Current medication use was assessed according to standardized questionnaires. \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Hypertension was defined as a systolic blood pressure above 140 mmHg and/or a diastolic above 90 mmHg or taking a blood pressure lowering medication. Diabetes mellitus was defined as self-reported diabetes or use of glucose lowering medications. \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Measurement of high-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, has previously been described. \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComputed Tomography for Body Composition\u003c/h2\u003e \u003cp\u003eA random subset of 1970 participants (946 men) at visits 2 and 3 (2002 to 2005) were enrolled in an ancillary study obtaining abdominal computed tomography (CT) scans, which were then interrogated for abdominal muscle area, abdominal radiodensity, visceral adipose tissue and subcutaneous fat tissue. At three clinical sites (Northwestern University, University of California Los Angeles, and Johns Hopkins University) electron-beam CT scanner (Imatron C-150) was used while at the remaining clinical sites (Columbia University, Wake Forest University, and University of Minnesota) multi-detector CT scanners (Sensation 64 GE lightspeed, Siemens S4 Volume Zoom, and Siemens Sensation 16) were used. CT scans were set at a collimation of 3mm with a slice thickness of 6 mm. In total, six cross-sectional slices were taken at L2/L3, L3/L4 and L4/L5 intervertebral disc spaces. Approximately half of the participants underwent CT scans at visit two and the other half at visit three.\u003c/p\u003e \u003cp\u003eAssessment of abdominal muscles and adipose tissue were obtained from these CT scans and have been described earlier.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Using a semi-automated method, measurement of total tissue, lean muscle, and adipose tissue were assessed using Medical Imaging Processing Analysis and Visualization (MIPAV) software version 4.1.2 (National Institutes of Health, Bethesda, Maryland). Abdominal tissue was categorized by Hounsfield units (HU) with \u0026minus;\u0026thinsp;190 to -30 HU assessed as adipose tissue, -30 to -0 HU defined as mixed connective tissue, while values 0 to 100 HU were set as lean muscle. \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e Abdominal muscle area and adipose tissue area were calculated by summing the number of pixels while muscle radiodensity was defined by average HU value measured within that muscle\u0026rsquo;s corresponding fascial plane. Research staff responsible for analyzing CT scans were blinded to participants\u0026rsquo; clinical information. The inter- and intra-rater reliability of measurements for total abdominal area as well as measurements for all muscle groups was 0.99 and 0.93 to 0.98, respectively.28\u003c/p\u003e \u003cp\u003eVisceral adipose tissue was determined as fat tissue in the visceral cavity, excluding intermuscular fat. Four abdominal muscle groups were assessed bilaterally. Area and radiodensity of the obliques, rectus abdominus and paraspinalis muscle groups comprised the muscles of stabilization, while the psoas muscles were the locomotor group. Combined area and radiodensity of muscles of stabilization and locomotion were defined as total abdominal muscle area (TAMA) and radiodensity (TAMD), respectively.\u003c/p\u003e \u003cp\u003eAdjustment for body mass index (BMI, kg/m\u003csup\u003e2\u003c/sup\u003e) was made for abdominal muscle areas and were defined as abdominal muscle indexes (total abdominal muscle area index (TAMAi) (TAMAi\u0026thinsp;=\u0026thinsp;TAMA/BMI), stabilizing muscle area index (TSMA/BMI) and locomotor muscle area index (TLMA/BMI).\u003csup\u003e40\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFor this analysis we excluded participants with missing data from CT scans, anthropometric measurements, endogenous sex hormones, lifestyle factors, co-morbidities, and medication use. The final sample size included 878 men \u003cem\u003e(\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of endogenous sex hormones\u003c/h2\u003e \u003cp\u003eMeasurement of endogenous sex hormone levels have previously been described. \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e In brief, total testosterone was measured using radioimmunoassay kits. Sex hormone binding globulin (SHBG) concentration was assessed by Chemiluminescent enzyme immunometric assay (Immulite kits, Diagnostic Products Corporation, Los Angeles, CA). A\u0026thinsp;~\u0026thinsp;10% blind pool was obtained to assess quality control serum. The coefficients of variation for total testosterone and SHBG were 12.3% and 9.0%, respectively. \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Estradiol was measured using an ultra-sensitive radioimmunoassay kit (Diagnostic System Laboratories, Webster, TX) with a coefficient of variation of 10.5%. \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Free testosterone( nmol/L) was calculated according to the method of S\u0026ouml;derg\u0026aring;rd. \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were reported as means and standard deviations (SD) while categorical variables were shown as frequencies and percentages. Abdominal muscle areas/radiodensities were the outcome variables. Total, locomotor and stabilizing abdominal muscles showed normal distributions. As such, multivariable linear regression models were conducted to assess the associations between levels of sex hormones and abdominal muscles. The outcome was defined as the change in HU for abdominal muscle radiodensity and square centimeters for abdominal muscle area for each 1-SD increment change in levels of testosterone, estradiol and SHBG.\u003c/p\u003e \u003cp\u003eModel 1 adjusted for age, race/ethnicity, and visceral adipose tissue. Model 2 included variables from model 1 and SHBG (when investigating the associations of total testosterone and estradiol), CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use, and time from baseline to CT. Model 3 included variables from Model 2 with further adjustment for hypertension, diabetes mellitus, dyslipidemia, use of cholesterol/thyroid/hypertension medication. No adjustment was made for SHBG when free testosterone was the independent variable.\u003c/p\u003e \u003cp\u003eA two-tailed \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as statistically significant. Analyses were conducted using IBM SPSS Statistics, version 29.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e The MESA study protocol was approved by the Institutional Review Board at the Johns Hopkins University Hospital, University of California Los Angeles, University of Minnesota, Wake Forest University Hospital, Northwestern University Hospital, and Columbia University. All methods were performed in accordance with the relevant guidelines and regulations as set by the approving institutions in a standardized manner. Written informed consent was given by all participants \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003e The supporting data for the conclusions drawn in this study can be obtained from the MESA committee, but access is subject to certain restrictions as they were utilized under license for the present study and are not publicly accessible. Nevertheless, interested parties can request access to the data directly from the authors, pending approval from the MESA committee. Amar Osmancevic retained unrestricted access to all data and takes accountability for both integrity of the data and the accuracy of the data analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003e \u003cb\u003eADDITIONAL INFORMATION\u003c/b\u003e \u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests\u003c/strong\u003e \u003cp\u003eThe authors declare no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study was supported by The Local Research and Development Council G\u0026ouml;teborg och S\u0026ouml;dra Bohusl\u0026auml;n, the VGR Regional Research and Development Council Grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement ALFGBG-966255. Moreover, this research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). The sex hormone ancillary study was supported by R01 HL074406 and R01 HL074338 from the National Heart, Lung, and Blood Institute. This paper has been reviewed and approved by the MESA Publications and Presentations Committee.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAO: Conceptualization, Methodology, Formal Analysis, Writing \u0026ndash; Original Review, MA, BD: Conceptualization, Writing \u0026ndash; Review and Editing, Supervision, Formal Analysis, Methodology, IM, CV, PO, PT: Writing \u0026ndash; Substantial Reviews, Interpretations and Edits. Each author has reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThe authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.mesa-nhlbi.org\u003c/span\u003e\u003cspan address=\"http://www.mesa-nhlbi.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e: The authors have nothing to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhang, C., Rexrode, K. M., Dam, R. M. v., Li, T. Y. \u0026amp; Hu, F. B. Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality. 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Am J Epidemiol 156, 871\u0026ndash;881 (2002). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1093/aje/kwf113\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1093/aje/kwf113\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"691\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eBaseline characteristics of the study population.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEN (N= 878)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD/N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e61.6 (\u0026plusmn; 10.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eSBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e125.7 (\u0026plusmn; 19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eDBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e75.4 (\u0026plusmn; 9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Abdominal Muscle Area (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003eTotal Abdominal Muscle Area Index (cm\u003csup\u003e2\u003c/sup\u003e/BMI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e116.3 (\u0026plusmn; 24.1)\u003c/p\u003e\n \u003cp\u003e4.26 (\u0026plusmn; 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Abdominal Muscle Radiodensity (HU)\u003c/p\u003e\n \u003cp\u003eAbdominal Stabilizing Muscle Area (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003eAbdominal Stabilizing Muscle Radiodensity (HU)\u003c/p\u003e\n \u003cp\u003eAbdominal Locomotor Muscle Area (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003eAbdominal Locomotor Muscle Radiodensity (HU)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e44.4 (\u0026plusmn; 5.0)\u003c/p\u003e\n \u003cp\u003e87.4 (\u0026plusmn; 20.2)\u003c/p\u003e\n \u003cp\u003e42.1 (\u0026plusmn; 5.4)\u003c/p\u003e\n \u003cp\u003e29.1 (\u0026plusmn; 6.1)\u003c/p\u003e\n \u003cp\u003e51.3 (\u0026plusmn; 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eAbdominal Visceral Fat Area (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003eAbdominal Subcutaneous Fat Area (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e163.0 (\u0026plusmn; 70.9)\u003c/p\u003e\n \u003cp\u003e209.0 (\u0026plusmn; 92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003eWHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e27.6 (\u0026plusmn; 4.2)\u003c/p\u003e\n \u003cp\u003e0.96 (\u0026plusmn; 0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003ehsCRP (mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e2.5 (\u0026plusmn; 4.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eTT (nmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e15.0 (\u0026plusmn; 5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003efT (pmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e0.3 (\u0026plusmn; 0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eSHBG (nmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e43.4 (\u0026plusmn;18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eEstradiol (nmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (\u0026plusmn; 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eRace/Ethnicity\u003c/u\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eNon-Hispanic White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e368 (42 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eChinese American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e125 (14 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e153 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eHispanic/Latino\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e229 (27 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eTime from baseline to CT (years)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e2.63 (\u0026plusmn; 1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Physical activity (hours/week)\u003c/p\u003e\n \u003cp\u003eSedentary Behavior (hours/week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e11.99 (\u0026plusmn; 5.5)\u003c/p\u003e\n \u003cp\u003e24,8 (\u0026plusmn; 14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eCurrent cigarette smoker\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e115 (13 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e129 (15 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e368 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.92764109985528%\" valign=\"top\"\u003e\n \u003cp\u003eCholesterol medicine use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.07235890014472%\" valign=\"top\"\u003e\n \u003cp\u003e213 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSBP (systolic blood pressure), DBP (diastolic blood pressure), BMI (body mass index), WHR (waist-hip-ratio), hsCRP (high sensitivity c-reactive protein), SHBG (sex-hormone binding globulin), fT (free Testosterone), TT (Total Testosterone)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 (a-c).\u003c/strong\u003e Association between levels of serum testosterone (total and free), SHBG, estradiol and abdominal muscle variables. \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e2a) Total Abdominal Muscle Area\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.273273273273272%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.4, 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-1.3, 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.8,3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003emodel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.2, 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.3, 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-1.3, 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.6, 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.1, 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.3, 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-1.3, 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.4, 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e2b) Total Abdominal Muscle Area INDEX\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.210526315789473%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.406015037593985%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.962406015037594%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; ESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.481203007518797%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.93984962406015%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.992481203007518%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.338345864661655%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2406015037594%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.481203007518797%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.93984962406015%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.992481203007518%\" valign=\"top\"\u003e\n \u003cp\u003e-0., 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.338345864661655%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2406015037594%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.481203007518797%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.93984962406015%\" valign=\"top\"\u003e\n \u003cp\u003e0.1, 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.992481203007518%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.338345864661655%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2406015037594%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.481203007518797%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.93984962406015%\" valign=\"top\"\u003e\n \u003cp\u003e0.1, 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.992481203007518%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.067669172932331%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.338345864661655%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2406015037594%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e2C) Total Abdominal Muscle RADIOdENSITY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.18018018018018%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.474474474474473%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.21921921921922%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.126126126126128%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; ESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.795180722891565%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.831325301204819%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.728915662650603%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.795180722891565%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.831325301204819%\" valign=\"top\"\u003e\n \u003cp\u003e-0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e-0.6, -0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.728915662650603%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.795180722891565%\" valign=\"top\"\u003e\n \u003cp\u003e0.1, 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.831325301204819%\" valign=\"top\"\u003e\n \u003cp\u003e-0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e-0.6, -0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.728915662650603%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.795180722891565%\" valign=\"top\"\u003e\n \u003cp\u003e0.1, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.831325301204819%\" valign=\"top\"\u003e\n \u003cp\u003e-0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e-0.6, -0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.325301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.728915662650603%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eLinear regressions are used to investigate the associations in three models. Model 1(adjustment for age, race/ethnicity, and visceral adipose tissue), model 2(adjustment for model 1 + SHBG, CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use and time from baseline to CT), model 3 (adjustment for model 2 + hypertension, diabetes mellitus, dyslipidemia, cholesterol medication, thyroid agents), SHBG (sex-hormone binding globulin), CRP (C-reactive protein), fT (free testosterone).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3(a-c).\u003c/strong\u003e Association between testosterone (total and free), SHBG, estradiol and abdominal stabilizing muscles.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e3a) Abdominal STABILIZING Muscle Area\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.273273273273272%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.35, 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.5, 1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-1.2, 1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.2, 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003emodel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.3, 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.5, 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-1.3, 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.1, 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.3, 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.5, 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-1.3, 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e3B) Abdominal Stabilizing Muscle Area INDEX\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.273273273273272%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003emodel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e3C) Abdominal Stabilizing Muscle RADIODENSITY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.273273273273272%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.6, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003emodel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.2, 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.6, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.1, 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.6, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLinear regressions are used to investigate the associations in three models. Model 1(adjustment for age, race/ethnicity, and visceral adipose tissue), model 2(adjustment for model 1 + SHBG, CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use and time from baseline to CT), model 3 (adjustment for model 2 + hypertension, diabetes mellitus, dyslipidemia, cholesterol medication, thyroid agents), SHBG (sex-hormone binding globulin), CRP (C-reactive protein), fT (free testosterone).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 (a-c).\u003c/strong\u003e Association between testosterone (total and free), SHBG, estradiol and abdominal locomotor muscles.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e4a) Abdominal LOCOMOTOR Muscle Area\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.273273273273272%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.2, 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.3, 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003emodel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.2, 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.3, 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.2, 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.3, 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.3, 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e4B) Abdominal LOCOMOTOR Muscle Area INDEX\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.273273273273272%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003emodel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e0.0, 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e4C) Abdominal LOCOMOTOR Muscle RADIODENSITY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; fT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.174174174174173%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SHBG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.273273273273272%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESTRADIOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.4, 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e0.2, 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e-0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.8, -0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003emodel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.3, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e-0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.8, -0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMODEL 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.963855421686747%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.2, 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e-0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\" valign=\"top\"\u003e\n \u003cp\u003e-0.8, -0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078313253012048%\" valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.265060240963855%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0, 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLinear regressions are used to investigate the associations in three models. Model 1(adjustment for age, race/ethnicity, and visceral adipose tissue), model 2(adjustment for model 1 + SHBG, CRP, physical activity, sedentary behavior, cigarette smoking, alcohol use and time from baseline to CT), model 3 (adjustment for model 2 + hypertension, diabetes mellitus, dyslipidemia, cholesterol medication, thyroid agents), SHBG (sex-hormone binding globulin), CRP (C-reactive protein), fT (free testosterone).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3909259/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3909259/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eInformation on the associations of testosterone levels with abdominal muscle volume and quality in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. To investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis. A community-based sample of 907 men aged 45\u0026ndash;84 years; 878 men with complete data were included in the analysis. CT scans of the abdomen were interrogated for muscle characteristics. Multivariable linear regressions were used to test the associations. After adjustment, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.79, 0.1\u0026ndash;3.4, \u0026amp; 1.79, 0.4\u0026ndash;3.2, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0\u0026ndash;0.6, \u0026amp; -0.34, -0.6 - -0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity.\u003c/p\u003e","manuscriptTitle":"Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-12 21:46:58","doi":"10.21203/rs.3.rs-3909259/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-26T12:23:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-23T10:14:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-21T08:53:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-14T14:31:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0b9b57de-1c28-4d24-ad41-530381a43f68","date":"2024-04-01T02:00:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274f096f-93d1-4e22-bc76-0455426e7121","date":"2024-03-28T07:41:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"c697f787-7491-4124-b460-207b0e35f8bf","date":"2024-03-27T21:53:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-25T18:01:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-19T08:36:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-08T20:03:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-08T19:57:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-01-29T16:49:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0f377e52-00ae-4e17-a52d-833909f78001","owner":[],"postedDate":"February 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":28702214,"name":"Health sciences/Endocrinology/Endocrine system and metabolic diseases/Obesity"},{"id":28702215,"name":"Health sciences/Endocrinology/Endocrine system and metabolic diseases/Endocrine reproductive disorders"},{"id":28702216,"name":"Biological sciences/Developmental biology/Ageing"},{"id":28702217,"name":"Health sciences/Anatomy/Musculoskeletal system/Muscle/Skeletal muscle"},{"id":28702218,"name":"Health sciences/Medical research/Epidemiology"}],"tags":[],"updatedAt":"2024-07-05T08:51:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-12 21:46:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3909259","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3909259","identity":"rs-3909259","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}