{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:21:01Z","timestamp":1787728861225,"version":"build-2784847793"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T00:00:00Z","timestamp":1712707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sex hormones play a critical role in sex differences and cardiovascular disease risk associated with metabolic syndrome (MS) and inflammation. However, the associations of sex hormone ratios with metabolic and inflammatory markers are unclear according to sex and age differences. We evaluated the associations of sex hormone ratios with MS and inflammation among males and females.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cross-sectional study was conducted by including all adults from the National Health and Nutrition Examination Survey cycles 2013-2016 and excluding any pregnant women, heart disease, diabetes, and those currently taking insulin. MS was defined using the National Cholesterol Education Program criteria and a high-sensitivity C-reactive protein (CRP) level&amp;gt;3 mg\/L was defined as a high CRP. Measures of MS components and CRP concentrations were also analyzed. The primary exposures were testosterone to estradiol (excess androgen index), testosterone to sex hormone-binding globulin (free androgen index), and estradiol to sex hormone-binding globulin (free estradiol index). The adjusted associations were summarized with a relative risk (RR) and 95% confidence interval (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study included 9167 subjects with 4360 males and 4807 females. Increases in free estradiol index were positively associated with MS (RR=1.48; 95%CI: 1.39, 1.58; RR=1.31; 95%CI: 1.22, 1.40) and high CRP (RR=1.49; 95%CI: 1.25, 1.77; RR=1.26; 95%CI: 1.06, 1.50) in men with age&amp;lt;50 years and age\u226550 years, respectively. Similarly, higher free estradiol index was also robustly associated with increased prevalence of MS (RR=1.22; 95%CI: 1.15, 1.28) and high CRP (RR=1.68; 95%CI: 1.48, 1.90) in women with age \u226550 years. Among women with age&amp;lt;50 years, a higher free androgen index was associated with MS (RR=1.34; 95%CI: 1.25, 1.42) and high CRP (RR=1.13; 95%CI: 1.02, 1.25). These associations were unchanged even after adjusting for all sex hormones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Free estradiol index was consistently and positively associated with MS and high CRP in males of all ages and older females. Free androgen index was positively associated with MS and high CRP in females with age&amp;lt;50 years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2024.1384603","type":"journal-article","created":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T01:12:55Z","timestamp":1712711575000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Associations of sex hormone ratios with metabolic syndrome and inflammation in US adult men and women"],"prefix":"10.3389","volume":"15","author":[{"given":"Pallavi","family":"Dubey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishwajeet","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikit","family":"Venishetty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meesha","family":"Trivedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sireesha Y.","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajkumar","family":"Lakshmanaswamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok Kumar","family":"Dwivedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2021.03.033","article-title":"Prevalence of at-risk hyperandrogenism by age and race\/ethnicity among females in the United States using NHANES III","volume":"260","author":"Dubey","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.05.034","article-title":"The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis","volume":"56","author":"Mottillo","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad067","article-title":"Association of polycystic ovary syndrome with cardiovascular disease among female hospitalizations in the United States","volume":"188","author":"Dwivedi","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.1161\/CIR.0b013e31823ac046","article-title":"Heart disease and stroke statistics\u20132012 update: a report from the American Heart Association","volume":"125","author":"Roger","year":"2012","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s13293-019-0246-6","article-title":"Sex hormones, aging and cardiometabolic syndrome","volume":"10","author":"Faulkner","year":"2019","journal-title":"Biol Sex Differ"},{"key":"B6","doi-asserted-by":"publisher","first-page":"CD002229","DOI":"10.1002\/14651858","article-title":"Hormone therapy for preventing cardiovascular disease in post-menopausal women","volume":"2015","author":"Boardman","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0643-8","article-title":"Sex differences in cardiometabolic disorders","volume":"25","author":"Gerdts","year":"2019","journal-title":"Nat Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4103\/ijem.IJEM_505_18","article-title":"Sex hormone levels - 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