DHEA & Abdominal Fat

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JAMA

Vol. 292 No. 18, November 10, 2004

Effect of DHEA on Abdominal Fat and Insulin Action in Elderly Women and Men

A Randomized Controlled Trial

Dennis T. Villareal, MD; O. Holloszy, MD

JAMA. 2004;292:2243-2248.

Context Dehydroepiandrosterone (DHEA) administration has been shown to reduce

accumulation of abdominal visceral fat and protect against insulin resistance in

laboratory animals, but it is not known whether DHEA decreases abdominal obesity

in humans. DHEA is widely available as a dietary supplement without a

prescription.

Objective To determine whether DHEA replacement therapy decreases abdominal fat

and improves insulin action in elderly persons.

Design and Setting Randomized, double-blind, placebo-controlled trial conducted

in a US university-based research center from June 2001 to February 2004.

Participants Fifty-six elderly persons (28 women and 28 men aged 71 [range,

65-78] years) with age-related decrease in DHEA level.

Intervention Participants were randomly assigned to receive 50 mg/d of DHEA or

matching placebo for 6 months.

Main Outcome Measures The primary outcome measures were 6-month change in

visceral and subcutaneous abdominal fat measured by magnetic resonance imaging

and glucose and insulin responses to an oral glucose tolerance test (OGTT).

Results Of the 56 men and women enrolled, 52 underwent follow-up evaluations.

Compliance with the intervention was 97% in the DHEA group and 95% in the

placebo group. Based on intention-to-treat analyses, DHEA therapy compared with

placebo induced significant decreases in visceral fat area (-13 cm2 vs +3 cm2,

respectively; P = .001) and subcutaneous fat (-13 cm2 vs +2 cm2, P = .003). The

insulin area under the curve (AUC) during the OGTT was significantly reduced

after 6 months of DHEA therapy compared with placebo (-1119 µU/mL per 2 hours vs

+818 µU/mL per 2 hours, P = .007). Despite the lower insulin levels, the glucose

AUC was unchanged, resulting in a significant increase in an insulin sensitivity

index in response to DHEA compared with placebo (+1.4 vs -0.7, P = .005).

Conclusion DHEA replacement could play a role in prevention and treatment of

the metabolic syndrome associated with abdominal obesity.