Dataset Information

A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study.

ABSTRACT:

Context

Evidence for an association of measures of generalized and central obesity with salivary cortisol secretion is equivocal.

Objective

The objective of this study was to assess the relationship between body mass index (BMI), waist circumference, and salivary cortisol.

Design

The design was a cross-sectional study of BMI, waist circumference, and salivary cortisol from phase 7 (2002-2004) of the Whitehall II study.

Setting

The occupational cohort was originally recruited in 1985-1988.

Participants

Participants included 2915 men and 1041 women aged 50-74 yr with complete information on height, weight and waist circumference, and cortisol secretion.

Outcome measures

Saliva samples were taken on waking, waking plus 0.5, 2.5, 8, and 12 h, and bedtime for the assessment of cortisol. The cortisol awakening response and slope in diurnal secretion were calculated.

Results

After adjustment for age, sex, social position, waking time, and time since waking of sample collection, increasing central and generalized obesity was associated with lower waking cortisol (P = 0.001). U-shaped associations were apparent between diurnal slope in salivary cortisol and both BMI and waist circumference (P < 0.0001 for quadratic term). For example, the shallowest (most adverse) slopes in salivary cortisol were associated with highest (>31 kg/m(2)) and lowest (<21 kg/m(2)) levels of BMI, and the steepest slopes were apparent for those with BMI of 26 kg/m(2), independently of the 12 covariates examined. No associations were apparent for the cortisol awakening response (P > 0.05).

Conclusion

The associations of measures of generalized and central obesity with diurnal slope in salivary cortisol are not linear in older adults. These nonlinear associations may explain previously described mixed findings.

SUBMITTER: Kumari M

PROVIDER: S-EPMC2936066 | biostudies-literature | 2010 Sep

REPOSITORIES: biostudies-literature

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Publications

A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study.

Kumari Meena M Chandola Tarani T Brunner Eric E Kivimaki Mika M

The Journal of clinical endocrinology and metabolism 20100630 9

<h4>Context</h4>Evidence for an association of measures of generalized and central obesity with salivary cortisol secretion is equivocal.<h4>Objective</h4>The objective of this study was to assess the relationship between body mass index (BMI), waist circumference, and salivary cortisol.<h4>Design</h4>The design was a cross-sectional study of BMI, waist circumference, and salivary cortisol from phase 7 (2002-2004) of the Whitehall II study.<h4>Setting</h4>The occupational cohort was originally r ...[more]

PMID: 20591984

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Project description:Abnormal hypothalamic-pituitary-adrenal (HPA) axis function, as indexed by elevated diurnal cortisol levels and/or a blunted cortisol awakening response (CAR), has been observed among patients with first episode psychosis and associated with neurocognitive deficits in this population. However, the extent to which these features precede illness onset is unclear. The current study aimed to determine whether children who are at putatively elevated risk for psychosis because they present multiple antecedents of schizophrenia (ASz), and high-risk children with a family history of illness (FHx), are characterized by abnormal cortisol levels when compared with their typically developing (TD) peers. A further aim was to investigate the extent to which cortisol levels are associated with psychosocial stress and neurocognitive function. Thirty-three ASz children, 22 FHx children, and 40 TD children were identified at age 9-12 years using a novel community-based screening procedure or as relatives of individuals with schizophrenia. All participants were antipsychotic-naive and not currently seeking treatment for their symptoms. At age 11-14 years, participants provided salivary cortisol samples and completed psychosocial stress measures and tests of memory and executive function. Results indicated that FHx children, but not ASz children, were characterized by a blunted CAR relative to their TD peers (effect size=-0.73, p=0.01) that was not explained by psychosocial stress exposure or by distress relating to these experiences. Neither FHx nor ASz children were characterized by elevated diurnal cortisol. Among both FHx and ASz children, more pronounced HPA axis function abnormalities (i.e., higher diurnal cortisol levels and greater blunting of the CAR) were associated with poorer performance on tests of verbal memory and executive function. These findings support the notion that at least some HPA axis abnormalities described in psychosis precede illness onset, rather than being a subsequent epiphenomenon. We speculate that the blunted CAR may constitute an early (potentially genetically mediated) marker of psychosis vulnerability, whilst elevated diurnal cortisol levels may emerge only proximally to disease onset.

Project description:BackgroundPatients with type 2 diabetes vary greatly with respect to degree of obesity at time of diagnosis. To address the heterogeneity of type 2 diabetes, we characterised patterns of change in body mass index (BMI) and other cardiometabolic risk factors before type 2 diabetes diagnosis.Methods and findingsWe studied 6,705 participants from the Whitehall II study, an observational prospective cohort study of civil servants based in London. White men and women, initially free of diabetes, were followed with 5-yearly clinical examinations from 1991-2009 for a median of 14.1 years (interquartile range [IQR]: 8.7-16.2 years). Type 2 diabetes developed in 645 (1,209 person-examinations) and 6,060 remained free of diabetes during follow-up (14,060 person-examinations). Latent class trajectory analysis of incident diabetes cases was used to identify patterns of pre-disease BMI. Associated trajectories of cardiometabolic risk factors were studied using adjusted mixed-effects models. Three patterns of BMI changes were identified. Most participants belonged to the "stable overweight" group (n?=?604, 94%) with a relatively constant BMI level within the overweight category throughout follow-up. They experienced slightly worsening of beta cell function and insulin sensitivity from 5 years prior to diagnosis. A small group of "progressive weight gainers" (n?=?15) exhibited a pattern of consistent weight gain before diagnosis. Linear increases in blood pressure and an exponential increase in insulin resistance a few years before diagnosis accompanied the weight gain. The "persistently obese" (n?=?26) were severely obese throughout the whole 18 years before diabetes diagnosis. They experienced an initial beta cell compensation followed by loss of beta cell function, whereas insulin sensitivity was relatively stable. Since the generalizability of these findings is limited, the results need confirmation in other study populations.ConclusionsThree patterns of obesity changes prior to diabetes diagnosis were accompanied by distinct trajectories of insulin resistance and other cardiometabolic risk factors in a white, British population. While these results should be verified independently, the great majority of patients had modest weight gain prior to diagnosis. These results suggest that strategies focusing on small weight reductions for the entire population may be more beneficial than predominantly focusing on weight loss for high-risk individuals.

Dataset Information

A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study.

Context

Objective

Design

Setting

Participants

Outcome measures

Results

Conclusion

Publications

A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study.

Similar Datasets

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