Concurrent and longitudinal associations between diurnal cortisol and body mass index across adolescence

Variation in diurnal cortisol patterns among the Indigenous Shuar of Amazonian Ecuador

OBJECTIVES

The hypothalamic-pituitary-adrenal (HPA) axis and its primary end product, the glucocorticoid cortisol, are major components of the evolved human stress response. However, most studies have examined these systems among populations in high-income settings, which differ from the high pathogen and limited resource contexts in which the HPA axis functioned for most of human evolution.

METHODS

We investigated variability in diurnal salivary cortisol patterns among 298 Indigenous Shuar from Amazonian Ecuador (147 males, 151 females; age 2-86 years), focusing on the effects of age, biological sex, and body mass index (BMI) in shaping differences in diurnal cortisol production. Saliva samples were collected three times daily (waking, 30 minutes post-waking, evening) for three consecutive days to measure key cortisol parameters: levels at waking, the cortisol awakening response, the diurnal slope, and total daily output.

RESULTS

Age was positively associated with waking levels and total daily output, with Shuar juveniles and adolescents displaying significantly lower levels than adults (p < .05). Sex was not a significant predictor of cortisol levels (p > .05), as Shuar males and females displayed similar patterns of diurnal cortisol production across the life course. Moreover, age, sex, and BMI significantly interacted to moderate the rate of diurnal cortisol decline (p = .027). Overall, Shuar demonstrated relatively lower cortisol concentrations than high-income populations.

CONCLUSIONS

This study expands the documented range of global variation in HPA axis activity and diurnal cortisol production and provides important insights into the plasticity of human stress physiology across diverse developmental and socioecological settings.

Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States

The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19-70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.

Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis

Stress has a damaging impact on our mental and physical health, and as a result, there is an on-going demand for effective stress management interventions. However, there are no reviews or meta-analyses synthesising the evidence base of randomised controlled trials testing the effectiveness of psychological interventions on changing cortisol levels (the stress hormone) in non-patient groups. Therefore, the primary aim of this systematic review and meta-analysis was to address this gap. Six databases (Medline, PsychInfo, Embase, CINAHL, Cochrane and Web of Science) were searched (1171 studies identified) with 58 studies (combined N = 3508) included in the meta-analysis. The interventions were coded into one of four categories; mind body therapies, mindfulness, relaxation or talking therapies. A random effects meta-analysis on cortisol as measured in blood, saliva or hair found that stress management interventions outperformed pooled control conditions with a medium positive effect size (g = 0.282). The studies that utilised cortisol awakening measures (g = 0.644) revealed larger effects of stress management interventions than those that measured diurnal cortisol (g = 0.255). Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes. Additionally, studies that utilised an active control group (g = 0. 477) over passive control group (g = 0.129) were found to have stronger effects. Length of the intervention, study quality, risk of bias, age and gender did not influence the effectiveness of interventions and there was no evidence of publication bias. Overall, the current findings confirm that stress management interventions can positively influence cortisol levels. Future research should investigate the longer term implications for health and health outcomes.

Stress, Stress Reduction and Obesity in Childhood and Adolescence

BACKGROUND

Obesity in childhood and adolescence remains a great global health challenge. Stress exposure during childhood and adolescence is associated with a higher risk for obesity, yet the linkage between stress and obesity is multidimensional, and its biological and behavioral mechanisms are still not fully understood.

SUMMARY

In this literature review, we identified different types of stress exposure in children and adolescents, including first studied effects of the COVID-19 pandemic as a prolonged stress exposure and their association with obesity risk. We investigated studies on the connection of altered stress biology and behavioral pathways as well as intervention programs on stress reduction in children and adolescents with obesity.

KEY MESSAGES

There is evidence that stress exposure in childhood and adolescence promotes biological and behavioral alterations that contribute to the multifactorial pathogenesis of obesity. COVID-19 related-stress presents the most current example of a negative influence on weight development in children and adolescents. However, longitudinal studies on the linkage between environmental, behavioral, and biological factors across development are few, and results are partly equivocal. Intervention programs to reduce stress in children through mindfulness might be a promising adjunctive tool in the prevention and treatment of childhood and adolescent obesity that could further offer proof of concept of theoretically elaborated cause-and-effect relationships.

Stress and eating responses in adolescent females predisposed to obesity: A pilot and feasibility study

OBJECTIVE

To explore how chronic stress, reactivity to acute stress, and obesogenic eating are linked in adolescent females predisposed to obesity.

METHODS

Participants included 21 adolescent females (m_age = 14.57 years) and their biological mothers with obesity (body mass index [BMI] ≥ 30 kg/m²). The pilot and feasibility study involved adolescent self-report of chronic stress, an acute stress-induction paradigm (Trier Social Stress Task, TSST), salivary cortisol collection to assess stress reactivity, and both subjective (self-report) and objective (snack buffet) measures of obesogenic eating.

RESULTS

Adolescent females reporting high chronic stress were significantly more likely to engage in self-reported emotional and external eating and to have higher food cravings (p's < .05) compared to adolescents with low chronic stress. Effect size estimates suggested a blunting effect of cortisol in the high chronic stress group. Blunted cortisol reactivity significantly predicted higher self-reported food cravings for the high chronic stress group (p = .04). Associations among chronic stress, cortisol, and self-reported and objective obesogenic eating reflected medium to large effect sizes.

CONCLUSIONS

This study built on limited extant research on stress and eating to demonstrate that chronic stress was associated with self-reported obesogenic eating patterns in adolescent females predisposed to obesity. Different patterns of cortisol reactivity and eating emerged depending on chronic stress group (low versus high). Understanding these eating patterns in the context of chronic stress can inform interventions to reduce obesity risks in adolescence.

Associations Between Different Cortisol Measures and Adiposity in Children: A Systematic Review and Meta-Analysis

This study examined associations between hair, salivary, serum, and urinary cortisol concentration with adiposity-related indicators in children, and explored their potential effects modification by age, sex, cortisol measurement method, and country developmental context. We systematically searched PubMed, Web of Science, and Embase for studies examining at least one of the four aforementioned cortisol with objectively measured adiposity-related outcomes in children. Meta-analyses of cross-sectional studies revealed that hair cortisol concentration was associated with fat mass index (FMI)-standard deviation score (SDS)/FMI z-score (pooled-β = 0.04, 95% CI: 0.01, 0.08) and BMI/BMI z-score (pooled-β = 0.15, 95% CI: 0.06, 0.25), and these associations were significant among children aged ≤ 12 years (pooled-β = 0.15, 95% CI: 0.05, 0.26) and >12 years (pooled-β = 0.13, 95% CI: 0.04, 0.22), children from developed countries (pooled β = 0.12, 95% CI: 0.03, 0.21) and developing countries (pooled-β = 0.193, 95% CI: 0.188, 0.198), and in studies extracting cortisol via LC-MS/MS (pooled-β = 0.18, 95% CI: 0.06, 0.29) but not ELISA (pooled-β = 0.08, 95% CI: −0.06, 0.22). Meta-analyses of both cohort and cross-sectional studies revealed non-significant associations of morning salivary cortisol concentration and total daily cortisol output with BMI/BMI z-score. Serum cortisol concentration was not associated with BMI or waist circumference. Meta-analysis of urinary cortisol concentration and adiposity was hindered by insufficient data. These findings further corroborate understanding of chronic stress’ physiological contribution to increased pediatric obesity risk.

Serum adiponectin and cortisol levels are not affected by studied ADIPOQ gene variants: Tehran lipid and glucose study

BACKGROUND

Obesity is a major public health concern in developed and even developing countries worldwide. Adiponectin is a protein secreted by adipose tissue that modulates many metabolic processes and plays a vital role in obesity. This study aimed to determine the association of four variants of the ADIPOQ gene with serum adiponectin, cortisol levels and obesity status.

METHODS

This case-control study was performed on 164 obese individuals compared by 156 control from the Tehran Lipid and Glucose Study (TLGS). Standard procedures obtained anthropometric measures and metabolic parameters. Cortisol and adiponectin levels were measured by ELISA method. rs1501299, rs266729, rs17300539, and rs17366743 on the ADIPOQ gene were genotyped using the PCR-RFLP. The correlation between adiponectin gene SNPs and obesity were calculated by Additive, dominant, and recessive genetic models. Pearson's or Spearman's found correlations between adiponectin levels and metabolic and anthropometric variables. Data were analyzed using SPSS software Version 20.

RESULTS

Adiponectin and cortisol levels were significantly lower in obese subjects compared to the control group (p < 0.05). There was a significant negative correlation between serum adiponectin level and BMI, waist circumference (WC), waist-hip ratio, hip circumference (HC), Fasting blood sugar (FBS) Triglyceride (TG), Total cholesterol (TC), Systolic blood pressure (SBP), Diastolic blood pressure (DBP) (r = - 0.147, r = - 0.324, r = 0.371, r = - 0.179, r = - 0.299, r = - 0.277, r = - 0.041, r = - 0.134, and r = - 0.149, respectively). A positive correlation was found between adiponectin and high-density lipoprotein cholesterol (HDL-C) (r = 0.29), but no significant correlations were found between adiponectin and Low-density lipoprotein cholesterol(LDL-C) and cortisol. ADIPOQ variant rs1501299 was significantly associated with cortisol levels in subjects with BMI ≥ 25 (P-value =0.039).

CONCLUSIONS

Adiponectin and cortisol levels were associated with obesity. No ADIPOQ gene variants and haplotypes were associated with cortisol, Adiponectin, and obesity.

Impact of loneliness on diurnal cortisol in youth

Loneliness is associated with multiple forms of psychopathology in youth. However, we do not yet know how loneliness gets "under the skin" in ways that may impact the long-term health and development of early adolescents. In particular, loneliness may influence youths' patterns of diurnal cortisol, an index of hypothalamic-pituitary-adrenal (HPA) axis functioning and a central predictor of health across the lifespan. The current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, or COVID-19) pandemic represents a salient period in which to study the consequences of loneliness, as recent work has provided evidence that the physical-distancing measures put in place to contain the virus have resulted in greater loneliness, particularly among youth. Thus, the current study aimed to examine the prospective association between loneliness during the COVID-19 pandemic and diurnal cortisol in early adolescents. We found that greater loneliness was associated with higher levels of cortisol at waking and a blunted cortisol awakening response (CAR). These results held even when controlling for covariates that can influence diurnal trajectories of cortisol. Critically, this pattern of HPA-axis functioning increases risk for adverse mental and physical health outcomes across adolescence and into adulthood. This study is the first to examine the prospective association between loneliness and diurnal cortisol in early adolescence, and the first to identify mechanisms that contribute to biological markers of distress during the COVID-19 pandemic. Findings underscore the importance of developing and distributing strategies to mitigate feelings of loneliness among youth.

A Researcher's Guide to the Measurement and Modeling of Puberty in the ABCD Study® at Baseline

The Adolescent Brain Cognitive Development℠ (ABCD) Study is an ongoing, diverse, longitudinal, and multi-site study of 11,880 adolescents in the United States. The ABCD Study provides open access to data about pubertal development at a large scale, and this article is a researcher's guide that both describes its pubertal variables and outlines recommendations for use. These considerations are contextualized with reference to cross-sectional empirical analyses of pubertal measures within the baseline ABCD dataset by Herting, Uban, and colleagues (2021). We discuss strategies to capitalize on strengths, mitigate weaknesses, and appropriately interpret study limitations for researchers using pubertal variables within the ABCD dataset, with the aim of building toward a robust science of adolescent development.

Altered glucocorticoid metabolism in girls with central obesity

BACKGROUND

Dysregulation of glucocorticoid metabolism is known to be a causative factor of obesity. However, only a few studies have evaluated the enzymatic activities involved in glucocorticoid metabolism in the pediatric population.

OBJECTIVE

To examine whether circulating glucocorticoid metabolites and their ratios reflecting the activities of metabolic enzyme are associated with obesity and body composition in girls.

METHODS

A total of 227 girls aged 7-13 years (131 control, 45 overweight, 51 obese) were enrolled in this study. Serum concentrations of glucocorticoids (11-deoxycortisol, cortisol, tetrahydrocortisol [THF], allo-THF, allo-dihydrocortisol [allo-DHF], and cortisone) were evaluated by gas chromatography-mass spectrometry. Enzyme activities corresponding to the ratios of cortisol and cortisone to their respective precursors and metabolites were also assessed.

RESULTS

Serum levels of allo-THF were significantly higher in obese girls compared with those in overweight and control girls (P = 0.018); however, concentrations of other cortisol metabolites were not significantly different between the groups studied. According to the severity of obesity, increasing trends in the metabolic ratios reflecting the activity of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) [(cortisol + allo-DHF + allo-THF + THF)/cortisone], relative 5α/5β-reductase [allo-THF/THF] activity, and 3α-HSD [allo-THF/allo-DHF] activity, were noted (P-for-trend <0.05). Body fat percentage and waist-to-height ratio positively correlated with the activities of 11β-HSD1 and 3α-HSD (P < 0.05). Following covariate control, girls with central obesity demonstrated significantly higher metabolic ratios reflecting 11β-HSD1, relative 5α/5β-reductase, and 3α-HSD activities (P < 0.05).

CONCLUSIONS

We found an altered glucocorticoid metabolism suggesting increased production of cortisol by 11β-HSD1 and increased metabolic clearance of cortisol catalyzed by 3α-HSD in girls with central obesity.

Stress coping strategies and stress reactivity in adolescents with overweight/obesity

This study explored the associations between the frequency and effectiveness of habitual stress coping strategies on physiological and psychological stress responses to an acute laboratory stressor in adolescents with overweight/obesity (51 adolescents; 47% female; ages 14-19 years). Coping strategies were assessed using the Schoolager's Coping Strategies Inventory. Acute physiological stress responses were measured as salivary cortisol and α-amylase output during the Trier Social Stress Test and during a control condition. Acute psychological stress was measured using a Likert-type scale, and systolic blood pressure (SBP) and heart rate were measured at baseline. Results revealed that higher coping effectiveness was associated with lower log-based α-amylase during the stress (β = -0.025, p = 0.018) and control (β = -0.030, p = 0.005) conditions, but not with cortisol across either condition (all ps > 0.05). SBP moderated the association between coping effectiveness and α-amylase during the stress condition, with higher coping effectiveness associated with lower α-amylase only among individuals with lower SBP (β = 0.002, p = 0.027). Coping frequency was not associated with cortisol responses, neither was habitual stress coping strategies associated with psychological stress (all ps > 0.05). These findings provide preliminary evidence that effective use of stress coping strategies may provide a dampening effect on sympathetic activity in an at-risk adolescent population.

Cognitive disengagement and biological stress responses in early adolescence

Individual differences in biological responses to stress increase risk for the onset and exacerbation of health and psychiatric conditions. Biases in cognitive disengagement are hypothesized to underlie these individual differences in biological responses to stress. However, no studies have examined which cognitive disengagement bias has the strongest relation with biological responses to stress, and no studies have examined this relation during early adolescence, despite evidence that this is a critical developmental window in which patterns of cognition and biological responses to stress influence trajectories of health throughout life. The current study is the first to test whether difficulty disengaging attention versus working memory from valenced stimuli is associated with biological responses to stress in early adolescence. Youth between 11 and 13 years of age completed two computer-based tasks to assess biases in attention and working memory disengagement to valenced stimuli, and then completed a standardized psychosocial stressor. Consistent with expectations, attention and working memory disengagement biases were associated with stress responses of both the neuroendocrine and autonomic nervous systems, but bias valence and cognitive system influenced the directionality of results. These findings inform our understanding of cognitive mechanisms that influence biological stress reactivity.

Cesarean delivery and infant cortisol regulation

BACKGROUND

Cesarean delivery reduces the risk of infant and maternal morbidity and mortality when medically indicated, however, the cesarean delivery rate is estimated to be two to three times higher than medically necessary. The World Health Organization and American College of Obstetricians and Gynecologists have expressed concern over the high rates of cesarean delivery, citing evidence that cesarean delivery has negative short- and long-term consequences for the health of the infant, mother, and for future pregnancies. Infants delivered by cesarean are at an increased risk of metabolic disease and immune dysfunction throughout the lifespan. Preliminary research suggests that the hypothalamic pituitary adrenal (HPA) axis is a plausible pathway linking cesarean delivery to poor health later in life. The present study examines the relation between mode of delivery and HPA axis function in six-month-old infants. We also examine whether the cesarean delivery was elective or indicated altered to the relation between mode of delivery and infant cortisol profiles.

METHODS

The sample included 136 mother/infant pairs. Thirty-nine women delivered by cesarean and 97 delivered vaginally. Maternal and infant medical records were reviewed for prenatal medical history and birth outcomes. Infant saliva was collected for cortisol analysis at a 6-month well-baby checkup. Samples were collected upon arrival to the appointment (baseline) and 20 min after exposure to a painful stressor, the inoculation procedure (response). A mixed model ANCOVA was conducted to determine whether salivary cortisol concentrations differed between the two delivery groups. To examine whether complications related to having an indicated cesarean delivery contributed to any association between mode of delivery and cortisol production, cortisol concentrations were compared between the subgroup of infants whose cesarean deliveries were elective (e.g. maternal request or previous cesarean delivery) to infants delivered vaginally.

RESULTS

Infants delivered by cesarean had lower cortisol concentrations at baseline and after the inoculation procedure compared to those delivered vaginally. Further, the relation between mode of delivery and cortisol levels persisted even when the analyses were restricted to compare only the elective cesarean deliveries (e.g. maternal request or previous cesarean delivery) to those delivered vaginally.

DISCUSSION

This study provides evidence for an association between cesarean delivery and infant HPA axis function in infancy. Findings are consistent with the hypothesis that the HPA axis is a plausible pathway that links cesarean delivery with long-term health outcomes.

Stress and Health: A Review of Psychobiological Processes

The cumulative science linking stress to negative health outcomes is vast. Stress can affect health directly, through autonomic and neuroendocrine responses, but also indirectly, through changes in health behaviors. In this review, we present a brief overview of (a) why we should be interested in stress in the context of health; (b) the stress response and allostatic load; (c) some of the key biological mechanisms through which stress impacts health, such as by influencing hypothalamic-pituitary-adrenal axis regulation and cortisol dynamics, the autonomic nervous system, and gene expression; and (d) evidence of the clinical relevance of stress, exemplified through the risk of infectious diseases. The studies reviewed in this article confirm that stress has an impact on multiple biological systems. Future work ought to consider further the importance of early-life adversity and continue to explore how different biological systems interact in the context of stress and health processes.

Role Fulfillment Mediates the Association Between Daily Family Assistance and Cortisol Awakening Response in Adolescents

Family assistance (helping the family) is associated with both positive and negative psychological and biological outcomes during adolescence. However, the association between family assistance and the hypothalamic-pituitary-adrenal (HPA) axis remains unstudied. Thus, we assess how helping the family relates to adolescents' diurnal cortisol, an index of HPA activity, and psychological outcomes. Three hundred and seventy ethnically diverse adolescents (ages 11-18) reported daily helping behaviors and psychological experiences for 14 days and provided four saliva samples per day for 4 days. Multilevel modeling revealed that cortisol awakening response was lower the day after adolescents helped their families more. This association was explained, in part, by perceived role fulfillment (feeling like a good son, daughter, and sibling). Results highlight a possible psychological and biological benefit of assisting the family during adolescence.

Biobehavioral Dysregulation and its Association with Obesity and Severe Obesity Trajectories from 2 to 15 Years of Age: A Longitudinal Study

OBJECTIVE

This study aimed to identify obesity trajectories from childhood to adolescence (2-15 years of age) and investigate differences in behavioral, eating, and adrenocortical regulation by trajectory membership.

METHODS

A total of 1,077 households from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were included. Anthropometrics were measured 11 times between ages 15 months and 15 years. Behavioral self-regulation was assessed at ages 3 and 4 years. Disordered eating behaviors and awakening cortisol were assessed at age 15 years.

RESULTS

Latent growth curve modeling identified four BMI trajectories: two nonoverweight trajectories based on average BMI at the 40th and 70th percentiles and overweight/obesity and severe obesity trajectories. Youth in the severe obesity trajectory exhibited lower behavioral self-regulation in early childhood and lower awakening cortisol at age 15 years compared with youth in the nonoverweight trajectories. Youth in the overweight/obesity and severe obesity trajectories showed higher levels of disordered eating behaviors at age 15 years.

CONCLUSIONS

Obesity trajectories were associated with biobehavioral markers of dysregulation in early childhood and adolescence. Dysregulation across biobehavioral domains was particularly apparent among youth who developed severe obesity. Further work is needed to better understand resilience factors that distinguish youth who develop obesity and severe obesity from those who do not.

The synergic relationship between social anxiety, depressive symptoms, poor sleep quality and body fatness in adolescents

BACKGROUND

The aim of the current study was to evaluate the cross-sectional synergic relationship among social anxiety, poor sleep quality, depressive symptoms and body fatness.

METHODS

A cross-sectional study was performed with 1,242 adolescents from a north-eastern district in Brazil. It was used the Social Anxiety Scale for Adolescents for symptoms of social anxiety, the Pittsburgh Sleep Quality Index for sleep quality and the Depression Scale of the Center for Epidemiologic Studies for depressive symptoms. Body fatness was the sum of triceps and subscapular skinfolds. Structural equation modelling was used to evaluate associations among these comorbidities.

RESULTS

Social anxiety was directly and positively associated with depressive symptoms, poor sleep quality and body fatness (β = 0.316 standard deviations [SD]; β = 0.299 SD; β = 0.072 SD, respectively). Moreover, social anxiety was indirectly associated with depressive symptoms via poor sleep quality (β = 0.113 SD). Poor sleep quality was directly associated with depressive symptoms (β = 0.377 SD). We did not observe a significant relationship of poor sleep quality and depressive symptoms with body fatness.

LIMITATIONS

This is a cross-sectional study; therefore, we cannot infer causality in the interpretation of the findings.

CONCLUSIONS

Social anxiety seemed to play pivotal role in adolescents' health, since it was associated with poor sleep quality, depressive symptoms and body fatness. Interventions targeting sleep quality, depressive symptoms and body fatness in adolescents should designate relevant effort addressing social anxiety.

Diurnal cortisol and obesity in adolescents with and without Down syndrome

BACKGROUND

The prevalence of obesity in adolescents with Down syndrome (DS) far exceeds that in the general population. Cortisol, an adrenal hormone, can be obesogenic when dysregulated. However, the diurnal patterns of this hormone have not been examined among individuals with DS. Variations in adiposity may also mediate cortisol regulation. This study sought to examine diurnal cortisol patterns in adolescents with DS as well as associations between cortisol function and obesity.

METHOD

A total of 32 adolescents, including 16 with DS and 16 controls with typical development (TD) of similar sex, age and Tanner pubertal stage (P > 0.05), participated in this preliminary study. Participants completed a dual-energy X-ray absorptiometry scan to measure body composition and collected saliva samples for cortisol measurements in the morning, afternoon and night. Linear mixed models with random intercepts and repeated measures were used to examine the daily trajectory of log-transformed cortisol concentrations between adolescents with and without DS. A second model examined the interaction between DS and presence of elevated body fatness.

RESULTS

Adolescents with DS had higher morning cortisol concentrations (intercept = 0.37 μg/dL), but this was not significantly different than in TD (0.35 μg/dL, P = 0.16). Cortisol significantly declined across hours (b = -0.026 μg/dL/h, P < 0.001), but this decline also did not differ from that observed in TD (b = -0.024 μg/dL/h, P = 0.43). While cortisol levels were slightly higher among adolescents with elevated body fatness, this difference was not statistically significant (P > 0.05; d = 0.30).

CONCLUSIONS

This study is the first to examine diurnal cortisol in DS but is limited in sample size. These preliminary findings suggest that diurnal cortisol patterns are not significantly different between adolescents with DS and TD and that cortisol levels are not associated with adiposity in this population. Despite these non-significant differences, youth with DS continue to be an 'at-risk' population for paediatric obesity in need of clinical intervention.

Child depressive symptoms: Associations with salivary cortisol and alpha amylase in two distinct challenges

Child depression has been inconsistency linked to cortisol and salivary alpha-amylase (sAA) reactivity. This study assessed three factors that contribute to inconsistencies: 1) the differential effectiveness of laboratory challenges to elicit cortisol and sAA; 2) the impact of cortisol-sAA coordination; and 3) variation in parent versus child ratings of depression. A community sample of 52 children participated in the Trier Social Stress Test-Child Version (TSST-C) and a competition challenge. Saliva was collected and assayed for cortisol and sAA. Analyses were conducted using multilevel modeling. Child-reported depressive symptoms were associated with a declining cortisol trajectory in the TSST-C. Mother-reported depressive symptoms were associated with higher baseline sAA in the TSST-C and the competition challenge. Further, child-reported depressive symptoms were associated with cortisol-sAA coordination in the competition challenge. Findings underscore the nature of the challenge and the behavioral informant as impacting associations between child depressive symptoms and cortisol and sAA secretion.

Negative affect amplifies the relation between appetitive-food-related neural responses and weight gain over three-year follow-up among adolescents

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Interaction of negative affect and hippocampal food-image response predicts BMI gain.

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Interaction of negative affect, vermis and precuneus food response predicts BMI gain.

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Interaction of stress and middle occipital gyrus milkshake response predicts BMI gain.

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Weight gain associated with restrained eating and eating-disorder related behavior.

Obesity is a major public health concern that is associated with disruption in food reward-related brain function. This study examined if negative affect and stressful events enhance the relation between the food reward-related neural response and future weight gain. Initially healthy weight adolescents (N = 135) completed fMRI paradigms in which they tasted milkshakes and viewed palatable food images, and reported on negative affect and stressful events at baseline; BMI was measured annually over 3-year follow-up. Whole-brain analyses revealed that among participants with higher negative affect, weight gain over 3-year follow-up was predicted by elevated response to appetitive versus unappetitive food images in the left hippocampus, and elevated response in the vermis and the bilateral precuneus to tastes of milkshake versus tasteless solution. Among participants who experienced more stressful events, elevated right middle occipital gyrus response to milkshakes predicted future weight gain. Profiling analyses suggested that participants with higher negative affect or more stressful events who later gained weight reported engaging in more restrained eating and eating disorder-related behaviors. Results suggest that negative affect or stressful events may amplify the relation of neural response to food and the risk for future weight gain.

No Association between Glucocorticoid Diurnal Rhythm in Breastmilk and Infant Body Composition at 3 Months

Objective: Glucocorticoids (GCs) in breastmilk have previously been associated with infant body growth and body composition. However, the diurnal rhythm of breastmilk GCs was not taken into account, and we therefore aimed to assess the associations between breastmilk GC rhythmicity at 1 month and growth and body composition at 3 months in infants. Methods: At 1 month postpartum, breastmilk GCs were collected over a 24-h period and analyzed by LC-MS/MS. Body composition was measured using air-displacement plethysmography at 3 months. Length and weight were collected at 1, 2, and 3 months. Results: In total, 42 healthy mother–infant pairs were included. No associations were found between breastmilk GC rhythmicity (area-under-the-curve increase and ground, maximum, and delta) and infant growth trajectories or body composition (fat and fat free mass index, fat%) at 3 months. Conclusions: This study did not find an association between breastmilk GC rhythmicity at 1 month and infant’s growth or body composition at 3 months. Therefore, this study suggests that previous observations linking breastmilk cortisol to changes in infant weight might be flawed by the lack of serial cortisol measurements and detailed information on body composition.

Longitudinal associations between overweight/obesity and stress biology in low-income children

Background/Objectives

Associations between overweight and altered stress biology have been reported cross-sectionally during childhood, but it is unclear whether overweight precedes altered stress biology or if altered stress biology predicts greater likelihood of overweight over time. The current longitudinal study investigates associations between overweight/obesity, salivary alpha amylase and cortisol morning intercept, diurnal slope, and reactivity to social stress in a cohort of low-income children during preschool and middle childhood.

Subjects/Methods

Children were recruited through Head Start and were observed and followed into middle childhood (N = 257; M = 8.0 years). Height and weight were measured at both time points. Saliva samples were collected across the day and in response to a social challenge at both ages for alpha amylase and cortisol determination.

Results

Cross-lagged panel analyses indicated that overweight/obesity at preschool predicted lower morning alpha amylase (β = −0.18, 95% CI: −0.34, −0.03; p = .023), lower morning cortisol (β = −0.22, 95% CI: −0.38, −0.06; p = .006), lower sAA diurnal slope (β = −0.18, 95% CI: −0.34, −0.03; p = .021), and lower cortisol stress reactivity (β = −0.19, 95% CI: −0.35, −0.02; p = .031) in middle childhood. Lower alpha amylase reactivity at preschool was the only biological factor that predicted higher likelihood of overweight/obesity at middle childhood (β = −0.20, 95% CI: −0.38, −0.01; p = .035).

Conclusions

These findings suggest that overweight/obesity may be driving changes in stress biology across early to middle childhood, particularly in down-regulation of morning levels of stress hormones, diurnal sAA slope, and cortisol reactivity to stress, rather than stress biology driving overweight/obesity.

Maternal early pregnancy body mass index and diurnal salivary cortisol in young adult offspring

Background Maternal early pregnancy overweight (body mass index [BMI] 25.0-29.9 kg/m²) and obesity (BMI ≥ 30 kg/m²) are associated with mental and physical health adversities in the offspring. Prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis has been put forward as one of the mechanisms that may play pathophysiological role. However, evidence linking maternal overweight and obesity with offspring HPA-axis activity is scarce. We studied if maternal early pregnancy BMI is associated with diurnal salivary cortisol, a marker of HPA-axis activity, in young adult offspring. Methods At a mean age of 25.3 (standard deviation [SD) = 0.6) years, 653 Arvo Ylppö Longitudinal Study participants collected saliva samples for cortisol analyses, at awakening, 15 and 30 min thereafter, 10:30AM, 12:00PM, 5:30PM and at bedtime. Maternal BMI was calculated from weight and height verified by a measurement in the first antenatal clinic visit before 12 weeks of gestation derived from healthcare records. Results Per each one kg/m² higher maternal early pregnancy BMI offspring diurnal average salivary cortisol was -1.4% (95% CI:-2.6, -0.2, p_FDR = 0.033) lower, at awakening it was -2.4% (95% CI:-4.0, -0.7, p_FDR = 0.025) lower and the morning average salivary cortisol was -2.0% (95% CI:-3.4, -0.5, p_FDR=0.017) lower. These associations were independent of the offspring's own young adulthood BMI, and other important covariates. Conclusion Our findings show that young adult offspring born to mothers with higher early pregnancy BMI show lower average levels of diurnal cortisol, especially in the morning. Whether these findings reflect prenatal programming of the offspring HPA-axis activity warrants further investigation.

Influence of Acute Physical Activity on Stress Reactivity in Obese and Normal Weight Children: A Randomized Controlled Trial

OBJECTIVE

Physical activity (PA) may influence acute stress reactivity in children differently depending on their weight. This randomized controlled trial investigated the impact of acute PA and of BMI status (overweight/obese (OB/OW) and normal weight (NW) on stress reactivity.

METHOD

50 prepubertal children (24 OW/OB and 26 NW) were randomly assigned to the PA or sedentary arm (SED) for 30 min followed by a stress task. Salivary cortisol, blood pressure (BP), and heart rate (HR) were measured.

RESULTS

An interaction effect between the randomization arms and weight status on salivary cortisol was found after the stress task (p = 0.04). Cortisol increased in the SED, but not in the PA arm (p = 0.004 for differences in time course) of NW children. Time course did not differ between both arms in OW/OB children (p = 0.7). OW/OB SED children had a flat cortisol course, and levels were reduced compared to the NW SED or the OW/OB PA children (p ≤ 0.03). Systolic BP increased only in the SED arm (p = 0.01). HR was higher in the PA than in the SED arm during stress (p < 0.001) and showed different time courses (p = 0.006).

CONCLUSION

PA impacted on acute stress reactivity and influenced stress reactivity differently in NW and OW/OB children.

Racial/ethnic disparities in cortisol diurnal patterns and affect in adolescence

Racial/ethnic minorities are more vulnerable to mental and physical health problems, but we know little about the psychobiological underpinnings of these disparities. In this study, we examined racial/ethnic differences in cortisol diurnal patterns and affect as initial steps toward elucidating long-term health disparities. A racially/ethnically diverse (39.5% White, 60.5% minority) sample of 370 adolescents (57.3% female) between the ages of 11.9 and 18 years (M = 14.65 years, SD = 1.39) participated in this study. These adolescents provided 16 cortisol samples (4 samples per day across 4 days), allowing the computation of diurnal cortisol slopes, the cortisol awakening response, and diurnal cortisol output (area under the curve), as well as daily diary ratings of high-arousal and low-arousal positive and negative affect. Consistent with prior research, we found that racial/ethnic minorities (particularly African American and Latino youth) exhibited flatter diurnal cortisol slopes compared to White youth, F (1, 344.7) = 5.26, p = .02, effect size g = 0.25. Furthermore, African American and Asian American youth reported lower levels of positive affect (both high arousal and low arousal) compared to White youth. Racial/ethnic differences in affect did not explain differences in cortisol patterns, suggesting a need to refine our models of relations between affect and hypothalamic-pituitary-adrenocortical activity. We conclude by proposing that a deeper understanding of cultural development may help elucidate the complex associations between affect and hypothalamic-pituitary-adrenocortical functioning and how they explain racial/ethnic differences in both affect and stress biology.

Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes

Altered stress response theoretically contributes to the etiology of cardiometabolic disease. Mindfulness may be a protective buffer against the effects of stress on health outcomes by altering how individuals evaluate and respond to stress. We engaged adolescent girls at risk for developing Type 2 diabetes in a cold-pressor test in order to determine the relationship of dispositional mindfulness to cortisol response and subjective stress, including perceived pain and unpleasantness during the stressor, and negative affect following the stressor. We also evaluated mindfulness as a moderator of psychological distress (depressive/anxiety symptoms) and stress response. Participants were 119 girls age 12-17 years with overweight/obesity, family history of diabetes, and mild-to-moderate depressive symptoms. Greater mindfulness was associated with less perceived pain and negative affect, but was unrelated to cortisol response to the stressor. Regardless of mindfulness, greater depressive/anxiety symptoms related to a more blunted cortisol response. Mindfulness might promote better distress tolerance in adolescents at risk for diabetes by altering how youth perceive and relate to acute stress, rather than through altering the physiological stress response. At all levels of mindfulness, depressive/anxiety symptoms relate to greater blunting of cortisol response. Findings contribute to emerging literature on the role of mindfulness in promoting the mental and physical health and well-being of individuals at risk for Type 2 diabetes.

Does the cortisol awakening response link childhood adversity to adult BMI?

OBJECTIVES

Childhood adversity is a risk factor for the development of obesity in adulthood. Dysregulated hypothalamic-pituitary-adrenal (HPA) activity, which has been associated separately with both adverse childhood experiences and obesity, has been posited as a mechanism by which stressful experiences influence body mass index (BMI); however, this mechanism has not yet been tested longitudinally. The present study uses multireporter, longitudinal data across three time points to test whether the adolescent cortisol awakening response (CAR), an index of diurnal HPA activity, mediates the association between adversity in childhood and BMI in adulthood.

METHOD

Eighty-two youth, mothers, and fathers reported on adverse childhood experiences from middle childhood to late adolescence. During adolescence, youth provided saliva samples three times each morning across three days, which were assayed for cortisol to calculate CAR. During early adulthood, youth reported height and weight to calculate BMI.

RESULTS

Greater adversity predicted flatter CAR and higher young adult BMI. Flatter CAR partially mediated the association between childhood adversity and young adult BMI.

CONCLUSIONS

Stress-related alterations to HPA activity account in part for the childhood adversity-adult obesity link. Findings are consistent with theoretical models implicating HPA alterations as linking childhood adversity to metabolic and behavioral determinants of BMI in adulthood. (PsycINFO Database Record

Salivary Cortisol Does Not Correlate with Metabolic Syndrome Markers or Subjective Stress in Overweight Children

OBJECTIVE

Being overweight is a risk factor for metabolic syndrome in children, but not all overweight children develop metabolic syndrome. Cortisol excess from chronic psychological stress has been proposed as an independent risk factor for metabolic syndrome in this already at-risk population. The present study assesses the relationship of biochemical and body composition radiographic markers of metabolic syndrome to salivary cortisol and self-report of chronic psychological stress in a cohort of overweight children.

METHODS

This cross-sectional study took place in a multi-disciplinary pediatric obesity clinic at a tertiary care hospital, and involved fifteen children with BMI at or above the 85th percentile for age and sex, 10 of whom provided salivary cortisol samples. The main outcomes measured were salivary bedtime cortisol, first-waking cortisol, and cortisol awakening response (CAR-the rise in cortisol in the first half hour after waking); fasting serum triglycerides, HDL cholesterol, glucose and insulin for HOMA-IR; the ratio of abdominal fat to total body fat by DXA scan; and scores of validated stress and bullying questionnaires (PANAS-C, PSS, and SEC-Q).

RESULTS

In this pilot study, no correlation was found between salivary cortisol measures and questionnaire scores of subjective stress or bullying, and no correlation was found between any of these measures and markers of metabolic syndrome (dyslipidemia, insulin resistance, increased abdominal fat).

CONCLUSIONS

These results suggest that measures of psychological stress, whether biochemical or subjective, do not appear to predict risk of metabolic syndrome in overweight children. While ease of collection and demonstrated utility both in detection of pediatric Cushing disease and in adult psychological research make salivary cortisol assessment an attractive clinical tool, further investigation into the value of salivary measures in pediatric stress research is needed.

The low single nucleotide polymorphism heritability of plasma and saliva cortisol levels

Cortisol is an important stress hormone affected by a variety of biological and environmental factors, such as the circadian rhythm, exercise and psychological stress. Cortisol is mostly measured using blood or saliva samples. A number of genetic variants have been found to contribute to cortisol levels with these methods. While the effects of several specific single genetic variants is known, the joint genome-wide contribution to cortisol levels is unclear. Our aim was to estimate the amount of cortisol variance explained by common single nucleotide polymorphisms, i.e. the SNP heritability, using a variety of cortisol measures, cohorts and analysis approaches. We analyzed morning plasma (n=5705) and saliva levels (n=1717), as well as diurnal saliva levels (n=1541), in the Rotterdam Study using genomic restricted maximum likelihood estimation. Additionally, linkage disequilibrium score regression was fitted on the results of genome-wide association studies (GWAS) performed by the CORNET consortium on morning plasma cortisol (n=12,597) and saliva cortisol (n=7703). No significant SNP heritability was detected for any cortisol measure, sample or analysis approach. Point estimates ranged from 0% to 9%. Morning plasma cortisol in the CORNET cohorts, the sample with the most power, had a 6% [95%CI: 0-13%] SNP heritability. The results consistently suggest a low SNP heritability of these acute and short-term measures of cortisol. The low SNP heritability may reflect the substantial environmental and, in particular, situational component of these cortisol measures. Future GWAS will require very large sample sizes. Alternatively, more long-term cortisol measures such as hair cortisol samples are needed to discover further genetic pathways regulating cortisol concentrations.

Developmental origins of the human hypothalamic-pituitary-adrenal axis

INTRODUCTION

The developmental origins of disease or fetal programming model predicts that intrauterine exposures have life long consequences for physical and psychological health. Prenatal programming of the fetal hypothalamic-pituitary-adrenal (HPA) axis is proposed as a primary mechanism by which early experiences are linked to later disease risk. Areas covered: This review describes the development of the fetal HPA axis, which is determined by an intricately timed cascade of endocrine events during gestation and is regulated by an integrated maternal-placental-fetal steroidogenic unit. Mechanisms by which stress-induced elevations in hormones of maternal, fetal, or placental origin influence the structure and function of the emerging fetal HPA axis are discussed. Recent prospective studies documenting persisting associations between prenatal stress exposures and altered postnatal HPA axis function are summarized, with effects observed beginning in infancy into adulthood. Expert commentary: The results of these studies are synthesized, and potential moderating factors are discussed. Promising areas of further research highlighted include epigenetic mechanisms and interactions between pre and postnatal influences.

Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis

Changes in levels of the stress-sensitive hormone cortisol from morning to evening are referred to as diurnal cortisol slopes. Flatter diurnal cortisol slopes have been proposed as a mediator between chronic psychosocial stress and poor mental and physical health outcomes in past theory and research. Surprisingly, neither a systematic nor a meta-analytic review of associations between diurnal cortisol slopes and health has been conducted to date, despite extensive literature on the topic. The current systematic review and meta-analysis examined associations between diurnal cortisol slopes and physical and mental health outcomes. Analyses were based on 179 associations from 80 studies for the time period up to January 31, 2015. Results indicated a significant association between flatter diurnal cortisol slopes and poorer health across all studies (average effect size, r=0.147). Further, flatter diurnal cortisol slopes were associated with poorer health in 10 out of 12 subtypes of emotional and physical health outcomes examined. Among these subtypes, the effect size was largest for immune/inflammation outcomes (r=0.288). Potential moderators of the associations between diurnal cortisol slopes and health outcomes were examined, including type of slope measure and study quality indices. The possible roles of flatter slopes as either a marker or a mechanism for disease etiology are discussed. We argue that flatter diurnal cortisol slopes may both reflect and contribute to stress-related dysregulation of central and peripheral circadian mechanisms, with corresponding downstream effects on multiple aspects of biology, behavior, and health.

Is HPA axis reactivity in childhood gender-specific? A systematic review

BACKGROUND

In adults, hypothalamus-pituitary-adrenal (HPA) axis activity shows sexual dimorphism, and this is thought to be a mechanism underlying sex-specific disease incidence. Evidence is scarce on whether these sex differences are also present in childhood. In a meta-analysis, we recently found that basal (non-stimulated) cortisol in saliva and free cortisol in 24-h urine follow sex-specific patterns. We explored whether these findings could be extended with sex differences in HPA axis reactivity.

METHODS

From inception to January 2016, PubMed and EMBASE.com were searched for studies that assessed HPA axis reactivity in healthy girls and boys aged ≤18 years. Articles were systematically assessed and reported in the categories: (1) diurnal rhythm, (2) cortisol awakening response (CAR), (3) protocolled social stress tests similar or equal to the Trier Social Stress Test for children (TSST-C), (4) pharmacological (ACTH and CRH) stress tests, and (5) miscellaneous stress tests.

RESULTS

Two independent assessors selected 109 out of 6158 records for full-text screening, of which 81 studies (with a total of 14,591 subjects) were included. Studies showed that girls had a tendency towards a more variable diurnal rhythm (12 out of 29 studies), a higher CAR (8 out of 18 studies), and a stronger cortisol response to social stress tests (9 out of 21 studies). We found no evidence for sex differences in cortisol response after a pharmacological challenge or to miscellaneous stress tests.

DISCUSSION

Sex differences in HPA axis reactivity appear to be present in childhood, although evidence is not unequivocal. For a better evaluation of sex differences in HPA axis reactivity, standardization of protocols and reports of stress tests is warranted.

Associations between stress biology indicators and overweight across toddlerhood

Biological stress responses are proposed as a pathway through which stress exposure can "get under the skin" and lead to health problems, specifically obesity. Yet, it is not clear when such associations may emerge or whether they are bidirectional. Cortisol and salivary alpha amylase (sAA) were considered indicators of the biological stress response. We tested the longitudinal association between cortisol and sAA and weight in 215 low-income children at ages 21, 27, and 33 months (52% male; 46% non-Hispanic white). sAA and cortisol intercept and slope (representing morning level and rate of change across the day) were calculated for each age point using random effect models. Children were weighed and length measured and categorized as overweight versus normal weight (overweight defined as weight-for-length z-score ≥85th percentile for age and sex). Cross-lagged models stratified by sex and controlling for birthweight z-score tested the concurrent and cross-lagged associations between each of 4 indices of stress biology individually (cortisol and sAA intercept and slope) and overweight. Overweight status was correlated across time. Cortisol and sAA were correlated across occasions of measurement, though somewhat less strongly in boys. There were no concurrent associations between stress indicators and overweight. sAA at 27 months predicted greater risk of overweight at 33 months in girls, such that both lower sAA intercept and more rapidly increasing sAA at 27 months predicted greater risk of overweight at 33 months (β=-0.64, p<0.05 and β=1.09, p<0.05, respectively). For boys only, overweight at 21 months predicted lower sAA intercept at 27 months (β=-0.35, p<0.05). Findings suggest that longitudinal associations of stress biology and weight status may be present only on a limited basis very early in the lifespan.

Low-Grade Inflammation and Ambulatory Cortisol in Adolescents: Interaction Between Interviewer-Rated Versus Self-Rated Acute Stress and Chronic Stress

OBJECTIVE

To determine whether the association between self-rated or interviewer-rated recent acute stress exposures and low-grade inflammation and daily cortisol production in adolescents is moderated by chronic stress ratings.

METHODS

Acute and chronic stress exposures were assessed in 261 adolescents aged 13 to 16 years using a semistructured life stress interview. The negative impact of acute stressors was independently rated by both adolescents (self-rated) and interviewers (interviewer-rated). Markers of inflammation (interleukin (IL)-6, IL-1ra, C-reactive protein) were measured from peripheral blood samples obtained via antecubital venipuncture. Participants collected 4 saliva samples at home on each of 6 consecutive days for the analysis of diurnal salivary cortisol profiles.

RESULTS

There were no main effects of acute stressors (self- and interviewer-rated) and chronic family or peer stress on adolescent inflammation markers and cortisol (p values > .10). However, the interaction between interviewer-rated acute stress and chronic family stress was significantly associated with adolescent inflammation markers (IL-6, IL-1ra). Specifically, as chronic family stress increased, the association between acute stressor impact (interviewer-rated) and inflammation markers became more positive (IL-6 (B = .054, SE = .023, p = .022); IL-1ra (B = .030, SE = .014, p = .034)). Interactions between self-rated acute stress and chronic family stress were not associated with any biological measures (p values > .10). Interactions between acute stressor impact (both self- and interviewer-rated) and chronic peer stress were also not significantly associated with any biological measures (p values > .05).

CONCLUSIONS

Among adolescents, interviewer-based ratings of acute stressor impact may allow for better prediction of health-relevant inflammation markers than adolescents' own ratings.

Associations between circadian and stress response cortisol in children

Hypothalamic-pituitary-adrenal (HPA) axis functioning is characterized by the baseline production of cortisol following a circadian rhythm, as well as by the superimposed production of cortisol in response to a stressor. However, it is relatively unknown whether the basal cortisol circadian rhythm is associated with the cortisol stress response in children. Since alterations in cortisol stress responses have been associated with mental and physical health, this study investigated whether the cortisol circadian rhythm is associated with cortisol stress responses in 6-year-old children. To this end, 149 normally developing children (M_age = 6.09 years; 70 girls) participated in an innovative social evaluative stress test that effectively provoked increases in cortisol. To determine the cortisol stress response, six cortisol saliva samples were collected and two cortisol stress response indices were calculated: total stress cortisol and cortisol stress reactivity. To determine children's cortisol circadian rhythm eight cortisol circadian samples were collected during two days. Total diurnal cortisol and diurnal cortisol decline scores were calculated as indices of the cortisol circadian rhythm. Hierarchical regression analyses indicated that higher total diurnal cortisol as well as a smaller diurnal cortisol decline, were both uniquely associated with higher total stress cortisol. No associations were found between the cortisol circadian rhythm indices and cortisol stress reactivity. Possible explanations for the patterns found are links with children's self-regulatory capacities and parenting quality.

Cortisol response to an induction of negative affect among adolescents with and without loss of control eating

BACKGROUND

Adults with binge eating disorder may have an exaggerated or blunted cortisol response to stress. Yet, limited data exist among youth who report loss of control (LOC) eating, a developmental precursor to binge eating disorder.

METHODS

We studied cortisol reactivity among 178 healthy adolescents with and without LOC eating. Following a buffet lunch meal adolescents were randomly assigned to watch a neutral or sad film clip. After, they were offered snacks from a multi-item array to assess eating in the absence of hunger. Salivary cortisol was collected at -80, 0, 30 and 50 min relative to film administration, and state mood ratings were reported before and after the film.

RESULTS

Adolescents with LOC had greater increases in negative affect during the experimental paradigm in both conditions (ps > 0.05). Depressive symptoms, but not LOC, related to a greater cortisol response in the sad film condition (ps > 0.05). Depressive symptoms and state LOC were related to different aspects of eating behaviour, independent of film condition or cortisol response (ps > 0.05).

CONCLUSIONS

A film clip that induced depressed state affect increased salivary cortisol only in adolescents with more elevated depressive symptoms. Adolescents with and without LOC were differentiated by greater increases in state depressed affect during laboratory test meals but had no difference in cortisol reactivity. Future studies are required to determine if adolescents with LOC manifest alterations in stress reactivity to alternative stress-inducing situations.

Intimate partner violence and diurnal cortisol patterns in couples

This study examined whether physical intimate partner violence (IPV) victimization was associated with diurnal patterns of salivary cortisol in a community sample of 122 couples in their 30s from predominantly lower socioeconomic status backgrounds. Findings indicate that women with higher levels of victimization exhibited flatter patterns of diurnal cortisol characterized by both higher midday levels and more attenuated decreases in cortisol levels across the day, compared to women with lower levels of victimization. However, men's victimization was not associated with their diurnal cortisol levels. This study advances our understanding of the association between physical IPV victimization and dysregulated hypothalamic-pituitary-adrenal (HPA) axis functioning in women, which is likely to have further implications for their subsequent mental and physical health.

Adolescent adrenocortical activity and adiposity: differences by sex and exposure to early maternal depression

Prior research has linked either basal cortisol levels or stress-induced cortisol responses to adiposity; however, it remains to be determined whether these distinct cortisol measures exert joint or independent effects. Further, it is unclear how they interact with individual and environmental characteristics to predict adiposity. The present study aims to address whether morning cortisol levels and cortisol responses to a psychosocial stressor independently and/or interactively influence body mass index (BMI) in 218 adolescents (117 female) participating in a longitudinal community study, and whether associations are moderated by sex and exposure to early maternal depression. Reports of maternal depressive symptoms were obtained in infancy and preschool. Salivary cortisol measures included a longitudinal morning cortisol measure comprising sampling points across ages 11, 13, 15, and 18 and measures of stress-induced cortisol responses assessed via the Trier Social Stress Test (TSST) at age 18. Lower morning cortisol and higher TSST cortisol reactivity independently predicted higher age 18 BMI. Morning cortisol also interacted with sex and exposure to early maternal depression to predict BMI. Specifically, girls exposed to lower levels of early maternal depression displayed a strong negative morning cortisol-BMI association, and girls exposed to higher levels of maternal depression demonstrated a weaker negative association. Among boys, those exposed to lower levels of maternal depression displayed no association, while those exposed to higher levels of maternal depression displayed a negative morning cortisol-BMI association. Results point to the independent, additive effects of morning and reactive cortisol in the prediction of BMI and suggest that exposure to early maternal depression may exert sexually dimorphic effects on normative cortisol-BMI associations.