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Antoniotti V, Amore M, Caputo M, Fania C, Mancioppi V, Casoli G, Tini S, Antonioli A, Aimaretti G, Rabbone I, Bellone S, Prodam F. Glucose Alterations, Insulin Resistance, Arterial Hypertension, and Renin are Strictly Associated in Pediatric Obesity. J Endocr Soc 2023; 7:bvad088. [PMID: 37424701 PMCID: PMC10326241 DOI: 10.1210/jendso/bvad088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Indexed: 07/11/2023] Open
Abstract
Context Insulin resistance, glucose alterations, arterial hypertension (HTN), and the renin-angiotensin-aldosterone system (RAAS) are related in adult obesity. This crosstalk is still unexplored in childhood. Objective Characterize the relationships of fasting and postload glucose and insulin levels with new American Academy of Pediatrics classification of HTN and RAAS in pediatric obesity. Methods This was a retrospective observational study; 799 pediatric outpatients (11.4 ± 3.1 years) at a tertiary center who were overweight or obese and not yet on diet were included. The main outcome measures were mean and correlations among parameters of a complete clinical and metabolic screening (body mass index, blood pressure, and glucose and insulin levels during an oral glucose tolerance test, and renin and aldosterone levels and their ratio). Results 774 subjects had all the parameters, of whom 87.6% had HTN (5% elevated blood pressure, 29.2% stage I HTN, and 53.4% stage II HTN). Eighty subjects had 1 or more glucose alterations, and more frequently presented HTN. Blood pressure levels were higher in subjects with glucose alterations than in those with normal glucose levels. Fasting and stimulated glucose and insulin levels were directly related to the HTN stages, and insulin sensitivity was lower in HTN than in normal blood pressure. Aldosterone, renin, and aldosterone-renin ratio (ARR) were similar in sexes, whereas aldosterone was higher in prepubertal individuals. Subjects with impaired glucose tolerance (IGT) had higher renin and lower ARR. Renin was positively correlated with postload glucose, and ARR was negatively correlated with the Homeostatic Model Assessment for Insulin Resistance index. Conclusion A close relationship exists among insulin resistance, glucose alterations, HTN, and renin in childhood obesity. Specific categories of risk could provide indicators for strict clinical surveillance.
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Affiliation(s)
- Valentina Antoniotti
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Martina Amore
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Marina Caputo
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Chiara Fania
- SCDU Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Valentina Mancioppi
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Gloria Casoli
- SCDU Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Sabrina Tini
- Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Alessandro Antonioli
- Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Ivana Rabbone
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Simonetta Bellone
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Flavia Prodam
- Correspondence: Flavia Prodam, MD, PhD, Department of Health Sciences, SCDU Endocrinology, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy.
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Toledo-Corral CM, Ding L, Morales JC, Chapman TM, Romero MB, Weigensberg MJ. Morning Serum Cortisol Is Uniquely Associated with Cardiometabolic Risk Independent of Body Composition in Latino Adolescents. Metab Syndr Relat Disord 2023; 21:214-221. [PMID: 37042653 PMCID: PMC10181798 DOI: 10.1089/met.2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Background: Alterations in morning serum cortisol (MSC) have been associated with higher cardiometabolic risk. This finding has been documented primarily in populations with overweight or obesity; however, it has not been clearly established if obesity plays a requisite role in this relationship. This study seeks to extend earlier findings by examining whether body composition measures alter the relationship between MSC with glucose and insulin markers, blood pressure, and lipid parameters in Latino youth in middle adolescence. Methods: This cross-sectional study included 196 healthy adolescents (130F/66M; mean age: 16.4 ± 0.6 years; 95% Latino; mean body mass index, BMI: 24.3 ± 5.7) from Los Angeles, California. Morning cortisol, glucose, insulin, glycated hemoglobin, and lipids (triglycerides and high-density lipoprotein cholesterol) were assessed from a fasting blood sample. Sitting systolic and diastolic blood pressure was averaged from duplicate measures. Body composition measures included BMI and waist circumference, which were used as proxies for total body and abdominal adiposity, respectively. Triplicate measurements of weight and height were averaged for calculation of BMI; age- and sex-specific BMI z-score was used to classify into normal BMI or overweight/obese BMI status. Waist circumference was measured in duplicate and the average was used to classify participants into two strata: normal/healthy waist circumference (<90th percentile for age, sex, and ethnicity) and high waist circumference (≥90th percentile). Results: The primary findings were that higher MSC was associated with higher fasting glucose and systolic blood pressure after adjusting for age, sex, and BMI z-score (and/or waist circumference). BMI status or waist circumference status did not alter these relationships. Main Conclusion: Our results suggest that the relationships between hypothalamic-pituitary-adrenal axis function and certain cardiometabolic risk factors may be independent of adiposity. Future research is warranted to discover the contributors and underlying mechanisms of these relationships in adolescent populations. ClinicalTrials.gov identifier: NCT02088294.
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Affiliation(s)
- Claudia M. Toledo-Corral
- Department of Health Sciences & Health Equity and Research Education (HERE) Center, California State University Northridge, Northridge, California, USA
| | - Li Ding
- Department of Population and Public Health Sciences and University of Southern California, Los Angeles, California, USA
| | - Jeremy C. Morales
- Department of Population and Public Health Sciences and University of Southern California, Los Angeles, California, USA
| | - Tiffany M. Chapman
- Department of Population and Public Health Sciences and University of Southern California, Los Angeles, California, USA
| | - Melyssa B. Romero
- Department of Population and Public Health Sciences and University of Southern California, Los Angeles, California, USA
| | - Marc J. Weigensberg
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
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Soltani H, Keim NL, Laugero KD. Waking Salivary Cortisol Associated with Magnitude of Cholesterol Reduction in Women Fed a Healthy Whole-Food Diet for 8 Weeks. Curr Dev Nutr 2022; 6:nzac083. [PMID: 35669046 PMCID: PMC9155168 DOI: 10.1093/cdn/nzac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 04/22/2024] Open
Abstract
Background Diet and cortisol are independently linked to cardiometabolic function and health, but underlying alterations in circulating cortisol may influence beneficial cardiometabolic effects of consuming a healthy diet. Objective This study was a secondary analysis to examine whether baseline concentrations of waking salivary cortisol interacted with 8-wk whole-food diet interventions to affect cardiometabolic outcomes. Methods A randomized, double-blind, controlled 8-wk diet intervention was conducted in 44 participants. The trial was conducted at the Western Human Nutrition Research Center in Davis, California. Participants were overweight or obese women aged 20-64 y, minimally active, and insulin resistant and/or dyslipidemic. Diets were randomly assigned and based on the 2010 Dietary Guidelines for Americans (DGA) or a typical American diet (TAD). Cardiometabolic risk factors and salivary cortisol were assessed at baseline and at 8 wk. Primary outcome measures included 8-wk change in overnight fasted cardiometabolic risk factors, including blood pressure, BMI, and circulating triglycerides, cholesterol, glycated hemoglobin (HbA1c), nonesterified fatty acids, and high-sensitivity C-reactive protein. This trial was approved by the University of California, Davis, Institutional Review Board. Results Baseline waking cortisol concentrations interacted (P = 0.0474) with diet to affect 8-wk changes in fasting total cholesterol. Compared with a TAD, a DGA diet was associated with 8-wk decreases in total cholesterol in participants with low (10th percentile of all participants; 2.76 nmol/L) or average (7.76 nmol/L) but not higher (90th percentile of all participants; 13.44 nmol/L) baseline waking cortisol. Consistent with this finding, there was a DGA-specific positive association (P = 0.0047; b: 2.88 ± 0.94) between baseline waking cortisol and 8-wk increases in total cholesterol. Conclusions The underlying status of waking cortisol may explain interindividual variability in total cholesterol responses to whole-food diets. This trial was registered at www.clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT02298725) as NCT02298725.
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Affiliation(s)
- Hoda Soltani
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Nancy L Keim
- Department of Nutrition, University of California, Davis, Davis, CA, USA
- Obesity and Metabolism Research Unit, USDA/Agricultural Research Service/Western Human Nutrition Research Center, Davis, CA, USA
| | - Kevin D Laugero
- Department of Nutrition, University of California, Davis, Davis, CA, USA
- Obesity and Metabolism Research Unit, USDA/Agricultural Research Service/Western Human Nutrition Research Center, Davis, CA, USA
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Martens A, Duran B, Vanbesien J, Verheyden S, Rutteman B, Staels W, Anckaert E, Gies I, De Schepper J. Clinical and biological correlates of morning serum cortisol in children and adolescents with overweight and obesity. PLoS One 2021; 16:e0258653. [PMID: 34669746 PMCID: PMC8528324 DOI: 10.1371/journal.pone.0258653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background and aim A fraction of children with obesity have increased serum cortisol levels. In this study, we describe the clinical characteristics of obese children and adolescents with elevated morning serum cortisol levels and the relationship between the cortisol levels and components of the metabolic syndrome. Methods Retrospective medical record review study of children aged 4 to 18 years with overweight or obesity seen for obesity management in the Pediatric Obesity Clinic of the UZ Brussel between 2013 and 2015. Results A total of 234 children (99 boys and 135 girls) with overweight (BMI z-score > 1.3) without underlying endocrine or genetic conditions were included. Mean (SD) age was 10.1 (2.8) years, BMI SD-score 2.5 (0.6), and body fat percentage 37% (7.9). Serum fasting cortisol levels were elevated (>180 μg/L) in 49 children, normal (62–180 μg/L) in 168, and decreased (<62 μg/L) in 12. Serum fasting cortisol was not significantly correlated with gender, age, or degree of adiposity. But correlated significantly with fasting glucose (Rs = 0.193; p < 0.005), triglycerides (Rs = 0. 143; p < 0.05), fibrinogen (Rs = 0.144; p < 0.05) and leptin levels (Rs = 0.145; p < 0.05). After adjustment for serum insulin and leptin, the correlation between serum cortisol and fasting glucose remained significant. Conclusion Elevated morning serum cortisol levels were found in 20% of overweight or obese children and adolescents, irrespective of the degree of adiposity, and were associated with higher fasting glucose, irrespective of underlying insulin resistance. The long-term cardiometabolic consequences of hypercortisolemia in childhood obesity needs further study.
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Affiliation(s)
- Anton Martens
- Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bünyamin Duran
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jesse Vanbesien
- Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stephanie Verheyden
- Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Rutteman
- Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Willem Staels
- Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Research group BENE, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Anckaert
- Department of Clinical Chemistry, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Inge Gies
- Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Research group GRON, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean De Schepper
- Division of Pediatric Endocrinology, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Research group BITE, Vrije Universiteit Brussel, Brussels, Belgium
- * E-mail:
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Nehmi VA, Murata GM, Moraes RCMD, Lima GCA, De Miranda DA, Radloff K, Costa RGF, Jesus JDCRD, De Freitas JA, Viana NI, Pimenta R, Leite KRM, Otoch JP, Pessoa AFM. A novel supplement with yeast β-glucan, prebiotic, minerals and Silybum marianum synergistically modulates metabolic and inflammatory pathways and improves steatosis in obese mice. JOURNAL OF INTEGRATIVE MEDICINE 2021; 19:439-450. [PMID: 34108131 DOI: 10.1016/j.joim.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/06/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the synergic effects of a novel oral supplement formulation, containing prebiotics, yeast β-glucans, minerals and silymarin (Silybum marianum), on lipid and glycidic metabolism, inflammatory and mitochondrial proteins of the liver, in control and high-fat diet-induced obese mice. METHODS After an acclimation period, 32 male C57BL/6 mice were divided into the following groups: nonfat diet (NFD) vehicle, NFD supplemented, high-fat diet (HFD) vehicle and HFD supplemented. The vehicle and experimental formulation were administered orally by gavage once a day during the last four weeks of the diet (28 consecutive days). We then evaluated energy homeostasis, inflammation, and mitochondrial protein expression in these groups of mice. RESULTS After four weeks of supplementation, study groups experienced reduced glycemia, dyslipidemia, fat, and hepatic fibrosis levels. Additionally, proliferator-activated receptor-α, AMP-activated protein kinase-1α, peroxisome proliferator-activated receptor γ co-activator-1α, and mitochondrial transcription factor A expression levels were augmented; however, levels of inhibitor of nuclear factor-κB kinase subunit α and p65 nuclear factor-κB expression, and oxidative markers were reduced. Notably, the cortisol/C-reactive protein ratio, a well-characterized marker of the hypothalamic-pituitary-adrenal axis immune interface status, was found to be modulated by the supplement. CONCLUSION We discovered that the novel supplement was able to modify different antioxidant, metabolic and inflammatory pathways, improving the energy homeostasis and inflammatory status, and consequently alleviated hepatic steatosis.
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Affiliation(s)
- Victor Abou Nehmi
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - Gilson Masahiro Murata
- Laboratory of Medical Investigation (LIM-29), Clinic Medical Department, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - Ruan Carlos Macêdo de Moraes
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - Gabriely Cristina Alves Lima
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - Danielle Araujo De Miranda
- Department of Physiology, Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, SP 04023062, Brazil
| | - Katrin Radloff
- Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, BW 76131, Germany
| | - Raquel Galvão Figuerêdo Costa
- Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Joyce de Cassia Rosa de Jesus
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - Jéssica Alves De Freitas
- Laboratory of Medical Investigation (LIM-29), Clinic Medical Department, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - Nayara Izabel Viana
- Laboratory of Medical Investigation (LIM-55), Urology Department, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - Ruan Pimenta
- Laboratory of Medical Investigation (LIM-55), Urology Department, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, RJ 22281-100, Brazil
| | - Katia Ramos Moreira Leite
- Laboratory of Medical Investigation (LIM-55), Urology Department, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil
| | - José Pinhata Otoch
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil; Program in Anesthesiology, Surgical Sciences, and Perioperative Medicine, University of São Paulo, São Paulo, SP 01246903, Brazil
| | - Ana Flávia Marçal Pessoa
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP 01246903, Brazil; Program in Anesthesiology, Surgical Sciences, and Perioperative Medicine, University of São Paulo, São Paulo, SP 01246903, Brazil; Brazilian Academic Consortium for Integrative Health (CABSIN), Natural Products Committee, São Paulo, SP 05449-070, Brazil.
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Dai W, Wagh SA, Chettiar S, Zhou GD, Roy R, Qiao X, Visich PS, Hoffman EP. Blunted circadian cortisol in children is associated with poor cardiovascular health and may reflect circadian misalignment. Psychoneuroendocrinology 2021; 129:105252. [PMID: 34049197 DOI: 10.1016/j.psyneuen.2021.105252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Circadian cues in children (sunlight, exercise, diet patterns) may be associated with health outcomes. The primary objective was to assess associations of daily cortisol fluctuations (morning, night) with cardiovascular health outcomes. A secondary objective was to determine if 1-year longitudinal changes in circadian cortisol levels are associated with longitudinal changes in health outcomes. STUDY DESIGN The Cardiovascular Health Intervention Program (CHIP) was a cross-sectional and longitudinal study of cardiovascular risk profiles in public elementary school children in Southern Maine. Participants were 689 students in 4th grade (baseline; age = 9.20 ± 0.41 years), and 647 students in 5th grade (age = 10.53 ± 0.52 years). Longitudinal data (4th and 5th grade) was available for 347 participants. Clinical outcomes were blood pressure, hip/waist ratios, body mass index, percent fat. Laboratory measures were fasting glucose, lipids, and salivary cortisol measures (morning and evening). RESULTS Lower first-in-morning diurnal cortisol levels were associated with increased blood pressure (β -0.23 ± 0.05; p < 0.001), increased body fat (β -0.22 ± 0.05; p < 0.001), and poor lipid profiles (β -0.15 ± 0.07; p < 0.05). Inclusion of night cortisol in the model (stress-related) improved associations of the model with bodyfat composition (morning β -0.27 ± 0.05; p < 0.001; night β +0.16 ± 0.06; p < 0.01). Adjustments for potential confounding variables improved associations of morning cortisol with lipids (β -0.19 ± 0.07; p < 0.01). Longitudinal analysis showed that lower morning diurnal cortisol in 4th grade was associated with increases in blood pressure a year later (β -0.18 ± 0.08; p = 0.017) after adjusting for confounding variables. CONCLUSION Data presented suggest adding circadian misalignment (lower amplitude of first-in-morning cortisol) to existing models of metabolic syndrome in children. Further, circadian misalignment may be a factor contributing to high blood pressure.
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Affiliation(s)
- Weiying Dai
- Department of Computer Science, Binghamton University - SUNY, Binghamton, NY, USA
| | - Swanand A Wagh
- Department of Computer Science, Binghamton University - SUNY, Binghamton, NY, USA
| | - Steffi Chettiar
- Department of Computer Science, Binghamton University - SUNY, Binghamton, NY, USA
| | - Grace D Zhou
- Department of Pharmaceutical Sciences, Binghamton University -SUNY, Binghamton, NY, USA
| | - Runia Roy
- Department of Pharmaceutical Sciences, Binghamton University -SUNY, Binghamton, NY, USA; Department of Biomedical Engineering, Binghamton University -SUNY, Binghamton, NY, USA
| | - Xingye Qiao
- Department of Mathematical Sciences, Binghamton University -SUNY, Binghamton, NY, USA
| | - Paul S Visich
- Exercise and Sport Performance Department, University of New England, Biddeford, ME, USA
| | - Eric P Hoffman
- Department of Pharmaceutical Sciences, Binghamton University -SUNY, Binghamton, NY, USA.
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Kotanidou EP, Giza S, Tsinopoulou VR, Vogiatzi M, Galli-Tsinopoulou A. Diagnosis and Management of Endocrine Hypertension in Children and Adolescents. Curr Pharm Des 2020; 26:5591-5608. [PMID: 33185153 DOI: 10.2174/1381612826666201113103614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Hypertension in childhood and adolescence has increased in prevalence. Interest in the disease was raised after the 2017 clinical practice guidelines of the American Academy of Paediatrics on the definition and classification of paediatric hypertension. Among the secondary causes of paediatric hypertension, endocrine causes are relatively rare but important due to their unique treatment options. Excess of catecholamine, glucocorticoids and mineralocorticoids, congenital adrenal hyperplasia, hyperaldosteronism, hyperthyroidism and other rare syndromes with specific genetic defects are endocrine disorders leading to paediatric and adolescent hypertension. Adipose tissue is currently considered the major endocrine gland. Obesity-related hypertension constitutes a distinct clinical entity leading to an endocrine disorder. The dramatic increase in the rates of obesity during childhood has resulted in a rise in obesity-related hypertension among children, leading to increased cardiovascular risk and associated increased morbidity and mortality. This review presents an overview of pathophysiology and diagnosis of hypertension resulting from hormonal excess, as well as obesity-related hypertension during childhood and adolescence, with a special focus on management.
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Affiliation(s)
- Eleni P Kotanidou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Styliani Giza
- Fourth Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki-Regina Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Vogiatzi
- Division of Endocrinology and Diabetes, Children' s Hospital of Philadelphia, PA 19104, United States
| | - Assimina Galli-Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Sokol RL, Grummon AH, Lytle LA. Sleep duration and body mass: direction of the associations from adolescence to young adulthood. Int J Obes (Lond) 2020; 44:852-856. [PMID: 31582778 PMCID: PMC7103530 DOI: 10.1038/s41366-019-0462-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 11/08/2022]
Abstract
Research suggests that sleep duration and obesity are related, but the direction of this association remains uncertain. We applied autoregressive cross-lag models to evaluate the directionality of the relationship between sleep duration and BMI from adolescence through emerging and young adulthood, life stages where the risk for developing obesity are particularly high. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined sex-stratified associations between sleep duration and BMI in this cohort from adolescence (ages 12-18, year 1996), to emerging adulthood (ages 18-24, 2001-2002), to young adulthood (ages 24-32, 2008), controlling for key confounders. For both males and females, higher BMI during an earlier developmental stage was associated with shorter sleep duration in the subsequent stage (both Bs = -0.02, ps < 0.01). However, sleep duration at an earlier developmental stage was not associated with BMI at the subsequent stage. Findings suggest that researchers should be cautious when interpreting cross-sectional relationships between sleep and BMI, as higher BMI may precede shorter sleep during adolescence to young adulthood. Researchers may also wish to account for potential bi-directional associations when modeling sleep and BMI using longitudinal data.
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Affiliation(s)
- Rebeccah L Sokol
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Anna H Grummon
- Harvard Center for Population and Developmental Studies, Harvard TH Chan School of Public Health, 9 Box Street, Cambridge, MA, 02138, USA
| | - Leslie A Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Drive, 245 Rosenau Hall, CB #7461, Chapel Hill, NC, 27599, USA
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9
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Ricotti R, De Feudis M, Peri C, Corazzari M, Genoni G, Giordano M, Mancioppi V, Agosti E, Bellone S, Prodam F. Haptoglobin Phenotypes Are Associated with the Postload Glucose and Insulin Levels in Pediatric Obesity. Int J Endocrinol 2020; 2020:6035138. [PMID: 32695161 PMCID: PMC7368219 DOI: 10.1155/2020/6035138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/04/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Haptoglobin (Hp) is a protein involved in the acute-phase reaction of inflammation. Humans have three major phenotypes (Hp1-1, Hp1-2, and Hp2-2). Several studies have shown altered Hp regulation in adults with obesity and metabolic alterations. The Hp2-2 phenotype is associated with a high cardiovascular risk. Our aim was to investigate if Hp levels and the Hp2-2 phenotype are associated with glucose metabolism in pediatric obesity. METHODS We retrospectively studied 192 participants (92 males and 100 females), aged 4-18 years. Clinical and biochemical data were collected. The Hp phenotype (Hp1-1, Hp1-2, and Hp2-2) was identified through Western immunoblot. RESULTS Subjects carrying Hp1-1, Hp1-2, and Hp2-2 phenotypes were 13.6, 50.8, and 35.6%, respectively. Hp serum, fasting glucose, and insulin levels, as well as HOMA-IR, were similar among groups. Postload glucose and insulin levels (as insulin AUC) were progressively higher from the Hp1-1 to Hp2-2 phenotype. CONCLUSION To our knowledge, this is the first study on Hp phenotypes conducted in a pediatric population with obesity. We showed that the presence of Hp2 allele is associated with a worse response of glucose load in terms of both glucose and insulin levels. Thus, the Hp2-2 phenotype could predispose in pediatrics, at the same degree of obesity, to a worse glycemic and insulinemic compensation.
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Affiliation(s)
- Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Marilisa De Feudis
- Department of Translational Medicine, University of Piemonte Orientale, Novara 28100, Italy
| | - Caterina Peri
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Marco Corazzari
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
- Interdisciplinary Research Center of Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara 28100, Italy
| | - Giulia Genoni
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Mara Giordano
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
- Interdisciplinary Research Center of Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara 28100, Italy
| | - Valentina Mancioppi
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Emanuela Agosti
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
- Interdisciplinary Research Center of Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara 28100, Italy
| | - Flavia Prodam
- Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara 28100, Italy
- Interdisciplinary Research Center of Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara 28100, Italy
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10
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Pitchford EA, Hasson RE, Hornyak JE, Lumeng JC, Peterson KE, Ulrich DA. Diurnal cortisol and obesity in adolescents with and without Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1401-1412. [PMID: 31441183 DOI: 10.1111/jir.12682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/19/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- E A Pitchford
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - R E Hasson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - J E Hornyak
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - J C Lumeng
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - K E Peterson
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - D A Ulrich
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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11
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12
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Skoranski A, Kelly NR, Radin RM, Thompson KA, Galescu O, Demidowich AP, Brady SM, Chen KY, Tanofsky-Kraff M, Yanovski JA, Shomaker LB. Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:2254-2264. [PMID: 30100695 PMCID: PMC6085111 DOI: 10.1007/s10826-018-1065-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Amanda Skoranski
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Nichole R. Kelly
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
- Department of Counseling Psychology and Human Services and the Prevention Science Institute, College of Education, University of Oregon, Eugene, OR, USA
| | - Rachel M. Radin
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD, USA
| | - Katherine A. Thompson
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Ovidiu Galescu
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Andrew P. Demidowich
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Kong Y. Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, DHHS, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Lauren B. Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
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13
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de Oliveira JC, de Moura EG, Miranda RA, de Moraes AMP, Barella LF, da Conceição EPS, Gomes RM, Ribeiro TA, Malta A, Martins IP, Franco CCDS, Lisboa PC, Mathias PCDF. Low-protein diet in puberty impairs testosterone output and energy metabolism in male rats. J Endocrinol 2018; 237:243-254. [PMID: 29599416 DOI: 10.1530/joe-17-0606] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/28/2018] [Indexed: 11/08/2022]
Abstract
We examined the long-term effects of protein restriction during puberty on the function of hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes in male rats. Male Wistar rats from the age of 30 to 60 days were fed a low-protein diet (4%, LP). A normal-protein diet (20.5%) was reintroduced to rats from the age of 60 to 120 days. Control rats were fed a normal-protein diet throughout life (NP). Rats of 60 or 120 days old were killed. Food consumption, body weight, visceral fat deposits, lipid profile, glycemia, insulinemia, corticosteronemia, adrenocorticotropic hormone (ACTH), testosteronemia and leptinemia were evaluated. Glucose-insulin homeostasis, pancreatic-islet insulinotropic response, testosterone production and hypothalamic protein expression of the androgen receptor (AR), glucocorticoid receptor (GR) and leptin signaling pathway were also determined. LP rats were hypophagic, leaner, hypoglycemic, hypoinsulinemic and hypoleptinemic at the age of 60 days (P < 0.05). These rats exhibited hyperactivity of the HPA axis, hypoactivity of the HPG axis and a weak insulinotropic response (P < 0.01). LP rats at the age of 120 days were hyperphagic and exhibited higher visceral fat accumulation, hyperleptinemia and dyslipidemia; lower blood ACTH, testosterone and testosterone release; and reduced hypothalamic expression of AR, GR and SOCS3, with a higher pSTAT3/STAT3 ratio (P < 0.05). Glucose-insulin homeostasis was disrupted and associated with hyperglycemia, hyperinsulinemia and increased insulinotropic response of the pancreatic islets. The cholinergic and glucose pancreatic-islet responses were small in 60-day-old LP rats but increased in 120-day-old LP rats. The hyperactivity of the HPA axis and the suppression of the HPG axis caused by protein restriction at puberty contributed to energy and metabolic disorders as long-term consequences.
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Affiliation(s)
- Júlio Cezar de Oliveira
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
- Departamento de Ciências Fisiológicas, Laboratório de Fisiologia Endócrina, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso, Sinop, Brazil
| | - Egberto Gaspar de Moura
- Departamento de Ciências Fisiológicas, Laboratório de Fisiologia Endócrina, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosiane Aparecida Miranda
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Maria Praxedes de Moraes
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
| | - Luiz Felipe Barella
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
| | - Ellen Paula Santos da Conceição
- Departamento de Ciências Fisiológicas, Laboratório de Fisiologia Endócrina, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Mello Gomes
- Departamento de Ciências Fisiológicas, Universidade Federal de Goiás, Goiânia, Brazil
| | - Tatiane Aparecida Ribeiro
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
| | - Ananda Malta
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
| | - Isabela Peixoto Martins
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
| | - Claudinéia Conationi da Silva Franco
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
| | - Patrícia Cristina Lisboa
- Departamento de Ciências Fisiológicas, Laboratório de Fisiologia Endócrina, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Cezar de Freitas Mathias
- Laboratório de Biologia Celular da Secreção, Departamento de Biotecnologia, Genética e Biologia Celular, Universidade Estadual de Maringá, Maringá, Brazil
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14
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Bühlmeier J, Harris C, Koletzko S, Lehmann I, Bauer CP, Schikowski T, von Berg A, Berdel D, Heinrich J, Hebebrand J, Föcker M, Standl M, Libuda L. Dietary Acid Load and Mental Health Outcomes in Children and Adolescents: Results from the GINIplus and LISA Birth Cohort Studies. Nutrients 2018; 10:nu10050582. [PMID: 29738509 PMCID: PMC5986462 DOI: 10.3390/nu10050582] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/29/2018] [Accepted: 05/06/2018] [Indexed: 12/17/2022] Open
Abstract
High dietary acid load may have detrimental effects on mental health during childhood and adolescence. We examined cross-sectional and prospective associations of dietary acid load and mental health problems in a population-based sample, using data from the German birth cohort studies GINIplus (German Infant Nutritional Intervention plus environmental and genetic influences on allergy development) and LISA (Influences of lifestyle-related factors on the immune system and the development of allergies in childhood). These studies included detailed assessments of dietary intake through a food frequency questionnaire (FFQ), mental health outcomes measured through the Strengths and Difficulties Questionnaire (SDQ), and covariates. Using logistic regression, cross-sectional associations between dietary acid load measured as potential renal acid load (PRAL) and SDQ subscales were assessed at age 10 years (N = 2350) and 15 years (N = 2061). Prospective associations were assessed, considering PRAL at 10 years as exposure and SDQ subscales at 15 years as outcome (N = 1685). Results indicate that children with a diet higher in PRAL have more emotional problems (OR = 1.33 (95% CI = 1.15; 1.54); p < 0.001), and show hyperactivity more often (1.22 (1.04; 1.43); p = 0.014) at 10 years. No significant associations were present either cross-sectionally at age 15 years, nor prospectively. Results were confirmed in sensitivity analyses. These findings reveal first evidence for potential relationships between PRAL and mental health in childhood, although we cannot exclude reverse causality, i.e., that dietary behavior and PRAL are influenced by mental status. Future studies should address confirmation and identify biological mechanisms.
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Affiliation(s)
- Judith Bühlmeier
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
| | - Carla Harris
- Dr. von Hauner Children's Hospital, University Hospital, LMU of Munich, 80337 Munich, Germany.
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, 85764 Neuherberg, Germany.
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, University Hospital, LMU of Munich, 80337 Munich, Germany.
| | - Irina Lehmann
- Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research-UFZ, 04318 Leipzig, Germany.
- Charitè-Universitätsmedizin Berlin, 10117 Berlin, Germany.
- Berlin Institute of Health, 10178 Berlin, Germany.
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, 80804 Munich, Germany.
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany.
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, 46483 Wesel, Germany.
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, 46483 Wesel, Germany.
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, 85764 Neuherberg, Germany.
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), 80336 Munich, Germany.
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia.
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, 85764 Neuherberg, Germany.
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, 46483 Wesel, Germany.
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15
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Wirix AJG, Finken MJJ, von Rosenstiel-Jadoul IA, Heijboer AC, Nauta J, Groothoff JW, Chinapaw MJM, Holthe JEKV. Is There an Association Between Cortisol and Hypertension in Overweight or Obese Children? J Clin Res Pediatr Endocrinol 2017; 9:344-349. [PMID: 28720554 PMCID: PMC5785641 DOI: 10.4274/jcrpe.4802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The precise mechanisms behind the development of hypertension in overweight or obese children are not yet completely understood. Alterations in hypothalamic-pituitary-adrenal axis activity may play a role. We aimed to investigate the association between cortisol parameters and hypertension in overweight or obese children. METHODS Random urine (n=180) and early-morning saliva samples (n=126) for assessment of cortisol and cortisone were collected from 1) hypertensive overweight children (n=50), 2) normotensive overweight children (n=145), and 3) normotensive non-overweight children (n=75). RESULTS The age of participants was 10.4±3.3 years and 53% were boys. The urinary cortisol-to-cortisone ratio [β 1.11, 95% confidence interval (CI) 1.05-1.19] as well as urinary cortisol/creatinine (β 1.38, 95% CI 1.09-1.54), and cortisone/creatinine ratios (β 1.26, 95% CI 1.17-1.36) were significantly higher in overweight or obese than in non-overweight children. After adjusting for body mass index-standard deviation score and urinary cortisone/creatinine ratio, but not cortisol/creatinine ratio, was significantly associated with presence of hypertension (β 1.12, 95% CI 1.02-1.23). Salivary cortisol and cortisone levels were significantly lower in overweight or obese than in non-overweight children (β -4.67, 95% CI -8.19- -1.15, and β 0.89, 95% CI 0.80-0.97 respectively). There were no significant differences in cortisol parameters between hypertensive and normotensive overweight or obese children. CONCLUSION This study provided further evidence for an increased cortisol production rate with decreased renal 11β-hydroxysteroid dehydrogenase 2 activity and flattening of early-morning peak cortisol and cortisone in overweight or obese children. However, there were no significant differences in cortisol parameters between hypertensive and normotensive overweight and obese children.
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Affiliation(s)
- Aleid JG Wirix
- VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Amsterdam, The Netherlands
| | - Martijn JJ Finken
- VU University Medical Center, Department of Pediatric Endocrinology, Amsterdam, The Netherlands
| | | | - Annemieke C Heijboer
- VU University Medical Center, Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam, The Netherlands
| | - Jeroen Nauta
- Erasmus MC Sophia Children’s Hospital, Clinic of Pediatric Nephrology, Rotterdam, The Netherlands
| | - Jaap W Groothoff
- Emma Children’s Hospital/Academic Medical Center, Department of Pediatric Nephrology, Amsterdam, The Netherlands
| | - Mai JM Chinapaw
- VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Amsterdam, The Netherlands
| | - Joana E Kist-van Holthe
- VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Amsterdam, The Netherlands
,* Address for Correspondence: VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Amsterdam, The Netherlands Phone: +31 20 444 17 06 E-mail:
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16
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Hertel J, König J, Homuth G, Van der Auwera S, Wittfeld K, Pietzner M, Kacprowski T, Pfeiffer L, Kretschmer A, Waldenberger M, Kastenmüller G, Artati A, Suhre K, Adamski J, Langner S, Völker U, Völzke H, Nauck M, Friedrich N, Grabe HJ. Evidence for Stress-like Alterations in the HPA-Axis in Women Taking Oral Contraceptives. Sci Rep 2017; 7:14111. [PMID: 29074884 PMCID: PMC5658328 DOI: 10.1038/s41598-017-13927-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/03/2017] [Indexed: 12/15/2022] Open
Abstract
Using oral contraceptives has been implicated in the aetiology of stress-related disorders like depression. Here, we followed the hypothesis that oral contraceptives deregulate the HPA-axis by elevating circulating cortisol levels. We report for a sample of 233 pre-menopausal women increased circulating cortisol levels in those using oral contraceptives. For women taking oral contraceptives, we observed alterations in circulating phospholipid levels and elevated triglycerides and found evidence for increased glucocorticoid signalling as the transcript levels of the glucocorticoid-regulated genes DDIT4 and FKBP5 were increased in whole blood. The effects were statistically mediated by cortisol. The associations of oral contraceptives with higher FKBP5 mRNA and altered phospholipid levels were modified by rs1360780, a genetic variance implicated in psychiatric diseases. Accordingly, the methylation pattern of FKBP5 intron 7 was altered in women taking oral contraceptives depending on the rs1360780 genotype. Moreover, oral contraceptives modified the association of circulating cortisol with depressive symptoms, potentially explaining conflicting results in the literature. Finally, women taking oral contraceptives displayed smaller hippocampal volumes than non-using women. In conclusion, the integrative analyses of different types of physiological data provided converging evidence indicating that oral contraceptives may cause effects analogous to chronic psychological stressors regarding the regulation of the HPA axis.
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Affiliation(s)
- Johannes Hertel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany.
| | - Johanna König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Katharina Wittfeld
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Maik Pietzner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Tim Kacprowski
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Liliane Pfeiffer
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Anja Kretschmer
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anna Artati
- IEG (Institute of Experimental Genetics), Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Karsten Suhre
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany.,Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Jerzy Adamski
- IEG (Institute of Experimental Genetics), Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany.,DZD (German Center for Diabetes Research), site München-Neuherberg, Neuherberg, Germany.,Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
| | - Sönke Langner
- Institute of Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Völker
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.,Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Hans Joergen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
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17
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Kwok MK, Schooling CM, Subramanian SV, Leung GM, Kawachi I. Pathways from parental educational attainment to adolescent blood pressure. J Hypertens 2017; 34:1787-95. [PMID: 27348520 DOI: 10.1097/hjh.0000000000001003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Lower parental education is associated with higher adolescent blood pressure (BP). We examined the contribution of modifiable risk factors from infancy to adolescence that could potentially explain the link between parental education and SBP and DBP in the offspring. METHODS In a prospective Chinese birth cohort, 'Children of 1997' of 5604 adolescents (68% follow-up), we analyzed the relation between parental educational attainment and sex-specific, age-specific and height-specific BP z-scores at ∼13 years. Using mediation analysis, we examined the contribution of household income at birth (both absolute income and relative income deprivation), exposures during infancy (breastfeeding and early life second-hand smoking), lifestyles during childhood (diet, physical activity and screen-time), weight or BMI status during fetal, infancy, childhood and puberty, pubertal stage as well as parental BMI. RESULTS We found that adolescent BMI, but not birth weight or infant growth or childhood BMI, mediated the inverse association of parental education with adolescent SBP (proportion mediated: 24%), followed by maternal BMI (proportion mediated: 18%). Factors explaining the link between parental education and DBP were less clear. Absolute income, breastfeeding, childhood diet and physical activity, pubertal stage and paternal BMI did not mediate the association between parental education and adolescent BP. CONCLUSION Low parental education is a risk factor for high SBP and, to a lesser extent, DBP in adolescents. Important mediators of this relation include adolescent and maternal body weight.
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Affiliation(s)
- Man Ki Kwok
- aSchool of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China bCity University of New York School of Public Health and Hunter College, New York, New York cDepartment of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States
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Murphy MO, Cohn DM, Loria AS. Developmental origins of cardiovascular disease: Impact of early life stress in humans and rodents. Neurosci Biobehav Rev 2017; 74:453-465. [PMID: 27450581 PMCID: PMC5250589 DOI: 10.1016/j.neubiorev.2016.07.018] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 02/07/2023]
Abstract
The Developmental Origins of Health and Disease (DOHaD) hypothesizes that environmental insults during childhood programs the individual to develop chronic disease in adulthood. Emerging epidemiological data strongly supports that early life stress (ELS) given by the exposure to adverse childhood experiences is regarded as an independent risk factor capable of predicting future risk of cardiovascular disease. Experimental animal models utilizing chronic behavioral stress during postnatal life, specifically maternal separation (MatSep) provides a suitable tool to elucidate molecular mechanisms by which ELS increases the risk to develop cardiovascular disease, including hypertension. The purpose of this review is to highlight current epidemiological studies linking ELS to the development of cardiovascular disease and to discuss the potential molecular mechanisms identified from animal studies. Overall, this review reveals the need for future investigations to further clarify the molecular mechanisms of ELS in order to develop more personalized therapeutics to mitigate the long-term consequences of chronic behavioral stress including cardiovascular and heart disease in adulthood.
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Affiliation(s)
- M O Murphy
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - D M Cohn
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - A S Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States.
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19
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Wang WB, She F, Xie LF, Yan WH, Ouyang JZ, Wang BA, Ma HY, Zang L, Mu YM. Evaluation of Basal Serum Adrenocorticotropic Hormone and Cortisol Levels and Their Relationship with Nonalcoholic Fatty Liver Disease in Male Patients with Idiopathic Hypogonadotropic Hypogonadism. Chin Med J (Engl) 2017; 129:1147-53. [PMID: 27174321 PMCID: PMC4878158 DOI: 10.4103/0366-6999.181967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Prolonged gonadal hormone deficiency in patients with idiopathic hypogonadotropic hypogonadism (IHH) may produce adverse effects on the endocrine homeostasis and metabolism. This study aimed to compare basal serum adrenocorticotropic hormone (ACTH) and cortisol levels between male IHH patients and healthy controls. Moreover, this study compared the basal hypothalamic-pituitary-adrenal (HPA) axis in patients with and without nonalcoholic fatty liver disease (NAFLD), and also evaluated the relationship between basal HPA axis and NAFLD in male IHH patients. METHODS This was a retrospective case-control study involving 75 Chinese male IHH patients (mean age 21.4 ± 3.8 years, range 17-30 years) and 135 healthy controls after matching for gender and age. All subjects underwent physical examination and blood testing for serum testosterone, luteinizing hormone, follicle-stimulating hormone, ACTH, and cortisol and biochemical tests. RESULTS Higher basal serum ACTH levels (8.25 ± 3.78 pmol/L vs. 6.97 ± 2.81 pmol/L) and lower cortisol levels (366.70 ± 142.48 nmol/L vs. 452.82 ± 141.53 nmol/L) were observed in male IHH patients than healthy subjects (all p<0.05). IHH patients also showed higher metabolism parameters and higher prevalence rate of NAFLD (34.9% vs. 4.4%) than the controls (all P < 0.05). Basal serum ACTH (9.91 ± 4.98 pmol/L vs. 7.60 ± 2.96 pmol/L) and dehydroepiandrosterone sulfate (2123.7 ± 925.8 μg/L vs. 1417.1 ± 498.4 μg/L) levels were significantly higher in IHH patients with NAFLD than those without NAFLD (all P < 0.05). We also found that basal serum ACTH levels were positively correlated with NAFLD (r = 0.289,p<0.05) and triglyceride levels (r = 0.268, P< 0.05) in male IHH patients. Furthermore, NAFLD was independently associated with ACTH levels in male IHH patients by multiple linear regression analysis. CONCLUSIONS The male IHH patients showed higher basal serum ACTH levels and lower cortisol levels than matched healthy controls. NAFLD was an independent associated factor for ACTH levels in male IHH patients. These preliminary findings provided evidence of the relationship between basal serum ACTH and NAFLD in male IHH patients.
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Affiliation(s)
- Wen-Bo Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853; Department of Endocrinology, Tianjin Sanatorium of Beijing Military Region of PLA, Tianjin 300000, China
| | - Fei She
- Department of Medicine, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048,, China
| | - Li-Fang Xie
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Hua Yan
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jin-Zhi Ouyang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Bao-An Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hang-Yun Ma
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Li Zang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi-Ming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
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20
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FKBP5 polymorphism is associated with insulin resistance in children and adolescents with obesity. Obes Res Clin Pract 2016; 12:62-70. [PMID: 28007534 DOI: 10.1016/j.orcp.2016.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/06/2016] [Accepted: 11/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Since metabolic syndrome shares several clinical features with hypercortisolism, it was hypothesised that genes altering individual glucocorticoid (GC) sensitivity might be implicated in pathogenesis of obesity and its adverse outcomes. FKBP5 gene encodes a chaperon protein in the GC receptor (GR) complex, which modulates steroid action upon target genes. Its functional variant, rs1360780, may enhance FKBP5 gene transcription, affect GR signalling and thereby influence the hypothalamo-pituitary-adrenal axis. We investigated the association of rs1360780 with obesity and metabolic characteristics in 250 obese children and adolescents (mean age 12.3±3.6years, BMI ≥95th percentile). METHODS Anthropometric measurements, body composition, biochemical and hormonal results were analysed. Genotyping of rs1360780 was compared with 568 lean controls. RESULTS Impaired fasting glucose was present in 8.8%, glucose intolerance in 10.4%, diabetes in 2.8% and dyslipidemia in 28.8% obese individuals. Hypertension was diagnosed in 34 out of 143 patients. No difference was found in FKBP5 polymorphism distribution between subjects with obesity and controls (p>0.05). Stratification by rs1360780 revealed no differences in body mass and composition. However, carriers of the minor allele displayed enhanced insulin resistance (p=0.009) and elevated serum triglyceride (p=0.006), whereas cholesterol, HbA1c, and oral glucose challenge results were similar for all genotypes. Morning ACTH and cortisol did not differ but evening cortisol was higher in minor allele carriers (p=0.039), although this association was lost in logistic regression analysis. CONCLUSION This study does not support the association of FKBP5 with obesity but demonstrates plausible implication of its variant in susceptibility to obesity-related insulin resistance and hypertriglyceridemia.
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21
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Camargos ACR, Mendonça VA, Andrade CAD, Oliveira KSC, Tossige-Gomes R, Rocha-Vieira E, Neves CDC, Vieira ÉLM, Leite HR, Oliveira MX, Júnior ALT, Coimbra CC, Lacerda ACR. Neuroendocrine Inflammatory Responses in Overweight/Obese Infants. PLoS One 2016; 11:e0167593. [PMID: 27907172 PMCID: PMC5132240 DOI: 10.1371/journal.pone.0167593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/16/2016] [Indexed: 12/24/2022] Open
Abstract
Childhood obesity is related to a cascade of neuroendocrine inflammatory changes. However, there remains a gap in the current literature regarding the possible occurrence of these changes in overweight/obese infants. The objective of this study was to evaluate adipokines, cortisol, brain-derived neurotrophic factor (BDNF) and redox status in overweight/obese infants versus normal-weight peers. A cross-sectional study was conducted with 50 infants (25 in the overweight/obese group and 25 in the normal-weight group) between 6 and 24 months. Plasma levels of leptin, adiponectin, resistin, soluble tumor necrosis factor (TNF) receptors, chemokines, BDNF, serum cortisol and redox status were measured. Unpaired Student's t-test was used to analyze the results and a probability of p<0.05 was acceptable for rejection of the null hypothesis. The Pearson correlation was used to verify the association between the biomarkers analyzed in each group. Plasma levels of leptin (p = 0.0001), adiponectin (p = 0.0007) and BDNF (p = 0.003), and serum cortisol (p = 0.048) were significantly higher in overweight/obese infants than normal-weight infants. In contrast, the concentration of thiobarbituric acid reactive substances (TBARS) (p = 0.004), and catalase (p = 0.045) and superoxide dismutase activity (p = 0.02) were lower in overweight/obese infants than normal-weight peers. All the results together indicate neuroendocrine inflammatory response changes in overweight/obese infants between 6 and 24 months. Although there is already an environment that predisposes for a subsequent pro-inflammatory response, neuroendocrine secretion changes that permit the control of the inflammatory process in this age interval can be observed.
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Affiliation(s)
- Ana Cristina Resende Camargos
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.,Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil
| | - Vanessa Amaral Mendonça
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.,Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil
| | - Camila Alves de Andrade
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | - Rosalina Tossige-Gomes
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil
| | - Etel Rocha-Vieira
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil
| | - Camila Danielle Cunha Neves
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil
| | | | - Hércules Ribeiro Leite
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.,Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil
| | - Murilo Xavier Oliveira
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | - Cândido Celso Coimbra
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Rodrigues Lacerda
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.,Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Diamantina, Brazil
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22
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Child and Maternal Factors That Influence Child Blood Pressure in Preschool Children: An Exploratory Study. Appl Nurs Res 2016; 31:117-20. [DOI: 10.1016/j.apnr.2016.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
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23
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Le-Ha C, Herbison CE, Beilin LJ, Burrows S, Henley DE, Lye SJ, Matthews SG, Pennell CE, Mori TA. Hypothalamic-pituitary-adrenal axis activity under resting conditions and cardiovascular risk factors in adolescents. Psychoneuroendocrinology 2016; 66:118-24. [PMID: 26802599 DOI: 10.1016/j.psyneuen.2016.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 11/29/2015] [Accepted: 01/05/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Activation of the hypothalamic-pituitary-adrenal (HPA) axis has been associated with higher levels of cardiovascular (CVD) risk factors in adults. This study aimed to assess the relation between measures of HPA axis activity under resting conditions and CVD risk factors in a general population of adolescents at 17 years. METHODS A total of 1134 adolescents from the Western Australian Pregnancy Cohort (Raine) Study had phenotypic and socio-demographic data. The associations between HPA axis measures (plasma ACTH, total cortisol, calculated free cortisol, corticosteroid binding globulin (CBG), and salivary cortisol) and a range of cardiovascular risk factors were examined using multivariable linear regression models, with adjustment for gender, adiposity, birth weight, gestational age, and socio-behavioural factors. RESULTS Plasma total cortisol was positively associated with systolic blood pressure (SBP) (p=0.011), total cholesterol, HDL-cholesterol, and triglycerides (all p<0.001), and hs-CRP (p=0.047). Salivary cortisol was associated positively with HDL-C (p=0.033) and negatively with LDL-cholesterol (p=0.016); plasma calculated free cortisol was positively associated with triglycerides (p=0.006); plasma CBG was positively associated with total cholesterol and HDL-cholesterol (both p<0.001), LDL-cholesterol (p=0.022), and hs-CRP (p=0.001). After correction for multiple comparisons, significant associations remained for total cortisol with total cholesterol, HDL-C, and triglycerides; for calculated free cortisol with triglycerides; and for CBG with HDL-C, total cholesterol, and hs-CRP. Plasma ACTH was not associated with any cardiovascular risk factor. There was no association between BMI and any measure of HPA axis activity. CONCLUSION In an adolescent population, HPA axis measures under resting conditions are associated with a range of CVD risk factors. Clarification of the mechanisms underlying these associations in adolescence would be an important step in understanding the evolution of adult CVD.
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Affiliation(s)
- Chi Le-Ha
- School of Medicine and Pharmacology, University of Western Australia, Australia.
| | - Carly E Herbison
- School of Women's and Infant's Health, University of Western Australia
| | - Lawrence J Beilin
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Sally Burrows
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - David E Henley
- School of Medicine and Pharmacology, University of Western Australia, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Stephen J Lye
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada
| | | | - Craig E Pennell
- School of Women's and Infant's Health, University of Western Australia
| | - Trevor A Mori
- School of Medicine and Pharmacology, University of Western Australia, Australia
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Buehlmeier J, Remer T, Frings-Meuthen P, Maser-Gluth C, Heer M. Glucocorticoid activity and metabolism with NaCl-induced low-grade metabolic acidosis and oral alkalization: results of two randomized controlled trials. Endocrine 2016; 52:139-47. [PMID: 26349936 DOI: 10.1007/s12020-015-0730-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/27/2015] [Indexed: 01/09/2023]
Abstract
Low-grade metabolic acidosis (LGMA), as induced by high dietary acid load or sodium chloride (NaCl) intake, has been shown to increase bone and protein catabolism. Underlying mechanisms are not fully understood, but from clinical metabolic acidosis interactions of acid-base balance with glucocorticoid (GC) metabolism are known. We aimed to investigate GC activity/metabolism under alkaline supplementation and NaCl-induced LGMA. Eight young, healthy, normal-weight men participated in two crossover designed interventional studies. In Study A, two 10-day high NaCl diet (32 g/d) periods were conducted, one supplemented with 90 mmol KHCO3/day. In Study B, participants received a high and a low NaCl diet (31 vs. 3 g/day), each for 14 days. During low NaCl, the diet was moderately acidified by replacement of a bicarbonate-rich mineral water (consumed during high NaCl) with a non-alkalizing drinking water. In repeatedly collected 24-h urine samples, potentially bioactive-free GCs (urinary-free cortisol + free cortisone) were analyzed, as well as tetrahydrocortisol (THF), 5α-THF, and tetrahydrocortisone (THE). With supplementation of 90 mmol KHCO3, the marker of total adrenal GC secretion (THF + 5α-THF + THE) dropped (p = 0.047) and potentially bioactive-free GCs were reduced (p = 0.003). In Study B, however, GC secretion and potentially bioactive-free GCs did not exhibit the expected fall with NaCl-reduction as net acid excretion was raised by 30 mEq/d. Diet-induced acidification/alkalization affects GC activity and metabolism, which in case of long-term ingestion of habitually acidifying western diets may constitute an independent risk factor for bone degradation and cardiometabolic diseases.
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Affiliation(s)
- Judith Buehlmeier
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany.
- Institute of Nutrition and Food Science, University of Bonn, Endenicher Straße 11-13, 53115, Bonn, Germany.
| | - Thomas Remer
- Department of Nutritional Epidemiology, DONALD Study Center at the Research Institute of Child Nutrition, University of Bonn, Heinstück 11, 44225, Dortmund, Germany
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Christiane Maser-Gluth
- Department of Pharmacology, University of Heidelberg, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany
| | - Martina Heer
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
- Institute of Nutrition and Food Science, University of Bonn, Endenicher Straße 11-13, 53115, Bonn, Germany
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25
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Wirix AJG, Kaspers PJ, Nauta J, Chinapaw MJM, Kist-van Holthe JE. Pathophysiology of hypertension in obese children: a systematic review. Obes Rev 2015; 16:831-42. [PMID: 26098701 DOI: 10.1111/obr.12305] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 12/27/2022]
Abstract
Hypertension is increasingly common in overweight and obese children. The mechanisms behind the development of hypertension in obesity are complex, and evidence is limited. In order to effectively treat obese children for hypertension, it is important to have a deeper understanding of the pathophysiology of hypertension in obese children. The present review summarizes the main factors associated with hypertension in obese children and discusses their potential role in its pathophysiology. Systematic searches were conducted in PubMed and EMBASE for articles published up to October 2014. In total, 60 relevant studies were included. The methodological quality of the included studies ranged from weak to strong. Several factors important in the development of hypertension in obese children have been suggested, including endocrine determinants, such as corticosteroids and adipokines, sympathetic nervous system activity, disturbed sodium homeostasis, as well as oxidative stress, inflammation and endothelial dysfunction. Understanding the pathophysiology of hypertension in overweight and obese children is important and could have implications for its screening and treatment. Based on solely cross-sectional observational studies, it is impossible to infer causality. Longitudinal studies of high methodological quality are needed to gain more insight into the complex mechanisms behind the development of hypertension in obese children.
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Affiliation(s)
- A J G Wirix
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - P J Kaspers
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - J Nauta
- Department of Pediatric Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M J M Chinapaw
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - J E Kist-van Holthe
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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26
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Kwok MK, Subramanian SV, Leung GM, Schooling CM. Household income and adolescent blood pressure in a Chinese birth cohort: "Children of 1997". Soc Sci Med 2015; 144:88-95. [PMID: 26397867 DOI: 10.1016/j.socscimed.2015.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/24/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Abstract
The inconsistent relation of national income with population blood pressure raises questions as to whether social comparisons of relative income at individual or neighbourhood level may be more relevant than absolute income. We examined the associations of absolute household income (income per se), absolute neighbourhood median income (average income among geographically-proximate households), relative household income [deprivation using Yitzhaki index, or rank by position] (differences in income or rank compared with others) and relative neighbourhood income inequality [Gini coefficient] (income gap within a neighbourhood) with blood pressure z-score, prehypertension or hypertension at ∼13 years using a fixed effects multilevel linear or logistic model in a Chinese birth cohort (n = 5063, 61% of follow-up). Absolute household or neighbourhood income was not associated with adolescent blood pressure. Greater relative household income deprivation was associated with higher diastolic blood pressure (0.01 z-score per USD 128 difference in Yitzhaki index, 95% confidence interval (CI) 0.005 to 0.02), so was lower relative household income rank (-0.10, 95% CI -0.15 to -0.04), but relative neighbourhood income inequality was not, when considering each income measure separately. Such associations remained when considering all income measures together. Income measures were not associated with prehypertension or hypertension. Relative household income (greater deprivation or lower rank) were positively associated with adolescent blood pressure independent of absolute household income while absolute or relative neighbourhood income had little contribution, suggesting social comparisons at a key developmental stage could be relevant. Clarifying specific effects of socioeconomic position across the life-course could inform interventions.
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Affiliation(s)
- Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; City University of New York School of Public Health and Hunter College, New York, United States.
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27
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Wolkow A, Aisbett B, Reynolds J, Ferguson SA, Main LC. The impact of sleep restriction while performing simulated physical firefighting work on cortisol and heart rate responses. Int Arch Occup Environ Health 2015; 89:461-75. [PMID: 26271391 DOI: 10.1007/s00420-015-1085-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 08/05/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE Physical work and sleep restriction are two stressors faced by firefighters, yet the combined impact these demands have on firefighters' acute stress responses is poorly understood. The purpose of the present study was to assess the effect firefighting work and sleep restriction have on firefighters' acute cortisol and heart rate (HR) responses during a simulated 3-day and 2-night fire-ground deployment. METHODS Firefighters completed multiple days of simulated physical work separated by either an 8-h (control condition; n = 18) or 4-h sleep opportunity (sleep restriction condition; n = 17). Salivary cortisol was sampled every 2 h, and HR was measured continuously each day. RESULTS On day 2 and day 3 of the deployment, the sleep restriction condition exhibited a significantly higher daily area under the curve cortisol level and an elevated cortisol profile in the afternoon and evening when compared with the control condition. Firefighters' HR decreased across the simulation, but there were no significant differences found between conditions. CONCLUSION Findings highlight the protective role an 8-h sleep opportunity between shifts of firefighting work has on preserving normal cortisol levels when compared to a 4-h sleep opportunity which resulted in elevated afternoon and evening cortisol. Given the adverse health outcomes associated with chronically high cortisol, especially later in the day, future research should examine how prolonged exposure to firefighting work (including restricted sleep) affects firefighters' cortisol levels long term. Furthermore, monitoring cortisol levels post-deployment will determine the minimum recovery time firefighters need to safely return to the fire-ground.
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Affiliation(s)
- Alexander Wolkow
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
- Bushfire Co-Operative Research Centre, East Melbourne, 3002, Australia.
| | - Brad Aisbett
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
- Bushfire Co-Operative Research Centre, East Melbourne, 3002, Australia
| | - John Reynolds
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, 3125, Australia
| | - Sally A Ferguson
- Bushfire Co-Operative Research Centre, East Melbourne, 3002, Australia
- Appleton Institute, CQUniversity, Wayville, 5034, Australia
| | - Luana C Main
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
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Remer T. High salt intake: detrimental not only for blood pressure, but also for bone health? Endocrine 2015; 49:580-2. [PMID: 25957669 DOI: 10.1007/s12020-015-0626-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/04/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Remer
- Department of Nutritional Epidemiology, Institute of Nutrition and Food Science (IEL), University of Bonn, DONALD Study Centre, Dortmund, Germany,
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Ruble K, George A, Gallicchio L, Gamaldo C. Sleep disordered breathing risk in childhood cancer survivors: an exploratory study. Pediatr Blood Cancer 2015; 62:693-7. [PMID: 25597930 PMCID: PMC4486064 DOI: 10.1002/pbc.25394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/14/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sleep disordered breathing (SDB) is emerging as a significant health condition for children. The purpose of this study is to evaluate SDB symptoms in childhood cancer survivors and identify associations with quality of life (QOL) and psychological symptoms. PROCEDURE A sample of 62 survivors aged 8-18 years were recruited during routine survivorship visits. All subjects and their parents completed questionnaires to evaluate sleep, QOL and psychological symptoms; scales included were: Pediatric Sleep Questionnaire, Sleep Disordered Breathing Subscale (PSQ-SDBS), Pediatric Quality of Life Inventory (PedsQL) and Depression Anxiety Stress Scale (DASS-21). Continuous data were used for all scales and a threshold score of >0.33 on the PSA-SDBS was used to identify risk of SDB. The relationships between measures of sleep and independent variables were examined using Pearson correlations and multiple linear regression models for significant associations. RESULTS Of the 62 subjects enrolled, underlying diagnoses included 29 leukemias, 30 solid tumors and 3 non-malignant diseases. Nineteen percent of subjects were identified as having SDB risk on the PSQ-SDBS. The lowest mean PedsQL subscale score for parent and child ratings were school QOL; Parent mean 73(±SD 19) and Child mean 71(±SD 20). The severity of SDB per the PSQ was significantly associated with reduced total and school QOL which remained significant after adjusting for stress. CONCLUSIONS Symptoms suggestive of SDB are common in childhood cancer survivors with negative implications for overall quality of life and school performance.
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Affiliation(s)
- Kathy Ruble
- Johns Hopkins University, School of Medicine, Division of Pediatric Oncology, Baltimore, Maryland,Correspondence to: Kathy Ruble, Johns Hopkins University, School of Medicine, Division of Pediatric, Oncology, Baltimore, MD, 1800 Orleans St, Bloomberg Children’s Center, Baltimore, MD, 21287.
| | - Anna George
- Johns Hopkins Hospital, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Lisa Gallicchio
- The Prevention and Research Center, The Weinberg Center for Women’s Health and Medicine, Mercy Medical Center, Baltimore, Maryland
| | - Charlene Gamaldo
- Johns Hopkins University, School of Medicine, Division of Pulmonary and Critical Care, Baltimore, Maryland
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White MJ, Eren F, Agirbasli D, Williams SM, Agirbasli M. SHBG gene polymorphism (rs1799941) associates with metabolic syndrome in children and adolescents. PLoS One 2015; 10:e0116915. [PMID: 25647406 PMCID: PMC4380117 DOI: 10.1371/journal.pone.0116915] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Metabolic syndrome (MetS) is a complex disorder characterized by coexistence
of several cardiometabolic (CM) factors, i.e. hyperlipidemia, obesity, high
blood pressure and insulin resistance. The presence of MetS is strongly
associated with increased risk of cardiovascular disease (CVD). The syndrome
was originally defined as an adult disorder, but MetS has become
increasingly recognized in children and adolescents. Methods Genetic variants influence biological components common to the CM factors
that comprise MetS. We investigated single locus associations between six
single nucleotide polymorphisms (SNPs), previously shown to modulate lipid
or sex hormone binding globulin (SHBG) levels, with MetS in a Turkish
pediatric cohort (37 cases, 323 controls). Results Logistic regression analysis revealed a significant association between
rs1799941, located in SHBG, and MetS (OR = 3.09, p-value = 0.006). The
association with MetS remained after sequential adjustment for each CM
factor included in the syndrome definition, indicating that the identified
association is not being driven by any single trait. A relationship between
rs1799941 and SHBG levels, was also discovered, but it was dependent on MetS
status. In control subjects, the A allele of rs1799941 associated with a
significant increase in SHBG levels (p = 0.012), while in cases there was no
association between rs1799941 and SHBG levels (p = 0.963). Conclusions The significant association between rs1799941 and MetS in children is not
contingent on any single CM trait. Additionally, the presence of MetS may
abrogate effect of rs1799941 polymorphism on SHBG levels in children.
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Affiliation(s)
- Marquitta J. White
- Center for Human Genetic Research, Vanderbilt University, Nashville,
Tennessee, United States of America
- Department of Genetics, Institute for Quantitative Biomedical Sciences,
Dartmouth College, Hanover, New Hampshire, United States of
America
| | - Fatih Eren
- Department of Medical Biology, Marmara University School of Medicine,
Istanbul, Turkey
| | - Deniz Agirbasli
- Department of Medical Biology, Acıbadem University School of
Medicine, Istanbul, Turkey
| | - Scott M. Williams
- Department of Genetics, Institute for Quantitative Biomedical Sciences,
Dartmouth College, Hanover, New Hampshire, United States of
America
| | - Mehmet Agirbasli
- Department of Cardiology, Marmara University School of Medicine,
Istanbul, Turkey
- * E-mail:
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Abstract
Obesity is prevalent worldwide and associated with co-morbidities that result in increased cardiovascular risk. Hypertension is the most prevalent obesity comorbidity associated with increased cardiovascular risk. Obesity hypertension is a distinct subtype of essential hypertension. While endogenous Cushing's syndrome is an uncommon cause of both obesity and hypertension, the recent recognition of other hypercortisolemic states has raised the profile of hypercortisolism as an important contributor in obesity hypertension. The high prevalence of exogenous, iatrogenic, pseudo, and subclinical Cushing's syndromes makes hypercortisolism an important diagnostic consideration in the evaluation and management of patients with obesity hypertension who are resistant to conventional management. Available data suggest that the renin-angiotensin-aldosterone system modulating antihypertensives have the best efficacy in hypercortisolism-mediated obesity hypertension. Strategies aimed at reducing cortisol production and action also have utility. This review provides a comprehensive overview of the epidemiology, etiopathogenesis and management options available for glucocorticoid-mediated obesity hypertension.
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Reinehr T, Kulle A, Wolters B, Knop C, Lass N, Welzel M, Holterhus PM. Relationships between 24-hour urinary free cortisol concentrations and metabolic syndrome in obese children. J Clin Endocrinol Metab 2014; 99:2391-9. [PMID: 24670085 DOI: 10.1210/jc.2013-4398] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Clinical features of Metabolic Syndrome (MetS) and Cushing's Syndrome are similar, suggesting a pathogenetic role of hypothalamus-pituitary-adrenal axis in MetS. OBJECTIVE The aim of the study was to determine whether MetS diagnosis and specific clusters of MetS components (waist circumference, dyslipidemia, hypertension, and impaired glucose metabolism) are associated with serum cortisol (SC) or 24-h urinary free cortisol (UFC) levels. DESIGN AND SETTING We conducted cross-sectional analyses of data from our obesity cohort. We studied 264 obese children (age, 11.0 ± 2.8 years; male, 48%; BMI, 28.2 ± 5.4 kg/m(2)). We examined UFC, SC, homeostasis model assessment (HOMA), and features of MetS (waist circumference, blood pressure, fasting lipids, and glucose). RESULTS Slightly increased UFC concentrations were measured in 30.7% of the children. Obese children with MetS had significantly (P = .003) higher UFC levels compared with obese children without MetS. Girls demonstrated significantly higher UFC concentrations compared with boys independent of pubertal stage. UFC and SC levels were significantly related to features of MetS, but the associations were stronger for UFC. In multivariate analyses adjusted for age, sex, and body mass index, none of the features of MetS but HOMA index was correlated with UFC, whereas SC demonstrated no significant association to any parameter of MetS or HOMA. CONCLUSIONS Our findings support the hypothesis that changes in the hypothalamus-pituitary-adrenal axis are related to MetS in obesity. UFC seems to be a suitable marker for this relationship. Norm values for UFC adapted to obese children may help to avoid unnecessary dexamethasone suppression tests.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology (T.R., B.W., C.K., N.L.), Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Witten, Germany; Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics (A.K., M.W., P.-M.H.), University Hospital of Schleswig Holstein, Campus Kiel/Christian, Albrechts University of Kiel, Kiel, Germany
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