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

Abstract

This study examined associations between hair, salivary, serum, and urinary cortisol concentration with adiposity-related indicators in children, and explored their potential effects modification by age, sex, cortisol measurement method, and country developmental context. We systematically searched PubMed, Web of Science, and Embase for studies examining at least one of the four aforementioned cortisol with objectively measured adiposity-related outcomes in children. Meta-analyses of cross-sectional studies revealed that hair cortisol concentration was associated with fat mass index (FMI)-standard deviation score (SDS)/FMI z-score (pooled-β = 0.04, 95% CI: 0.01, 0.08) and BMI/BMI z-score (pooled-β = 0.15, 95% CI: 0.06, 0.25), and these associations were significant among children aged ≤ 12 years (pooled-β = 0.15, 95% CI: 0.05, 0.26) and >12 years (pooled-β = 0.13, 95% CI: 0.04, 0.22), children from developed countries (pooled β = 0.12, 95% CI: 0.03, 0.21) and developing countries (pooled-β = 0.193, 95% CI: 0.188, 0.198), and in studies extracting cortisol via LC-MS/MS (pooled-β = 0.18, 95% CI: 0.06, 0.29) but not ELISA (pooled-β = 0.08, 95% CI: −0.06, 0.22). Meta-analyses of both cohort and cross-sectional studies revealed non-significant associations of morning salivary cortisol concentration and total daily cortisol output with BMI/BMI z-score. Serum cortisol concentration was not associated with BMI or waist circumference. Meta-analysis of urinary cortisol concentration and adiposity was hindered by insufficient data. These findings further corroborate understanding of chronic stress’ physiological contribution to increased pediatric obesity risk.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020215111].

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“…Possible discrepancies between studies may be a result of differences in sample collection (both number of samples and timing of collection) as well as cortisol analysis methods. A recent meta-analysis of associations found a significant association between hair (but not serum or salivary) cortisol and children and BMI z-score; however, only in studies extracting cortisol via more sensitive and reliable LC-MS/MS, and not ELISA [ 64 ]. However, Hollanders et al [ 9 ] used the LC-MS/MS method, but also did not observe significant associations.…”

Preoperative Serum Cortisol Level Is Predictive of Weight Loss After Laparoscopic Sleeve Gastrectomy in Men with Severe Obesity but Not Women

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“…There are limits to which inflammatory markers are measurable in salivary samples (Salimetrics). While cortisol levels in saliva correlate with serum levels (Ma et al, 2022), this is not necessarily true for other biomarkers. For example, inflammatory biomarkers from saliva may represent local rather than systemic inflammation in individuals with poor oral health (Szabo & Slavish, 2021).…”