Clinical and biological correlates of morning serum cortisol in children and adolescents with overweight and obesity

Martens, Anton C.; Duran, Bünyamin; Vanbesien, Jesse; Verheyden, Stephanie; Rutteman, Bart; Staels, Willem; Anckaert, Ellen; Gies, Inge; Schepper, Jean De

doi:10.1371/journal.pone.0258653

Cited by 11 publications

(10 citation statements)

References 51 publications

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“…Interestingly, Wirix et al ( 43 ) and Yu et al ( 44 ) reported an increased cortisol production rate and lower morning and evening cortisol levels in overweight and obese children, which is opposite to our findings. Martens et al ( 45 ) found elevated morning serum cortisol levels in 20% of overweight or obese children and adolescents, which were associated with higher fasting glucose but showed no association between BMI and morning cortisol concentrations, which contradicts our results. In our study, we also observed a tendency of increased salivary cortisol concentration in the morning in both obese patients with OSA- and non-OSA.…”

Section: Discussioncontrasting

confidence: 99%

Circadian Rhythm of Salivary Cortisol in Obese Adolescents With and Without Apnea: A Pilot Study

et al. 2022

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Background and ObjectiveObstructive sleep apnea (OSA) and obesity are associated with stress system activation involving the hypothalamic-pituitary-adrenal (HPA) axis in adults, but these effects in childhood and adolescence remain unclear. We examined diurnal salivary cortisol as a measurement of the HPA axis function in obese adolescents with and without OSA and the relationships between cortisol levels, body weight, and parameters of polysomnography (PSG).MethodsAfter PSG, saliva samples were collected from obese participants (with and without OSA) and lean participants four times over a 24-h period, namely, at 7:00 h (m-sCort), 13:00 h (a-sCort), 19:00 h (e-sCort), and 23:00 h (n-sCort). An enzyme-linked immunosorbent assay (ELISA) was used to measure salivary cortisol levels. The mean values of cortisol levels and fixed-time point diurnal cortisol slope (DCS) were calculated and compared among the three study groups. Correlations between parameters were analyzed using Spearman's correlation coefficients.ResultsObese OSA participants had significantly higher e-sCort and n-sCort levels than both obese non-OSA participants and lean controls. However, m-sCort and a-sCort in these patients had a pronounced upward trend. M-sCort was significantly correlated with both the lowest oxygen saturation (SpO2) and time with SpO2 <90%. Moreover, in the obese OSA group, DCS was significantly flatter than in the other two groups. The a-sCort in obese non-OSA participants was significantly higher than that in the lean control group and, surprisingly, was positively correlated with the apnea/hypopnea index. Additionally, m-sCort was related to body weight.ConclusionThis study provided further evidence for alterations in diurnal cortisol production in obese adolescents, which may indicate a chronically stressed HPA axis. However, there were significant differences in salivary cortisol parameters between participants with and without OSA. Furthermore, patients with OSA had more associations between time-point cortisol levels and OSA-related indices. Nonetheless, this research is a pilot study, and further investigations are necessary.

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Section: Discussioncontrasting

confidence: 99%

Circadian Rhythm of Salivary Cortisol in Obese Adolescents With and Without Apnea: A Pilot Study

et al. 2022

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“…Cortisol secretion after ACTH stimulation was applied in clinical practice to assess the function of the HPA axis in patients with adrenal dysfunction due to pituitary, hypothalamic, or adrenal diseases [ 63 ]. Cortisol and ACTH were also not correlated with age, sex, and BMI percentile, as in previous studies in healthy children [ 64 , 65 , 66 ]. However, conflicting results have also been described, especially in young children under the age of eight.…”

Section: Discussionsupporting

confidence: 56%

“…The lack of differences at a later age is probably the result of the sex hormones on the hepatic metabolism of cortisol [ 67 , 68 ]. Carbohydrate metabolism markers in individuals with FASDs were not correlated with ACTH and cortisol levels, but a positive association with fasting glucose (R = 0.193, p < 0.005) and triglycerides (R = 0.143, p < 0.05) were noticed in children and adolescents with overweight and obesity [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of the Hypothalamic-Pituitary-Adrenal Axis with Appetite Regulation in Children with Fetal Alcohol Spectrum Disorders (FASDs)

et al. 2023

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Prenatal alcohol exposure causes growth impairment and a wide range of developmental, physical, and cognitive disorders in children, collectively referred to as fetal alcohol spectrum disorders (FASDs). In the course of FASDs, abnormalities can also affect eating behavior and nutritional status, but these problems have received little attention. Therefore, the aim of our study was to determine the levels of hormones involved in the action of the hypothalamic–pituitary–adrenal axis: proopiomelanocortin (POMC), cortisol, and adrenocorticotropic hormone (ACTH), in the serum of patients with FASDs. To our knowledge, none of these hormones studied have yet been evaluated in FASDs to date. We investigated 62 FASD patients and 23 healthy controls by applying an enzyme-linked immunosorbent method (ELISA). Fasting POMC levels were significantly lower in patients with FASDs (10.97 vs. 18,57 ng/mL, p = 0.039) compared to controls. However, there were no differences in cortisol concentrations. Additionally, the sex and subgroup status (fetal alcohol syndrome (FAS), neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE), and FASD risk) did not affect hormone levels. POMC was positively correlated with some clinical parameters such as age, BMI percentile, carbohydrate biomarkers, and ACTH. A positive correlation was observed between ACTH and cortisol levels, as well as ACTH and cholesterol levels. Data analysis showed no HPA axis abnormalities in the form of elevated serum cortisol and ACTH levels. Differences in POMC concentration may indicate the involvement and/or impairment of central nervous system structures in hormonal alterations in FASD individuals, caused by prenatal alcohol exposure. Hormonal dysregulation in FASDs can contribute to reduced growth and development, as well as many other disturbed processes, including neurological/neurodevelopmental dysfunctions. Further insightful studies involving a larger group of patients are needed to determine the potential impact of the measured hormones.

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“…Further, no study to date has investigated the effects of SG (or any other bariatric procedure) on thyroid hormones or hormones involved in the HPA axis in adolescents. However, recent studies have demonstrated a positive association between fasting serum cortisol with fasting glucose and triglycerides irrespective of adolescents' age, gender, or degree of adiposity ( 23 ). Although we did not observe any post SG changes in cortisol levels, ACTH was significantly lower at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Metabolic and hormonal changes after laparoscopic sleeve gastrectomy in pediatric population: An observational study

et al. 2022

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IntroductionDespite the growing popularity of laparoscopic sleeve gastrectomy (SG) for managing severe obesity in children, adolescents, and adults, there is a paucity of studies reporting the effects of SG on metabolic and hormonal outcomes in pediatric populations.MethodologyIn this single-centre, retrospective study, we assessed nutritional biomarkers (hemoglobin, ferritin, iron profile, Vitamin B12, Vitamin D, and calcium), glucose homeostasis indicators (C-peptide, HbA1C, and random blood glucose), blood lipids (triglycerides and cholesterol components), hormones involved in the hypothalamic-pituitary-adrenal axis (cortisol and adrenocorticotropic hormone), and thyroid hormones (T3, T4, thyroid-stimulating hormone, and parathyroid hormone) preoperatively and 12-month after SG in children aged 5–15 years.ResultsThis study included 64 adolescents (mean age = 11.2 ± 2.3 years) who underwent laparoscopic SG. Significant reduction in circulatory C-peptide (−62.1%; p = 0.005), HbA1C (−10.9%; p = 0.001), random blood glucose (−15.4%; p = 0.036), and triglycerides (−39.4%; p = 0.003) were observed postoperatively at 12 months compared to baseline. Although we did not observe any changes in cortisol levels, adrenocorticotropic hormone levels declined significantly by −40.9% postoperatively (p = 0.033). However, cholesterol components, thyroid hormones, and nutritional biomarkers remained unchanged from baseline.ConclusionsConsistent with prior literature, our study demonstrates improvement or resolution of diabetes and hypertriglyceridemia in the year following SG. However, given that blood cholesterol components, nutritional biomarkers, and thyroid profiles remained unchanged warrants long-term monitoring of nutritional, metabolic, and endocrine factors in adolescents undergoing laparoscopic SG. To the best of our knowledge, this is the first study reporting the effects of SG on thyroid and hypothalamic-pituitary-adrenal axis hormones in pediatric populations.

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Clinical and biological correlates of morning serum cortisol in children and adolescents with overweight and obesity

Cited by 11 publications

References 51 publications

Circadian Rhythm of Salivary Cortisol in Obese Adolescents With and Without Apnea: A Pilot Study

Circadian Rhythm of Salivary Cortisol in Obese Adolescents With and Without Apnea: A Pilot Study

The Association of the Hypothalamic-Pituitary-Adrenal Axis with Appetite Regulation in Children with Fetal Alcohol Spectrum Disorders (FASDs)

Metabolic and hormonal changes after laparoscopic sleeve gastrectomy in pediatric population: An observational study

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