Elsevier

Nutrition

Volume 27, Issue 6, June 2011, Pages 677-680
Nutrition

Applied nutritional investigation
Cortisol, energy intake, and food frequency in overweight/obese women

https://doi.org/10.1016/j.nut.2010.07.016Get rights and content

Abstract

Objective

This retrospective study investigated the relation between daily urinary free cortisol excretion rate, as a marker of cortisol production rate, to daily caloric intake, food choice, body mass index (BMI), and waist circumference.

Methods

One hundred twenty-seven overweight/obese women and 21 normal-weight subjects were enrolled in the study. Fasting blood samples for metabolic parameters were taken from each subject, followed by an oral glucose tolerance test. Cortisol excretion rate was assessed on 24-h urine collection (UFC/24 h). In obese patients, the daily caloric intake was calculated, and a weekly food-frequency questionnaire was assessed. Analysis of variance was used to assess the differences between groups. The relations between parameters were investigated by simple and multiple regressions.

Results

Obese women had significantly higher UFC/24 h than the normal-weight women (P < 0.001). The obese subjects had an unbalanced diet, particularly rich in saturated lipids, and weekly food choice showed a preference for highly caloric foods. UFC/24 h values and waist circumference were significantly correlated (P < 0.001), regardless of BMI. In the obese group, after adjustment for BMI, the UFC/24 h values were also significantly and positively correlated to daily carbohydrate and lipid intake and to weekly starchy food consumption.

Conclusion

We demonstrated a significant association between higher UFC/24 h and energy intake, fats, and consumption of starchy foods, and that these relations were independent of BMI.

Introduction

Obesity, particularly the abdominal phenotype, may be characterized by a mild hyperactivation or hyper-responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis [1], [2]. Long-term interventional studies performed in primates [3] and cross-sectional epidemiologic surveys and clinical studies performed in humans [4], [5] have demonstrated a disruption of negative feedback system [6]. These evidences suggest maladaptive mechanisms to chronic environmental stressors, which in turn may favor the development of obesity.

Studies performed in experimental animals have shown that chronic stressful situations lead to a desire for energy-dense foods [7], [8] by mechanisms that primarily involve an overactive HPA axis drive [9]. Interestingly, a sex difference has been documented, because female animals have been found to display increased stress sensitivity, with greater magnitude of hormonal response and delayed stress recovery compared with male animals [10], [11]. Accordingly, studies performed in humans have demonstrated that, when stressed, women tend to increase food consumption more than men [12]. This sex difference appears to be related to the influence of sex hormones on basal and stress-related HPA function [13].

The relation between the HPA axis and food intake and food choice is further complicated by the fact that this endocrine system is part of the brain-gut axis [14], [15], [16], [17], [18]. These two systems are able to modulate each other’s activities.

The aim of this study therefore was to retrospectively investigate the relation between daily urinary free cortisol excretion rate (UFC/24 h), an integrated measurement of HPA axis activity, and daily caloric intake and food choice, body mass index (BMI), waist circumference and the waist-to-hip ratio (WHR), and metabolic parameters in a large cohort of overweight/obese women.

Section snippets

Subjects

This study included 127 overweight/obese women (BMI >25 kg/m2) 18 to 71 y old and 21 normal-weight women (BMI ≤ 24.9 kg/m2) 20 to 48 y old. All overweight/obese women were attending the Division of Endocrinology of S. Orsola-Malpighi Hospital for the treatment of obesity and related comorbidities. Of them, one had type 2 diabetes, three were on l-thyroxine replacement for primary hypothyroidism, and five had essential hypertension. None had endogenous hypercortisolism, hyperandrogenism, and/or

General characteristics and metabolism

General parameters are presented in Table 1. As expected, age, body weight, BMI, waist, and WHR were significantly (all Ps < 0.001) different between the obese and control groups. Blood lipids, fasting glucose, and insulin levels (all Ps < 0.05) and systolic and diastolic blood pressures (P < 0.001) were significantly higher in the overweight/obese women than in the normal-weight women. The overweight/obese group also had significantly higher responses of glucose (P < 0.001) and insulin (P <

Discussion

In this study we confirm previous findings on the positive association between high UFC/24 h excretion and abdominal fat distribution in obese women, regardless of body weight. Moreover, the association between UFC/24 h and glucose-OGTT area under the curve and ISIcomposite suggests that excess subclinical cortisol production may have some importance in deteriorating glucose-insulin homeostasis and insulin sensitivity [19]. The new information is that, regardless of body weight, the UFC/24 h

References (27)

  • G. Oliver et al.

    Stress and food choice: a laboratory study

    Psychosom Med

    (2000)
  • R. Rosmond et al.

    Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities

    J Clin Endocrinol Metab

    (1998)
  • F. Cavagnini et al.

    Glucocorticoids and neuroendocrine function

    Int J Obes Relat Metab Disord

    (2000)
  • Cited by (32)

    • Stress-induced alterations in estradiol sensitivity increase risk for obesity in women

      2016, Physiology and Behavior
      Citation Excerpt :

      Obese women who gain weight following a stressful event show significantly higher levels of urinary free cortisol than women who have nonstress-related obesity [75]. Augmented urinary free cortisol levels in obese women are also associated with increased intake of CDD [76], supporting the notion that increased LHPA axis activity following exposure to acute psychosocial stressors in women shifts dietary preferences such that CDD are preferred [71,72]. These clinical data highlight the need to study the interaction of obesity and LHPA axis activity in a sex-dependent manner, and as such, more robust, translational animal models in females are necessary.

    • Sweet craving and ghrelin and leptin levels in women during stress

      2014, Appetite
      Citation Excerpt :

      This suggests that increased waist circumference is associated with higher glucocorticoid levels in stressed women. Vicennati et al. (2011) found a correlation between high urine cortisol levels and larger waist circumference in women. However, Abraham, Rubino, Sinaii, Ramsey, and Nieman (2013); Champaneri et al. (2013), and Baltrus, Shim, Ye, Watson, and Davis (2010) did not verify any association between high cortisol levels and increased waist circumference in women.

    • Academic stress levels were positively associated with sweet food consumption among Korean high-school students

      2013, Nutrition
      Citation Excerpt :

      It has been proposed that increased cortisol concentrations in the process of coping with stress cause an increase in the intake of sweet foods and energy-dense foods [1]. Vicennati et al. [30] also reported the positive relation between the urinary cortisol concentration and intakes of energy, fat, and starchy foods. Furthermore, cortisol results in the accumulation of visceral fat tissues by the activation of lipoprotein lipase [31], ultimately leading to a higher risk of chronic diseases, such as obesity, metabolic syndrome, cardiovascular disease, and cancer [1,31,32].

    • Perinatal overnutrition and the programming of food preferences: Pathways and mechanisms

      2012, Journal of Developmental Origins of Health and Disease
    View all citing articles on Scopus
    View full text