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