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Cortisol Measures Across the Weight Spectrum.

Melanie Schorr1, Elizabeth A Lawson1, Laura E Dichtel1

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Cortisol levels show a U-shaped pattern with body mass index (BMI), being lowest in overweight individuals and highest in anorexia nervosa (AN). Both extreme underweight and overweight states may activate the hypothalamic-pituitary-adrenal (HPA) axis.

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Area of Science:

  • Endocrinology
  • Human Physiology
  • Metabolic Disorders

Background:

  • Conflicting reports exist regarding hypothalamic-pituitary-adrenal (HPA) axis activation in obesity.
  • A consistent finding is an inverse relationship between body mass index (BMI) and morning cortisol.
  • Cortisol levels are elevated in anorexia nervosa (AN), a low-BMI state.

Purpose of the Study:

  • To investigate cortisol measures across the full spectrum of body weight.
  • To understand the relationship between BMI, body composition, and HPA axis activity.
  • To explore the impact of weight status on bone mineral density (BMD) and lean mass.

Main Methods:

  • Cross-sectional study involving 60 women (18-45 years) categorized as overweight/obese (OB), AN, or normal-weight controls (HC).
  • HPA axis dynamics assessed via urinary free cortisol, overnight serum cortisol, morning/late-night salivary cortisol, and dexamethasone-CRH testing.
  • Body composition and BMD measured using dual-energy x-ray absorptiometry.

Main Results:

  • Cortisol levels exhibited a U-shaped relationship with BMI, reaching their lowest point in the overweight-class I obese range.
  • Cortisol levels were higher in AN compared to OB, and negatively associated with lean mass and BMD.
  • Visceral adipose tissue and total fat mass showed similar associations with cortisol measures as BMI.

Conclusions:

  • Cortisol levels are lowest in overweight-class I obese women, lower than in lean individuals.
  • Both extreme underweight (AN) and overweight states can activate the HPA axis.
  • Hypercortisolemia may contribute to increased adiposity, decreased BMD, and muscle wasting in both caloric excess and restriction.