Relationship between stress, inflammation and metabolism.
OBJECTIVE
Various threatening stimuli, such as pain, low blood pressure, or infection, elicit a set of neuroendocrine responses that include an increased secretion of catecholamines and glucocorticoid from the adrenal gland and activation of the sympathetic nervous system. These hormonal secretions allow a "fight or flight" response by mobilizing endogenous substrate. They also exert anti-insulin actions, and may in the long term induce a state of insulin resistance. In addition, stress stimulates inflammatory mediators in mononuclear cells. Given the possible role of low-grade inflammation in chronic metabolic disorders, this suggests that stress may be a factor in the development of insulin resistance and the metabolic syndrome.


RESULTS
Studies reviewed in this article cover: (1) the metabolic and haemodynamic effects of stress in healthy and insulin-resistant individuals; (2) the relationship between stress and inflammation and the role of the autonomic nervous system; and (3) some factors known to modulate the neuroendocrine responses to stress. Future perspectives, together with some hints regarding the role of neurotrophins such as brain-derived neurotrophic factor, are delineated.


CONCLUSIONS
Recent work performed in the field has indicated that stress may be a significant factor in the pathogenesis of metabolic disorders. Nutritional intervention or pharmacological agents targeted at modulating stress should be investigated.
Seematter
Gérald
G
Service of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland.
Binnert
Christophe
C
Martin
Jean-Luc
JL
Tappy
Luc
L
D016207:Cytokines / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology*; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000378:metabolism; D007333:Insulin Resistance; D008659:Metabolic Diseases / Q000503:physiopathology*; D018384:Oxidative Stress / Q000502:physiology; D013312:Stress, Physiological / Q000378:metabolism / Q000503:physiopathology*
D016207:Cytokines