title: Salivary cortisol increases after bariatric surgery in women.
abstract: Cortisol increases have been associated with psychological and physiological stress; however, cortisol dynamics after weight loss (bariatric) surgery have not been defined. Obese participants not using exogenous glucocorticoids were eligible to participate. Female participants (n=24) provided salivary cortisol samples at bedtime, upon awakening the following morning, and 30 min after awakening before, and at 6 or 12 months after bariatric surgery. The Medical Outcomes Study Short Form-12 version 2 questionnaire regarding health-related quality of life was also completed. Preoperatively, mean body mass index was 45.1±8.1 kg/m2. Mean late night (1.8±1.1 nmol/l), awakening (10.7±7.4 nmol/l), and after-awakening (11.5±7.9 nmol/l) salivary cortisol values were within normal ranges. The cortisol awakening response (mean 21.1±79.7%, median 13.7%) was at the low end of normal. Preoperatively, participants had lower mental and physical health-related quality of life scores than US adult norms (p<0.001). Salivary cortisol was not correlated with measures of health-related quality of life. Mean BMI decreased over time (p<0.001) and participants experienced improved physical and mental health-related quality of life (p≤0.011). Postoperative late night salivary cortisol was not different from preoperative values. Awakening and after-awakening cortisol levels were higher than preoperative values (15.3±7.7 nmol/l, p=0.013; 17.5±10.2 nmol/l, p=0.005; respectively), but the cortisol awakening response was not changed (mean 26.7±66.2%; median 7.8%). Morning salivary cortisol increased at long-term follow-up after bariatric surgery. Although self-evaluated mental and physical health improved after surgery, the cortisol awakening response is at the low end of normal, which may indicate continued physiological stress.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. ashleyv@stanford.edu
authors.forename: A R
authors.initials: AR
authors.lastname: Valentine
authors.forename: H
authors.initials: H
authors.lastname: Raff
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.forename: M
authors.initials: M
authors.lastname: Ballesteros
authors.forename: J M
authors.initials: JM
authors.lastname: Rose
authors.forename: G H
authors.initials: GH
authors.lastname: Jossart
authors.forename: P
authors.initials: P
authors.lastname: Cirangle
authors.forename: D M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D012463:Saliva / Q000378:metabolism*
chemical_list: D006854:Hydrocortisone