title: Cortisol, obesity, and the metabolic syndrome: a cross-sectional study of obese subjects and review of the literature.
abstract: OBJECTIVE
  Circulating cortisol and psychosocial stress may contribute to the pathogenesis of obesity and metabolic syndrome (MS). To evaluate these relationships, a cross-sectional study of 369 overweight and obese subjects and 60 healthy volunteers was performed and reviewed the previous literature.
  
  
  METHODS
  Overweight and obese subjects had at least two other features of Cushing's syndrome. They underwent measurements representing cortisol dynamics (24 h urine cortisol excretion (UFC), bedtime salivary cortisol, 1 mg dexamethasone suppression test) and metabolic parameters (BMI, blood pressure (BP); fasting serum triglycerides, HDL, insulin, and glucose). Subjects also completed the Perceived Stress Scale (PSS). UFC, salivary cortisol, and weight from 60 healthy volunteers were analyzed.
  
  
  RESULTS
  No subject had Cushing's syndrome. UFC and dexamethasone responses were not associated with BMI or weight. However, salivary cortisol showed a trend to increase as BMI increased (P < 0.0001), and correlated with waist circumference (WC) in men (rs = 0.28, P = 0.02) and systolic BP in women (rs = 0.24, P = 0.0008). Post-dexamethasone cortisol levels were weak to moderately correlated with fasting insulin (rs = -0.31, P = 0.01) and HOMA-IR (rs = -0.31, P = 0.01) in men and systolic (rs = 0.18, P = 0.02) and diastolic BP (rs = 0.20, P = 0.009) in women. PSS results were higher in obese subjects than controls, but were not associated with cortisol or metabolic parameters. As expected, WC correlated with fasting insulin, HOMA-IR, and systolic BP (adjusted for BMI and gender; P < 0.01). Literature showed inconsistent relationships between cortisol and metabolic parameters.
  
  
  CONCLUSIONS
  Taken together, these data do not support a strong relationship between systemic cortisol or stress and obesity or MS.
authors.affiliation: The Program in Reproductive and Adult Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Abraham
authors.forename: D
authors.initials: D
authors.lastname: Rubino
authors.forename: N
authors.initials: N
authors.lastname: Sinaii
authors.forename: S
authors.initials: S
authors.lastname: Ramsey
authors.forename: L K
authors.initials: LK
authors.lastname: Nieman
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000150:complications / Q000453:epidemiology / Q000378:metabolism; D003907:Dexamethasone / Q000494:pharmacology; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology / Q000378:metabolism* / Q000523:psychology; D008875:Middle Aged; D009765:Obesity / Q000209:etiology / Q000378:metabolism* / Q000523:psychology; D050177:Overweight; D012016:Reference Values; D012463:Saliva / Q000378:metabolism; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications / Q000378:metabolism*; D055105:Waist Circumference
chemical_list: D005938:Glucocorticoids; D007328:Insulin; D003907:Dexamethasone; D006854:Hydrocortisone