title: Internalizing and externalizing problems in obese children and adolescents: associations with daily salivary cortisol concentrations.
abstract: OBJECTIVE
  Pediatric obesity commonly co-exists with emotional and behavioral disorders, while disturbed cortisol concentrations have been reported in both obese and chronically stressed individuals with anxiety and/or depression. We investigated the prevalence of internalizing and externalizing problems, reported by both parents and children, in a clinical population of obese children (OC) compared to normal-weight children. We examined the role of cortisol as a potential mediator between obesity and such problems.
  
  
  METHODS
  We compared 110 obese with 31 normal-weight children. The Greek version of the child behavior checklist (CBCL) and the youth self-report (YSR) were used and salivary cortisol was determined serially five times a day.
  
  
  RESULTS
  T-scores of internalizing problems (anxiety/depression, social withdrawal, somatic complains) reported by both children (49.3±12.3 vs. 43.2±9.1) and mothers (60.6±11.3 vs. 50.6±10.4) were significantly higher (p=0.03 and p<0.001, respectively) in the obese than in the lean children. Externalizing problems (delinquency, rule-breaking behaviors) reported only by mothers were significantly higher in the OC (57.2 ±10.5 vs. 48.2±13.3, p=0.003). The cortisol area under the curve (AUC) was significantly smaller (p=0.03) in the OC than in the controls; however, a cortisol correlation with internalizing/externalizing symptoms was not observed.
  
  
  CONCLUSIONS
  There is a high prevalence of internalizing and externalizing problems in a clinical population of OC. A mediation effect of cortisol in the relation between internalizing/externalizing problems and obesity could not be supported.
authors.affiliation: First Department of Pediatrics, University of Athens, School of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Pervanidou
authors.affiliation: First Department of Pediatrics, University of Athens, School of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Despoina
authors.initials: D
authors.lastname: Bastaki
authors.affiliation: First Department of Pediatrics, University of Athens, School of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Giorgos
authors.initials: G
authors.lastname: Chouliaras
authors.affiliation: Department of Child Psychiatry, University of Athens, School of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Papanikolaou
authors.affiliation: First Department of Pediatrics, University of Athens, School of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Kanaka-Gantenbein
authors.affiliation: First Department of Pediatrics, University of Athens, School of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Chrousos
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D041923:Adolescent Development; D000367:Age Factors; D016022:Case-Control Studies; D057189:Checklist; D002648:Child; D002652:Child Behavior; D002657:Child Development; D003430:Cross-Sectional Studies; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D065886:Neurodevelopmental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000523:psychology; D063766:Pediatric Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000523:psychology; D015995:Prevalence; D011594:Psychometrics; D012307:Risk Factors; D012463:Saliva / Q000378:metabolism*; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D006854:Hydrocortisone