title: Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition.
abstract: Undernutrition is a stressor with long-term consequences, and the effect of nutritional recovery on cortisol and thyroid hormone status is unknown. To investigate basal thyroid hormones and the cortisol response to a cold pressor test in children recovered from undernutrition, a cross-sectional study was undertaken on children (6-16 years) separated into four groups: control (n 41), stunted (n 31), underweight (n 27) and recovered (n 31). Salivary cortisol was collected over the course of 10 h: upon awakening, before and after an unpleasant and a pleasant stimulus. Cortisol upon awakening was highest in the stunted and lowest in the underweight groups: control=5·05 (95% CI 3·71, 6·89) nmol/l, stunted=6·62 (95% CI 3·97, 11·02) nmol/l, underweight=2·51 (95% CI 1·75, 3·63) nmol/l and recovered=3·46 (95% CI 2·46, 4·90) nmol/l (P=0·005). Girls had higher cortisol concentrations upon awakening compared with boys (P=0·021). The undernourished groups showed an elevated cortisol response both to the unpleasant stimulus and at the last measurement (16.00 hours) compared with that of the recovered group: AUC, control=2·07 (95% CI 1·69, 2·45) nmol/l×30 min, stunted=2·48 (95% CI 1·91, 3·06) nmol/l×30 min, underweight=2·52 (95% CI 2·07, 2·97) nmol/l×30 min, recovered=1·68 (95% CI 1·26, 2·11) nmol/l×30 min (P=0·042); and control=2·03 (95% CI 1·75, 2·39) nmol/l×30 min, stunted=2·51 (95% CI 1·97, 3·19) nmol/l×30 min, underweight=2·61 (95% CI 2·16, 3·16) nmol/l×30 min, recovered=1·70 (95% CI 1·42, 2·03) nmol/l×30 min (P=0·009). Lower free thyroxine (T4) was found in the recovered and stunted groups: control=1·28 (95% CI 1·18, 1·39) pmol/l, stunted=0·98 (95% CI 0·87, 1·10) pmol/l, underweight=1·10 (95% CI 1·01, 1·21) pmol/l and recovered=0·90 (95% CI 0·83, 0·99) pmol/l (P<0·001). Multivariate analysis showed a lower cortisol concentration along 10 h (06.00-16.00 hours) in the recovered compared with the other groups (P=0·017), and similar concentrations between the recovered and control group. In conclusion, the children with recovery in weight and height had a cortisol stress response similar to control but a lower basal free T4. Longitudinal studies are warranted to determine the extent of these endocrine changes after recovery of undernutrition and in adulthood.
authors.affiliation: 1Department of Physiology,Federal University of São Paulo,Rua Botucatu, 862,Edifício de Ciências Biomédicas,2°andar,CEP 04023-060,São Paulo, SP,Brazil.
authors.forename: Vinicius J B
authors.identifier: http://orcid.org/0000-0002-0327-538X
authors.initials: VJ
authors.lastname: Martins
authors.affiliation: 1Department of Physiology,Federal University of São Paulo,Rua Botucatu, 862,Edifício de Ciências Biomédicas,2°andar,CEP 04023-060,São Paulo, SP,Brazil.
authors.forename: Andrea P O
authors.initials: AP
authors.lastname: Neves
authors.affiliation: 2Department of Biosciences,Federal University of São Paulo,Rua Silva Jardim, 136,Vila Mathias,CEP 11015-020,Santos, SP,Brazil.
authors.forename: Márcia C
authors.initials: MC
authors.lastname: Garcia
authors.affiliation: 2Department of Biosciences,Federal University of São Paulo,Rua Silva Jardim, 136,Vila Mathias,CEP 11015-020,Santos, SP,Brazil.
authors.forename: Regina C
authors.initials: RC
authors.lastname: Spadari
authors.affiliation: 3Nutrition College,Federal University of Alagoas,Campus A. C. Simões,Avenida Lourival Melo Mota, s/n,Cidade Universitária,CEP 57072-900,Maceió, AL,Brazil.
authors.forename: Ana Paula G
authors.initials: AP
authors.lastname: Clemente
authors.affiliation: 1Department of Physiology,Federal University of São Paulo,Rua Botucatu, 862,Edifício de Ciências Biomédicas,2°andar,CEP 04023-060,São Paulo, SP,Brazil.
authors.forename: Maria P
authors.initials: MP
authors.lastname: de Albuquerque
authors.affiliation: 4Department of Nutritional Sciences,Center for Childhood Nutrition Education and Research,Rutgers,The State University of New Jersey,Davison Hall, 228,26 Nichol Avenue New Brunswick,NJ 08901,USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Hoffman
authors.affiliation: 1Department of Physiology,Federal University of São Paulo,Rua Botucatu, 862,Edifício de Ciências Biomédicas,2°andar,CEP 04023-060,São Paulo, SP,Brazil.
authors.forename: Ana L
authors.initials: AL
authors.lastname: Sawaya
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D002648:Child; D003080:Cold Temperature; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System; D008297:Male; D044342:Malnutrition / Q000378:metabolism* / Q000628:therapy; D009752:Nutritional Status; D010913:Pituitary-Adrenal System; D012737:Sex Factors; D013312:Stress, Physiological; D013961:Thyroid Gland / Q000378:metabolism*; D013963:Thyroid Hormones / Q000097:blood; D013974:Thyroxine / Q000097:blood*
chemical_list: D013963:Thyroid Hormones; D013974:Thyroxine; D006854:Hydrocortisone
keywords: ACTH adrenocorticotropic hormone; CREN Centre for Nutritional Recovery and Education; Cortisol stress response; HAZ height for age; HPA hypothalamic–pituitary–adrenal; Nutritional recovery; T3 triiodothyronine; T4 thyroxine; TSH thyroid-stimulating hormone; Thyroid status; Undernutrition