title: Investigation of the Relationship Between Chronic Stress and Insulin Resistance in a Chinese Population.
abstract: BACKGROUND
  Chronic stress may facilitate the development of metabolic diseases. Insulin resistance is present long before the clinical manifestations of individual metabolic abnormalities. To explore whether chronic stress is an independent risk factor of insulin resistance, we investigated the relationship between the stress system, selected parameters of energy homeostasis, and insulin resistance in a Chinese population.
  
  
  METHODS
  We recruited 766 workers employed at four companies in Beijing. The degree of insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR). The highest quartile of HOMA-IR among all study subjects was further defined as insulin resistance in our study. The short standard version of the Copenhagen Psychosocial Questionnaire (COPSOQ) was used to assess job-related psychosocial stress. Pearson's correlation coefficients were calculated between cortisol level and HOMA-IR and components of metabolic syndrome, with stratification by gender. The relationship between cortisol and HOMA-IR independent of obesity was analyzed using a linear mixed model with company as a cluster unit.
  
  
  RESULTS
  The values of the two scales of COPSOQ, including "demands at work" and "insecurity at work", were significantly associated with insulin resistance and cortisol concentration (P < 0.05). Cortisol was significantly positively correlated with glucose, HOMA-IR, and waist circumference in males and females (P < 0.05). After adjusting for potential confounders, cortisol was an independent positive predictor for HOMA-IR (P < 0.05).
  
  
  CONCLUSIONS
  These findings showed that chronic stress was associated with insulin resistance and may contribute to the development of insulin resistance.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University.
authors.forename: Yu-Xiang
authors.initials: YX
authors.lastname: Yan
authors.forename: Huan-Bo
authors.initials: HB
authors.lastname: Xiao
authors.forename: Si-Si
authors.initials: SS
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: Yan
authors.initials: Y
authors.lastname: He
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Dong
mesh_terms: D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013315:Stress, Psychological / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D014937:Work / Q000523:psychology*
chemical_list: D006854:Hydrocortisone
references.citation: Endocrine. 2014 Dec;47(3):740-8
references.pmid: 25104270
references.citation: Scand J Work Environ Health. 2005 Dec;31(6):438-49
references.pmid: 16425585
references.citation: Obes Rev. 2001 May;2(2):73-86
references.pmid: 12119665
references.citation: Obes Res. 2003 May;11(5):625-31
references.pmid: 12740452
references.citation: Stress. 2011 Sep;14(5):468-74
references.pmid: 21848434
references.citation: Public Health. 2012 Mar;126(3):210-3
references.pmid: 22325671
references.citation: Med Klin (Munich). 2003 Apr 25;98(5):283-6
references.pmid: 12721674
references.citation: Nutr Rev. 2003 Dec;61(12):397-412
references.pmid: 14968910
references.citation: J Clin Endocrinol Metab. 1991 Oct;73(4):691-5
references.pmid: 1890146
references.citation: Med Hypotheses. 2008;71(1):45-52
references.pmid: 18406066
references.citation: Diabetes Metab Res Rev. 2005 Nov-Dec;21(6):487-94
references.pmid: 15977304
references.citation: J Clin Endocrinol Metab. 2004 Jun;89(6):2989-97
references.pmid: 15181089
references.citation: Diabetes Metab. 2004 Sep;30(4):321-6
references.pmid: 15525874
references.citation: Mol Cell Endocrinol. 2009 Jan 15;297(1-2):104-11
references.pmid: 18599191
references.citation: Diabetes Metab Res Rev. 2008 Feb;24(2):155-64
references.pmid: 18058844
references.citation: J Urban Health. 2012 Apr;89(2):329-38
references.pmid: 22203493
references.citation: Eur J Pharmacol. 2008 Apr 7;583(2-3):174-85
references.pmid: 18282566
references.citation: Biol Psychol. 2006 Oct;73(3):280-7
references.pmid: 16824664
references.citation: Stress. 2015 Jan;18(1):29-34
references.pmid: 25518867
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825