title: Attachment Strategies and Neuroendocrine Biomarkers in Obese Children.
abstract: BACKGROUND
  Quality of the parent-infant relationship influences the mechanisms of development of the child's physiological stress regulation. This study explored associations between attachment strategies and both cortisol and thyroid stimulating hormone, hypothesized to be respectively a potential mediator and a potential intervening variable of the mother-child relationship in obese children.
  
  
  METHODS
  A sample of 83 obese children (46 boys), aged 10.9 (1.8) years was recruited from a child obesity clinic. Obesity was defined by body mass index percentile adjusted for age and sex. Metabolic biomarkers were measured by routine methods. Attachment strategies were assessed with self and parent-report questionnaires. Family functioning was assessed with parent-reported questionnaires (FACES-III). Multivariate linear regression analyses were performed.
  
  
  RESULTS
  Type A, avoidant attachment strategies, had significant positive association with thyroid stimulating hormone levels and negative association with cortisol levels (R2 = 0.352). Type B, secure attachment strategies, had significant positive associations with both hypothyroidism and body mass index percentile (R2 = 0.541). 'Insecure attachment' (types A and C combined) strategies showed some evidence of positive association with thyroid stimulating hormone (R2 = 0.250).
  
  
  CONCLUSIONS
  These findings suggest that there may be commonalities in the regulation of hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes. Processes involved in development of the type A attachment strategy appear to be associated with effects on the regulatory mechanisms of the hypothalamic-pituitary-adrenal axis.
  
  
  CONCLUSIONS
  In obese children, different attachment strategies are associated with diverse metabolic profiles. How this may contribute to developing differentiated treatment approaches remains to be explored.
authors.affiliation: Department of Child and Adolescent Psychiatry. Hospital Beatriz Ângelo. Loures. Department of Psychiatry and Mental Health. Faculty of Medicine. University of Porto. Porto. Hospital Dona Estefânea. Centro Hospitalar Lisboa Central. Lisboa.
authors.forename: Inês
authors.initials: I
authors.lastname: Pinto
authors.affiliation: Adolescent Psychiatric Section. Lorenskog University Hospital. Oslo. Department of Research and Development. Division of Mental Health. Akershus University Hospital. Oslo.
authors.forename: Simon
authors.initials: S
authors.lastname: Wilkinson
authors.affiliation: Epidemiology and Statistics Office of the Research Unit. Centro Hospitalar de Lisboa Central. Lisboa.
authors.forename: Daniel
authors.initials: D
authors.lastname: Virella
authors.affiliation: Epidemiology and Statistics Office of the Research Unit. Centro Hospitalar de Lisboa Central. Lisboa.
authors.forename: Marta
authors.initials: M
authors.lastname: Alves
authors.affiliation: Nutrição e Metabolismo. Nova Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Center for Research in Health Technologies and Information Systems (CINTESIS). University of Porto. Porto.
authors.forename: Conceição
authors.initials: C
authors.lastname: Calhau
authors.affiliation: Department of Neurosciences and Mental Health. Faculdade de Medicina da Universidade do Porto. Porto. Institute for Research and Innovation inHealth (i3S). University of Porto. Porto.
authors.forename: Rui
authors.initials: R
authors.lastname: Coelho
mesh_terms: D015415:Biomarkers / Q000097:blood; D002648:Child; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D009034:Mother-Child Relations; D009769:Object Attachment; D063766:Pediatric Obesity / Q000097:blood* / Q000523:psychology*; D057566:Self Report; D013972:Thyrotropin / Q000097:blood*
chemical_list: D015415:Biomarkers; D013972:Thyrotropin; D006854:Hydrocortisone