Cortisol measures in women vary across the weight spectrum, with the lowest levels occurring in overweight-class 1 obese women, and the highest levels occurring in those with anorexia nervosa, according to findings from a cross-sectional study.

Cortisol levels rise with more significant obesity – but not to levels as high as those seen in women with anorexia nervosa, suggesting that extreme underweight and overweight states may activate the hypothalamic-pituitary-adrenal (HPA) axis and that hypercortisolemia may contribute to increased adiposity in those with caloric excess, Dr. Melanie Schorr and her colleagues at Massachusetts General Hospital and Harvard Medical School, Boston, reported online in the Journal of Clinical Endocrinology & Metabolism.

Among the 60 women, aged 18-45 years, who were included in the study, 21 were overweight/obese, 18 had anorexia nervosa, and 21 were of normal weight. A U-shaped relationship was seen between cortisol measures and body mass index (most notably between urinary free cortisol/creatinine clearance [UFC/CrCl] and BMI and between mean overnight serum cortisol and BMI, r = 0.55 and 0.66, respectively), and between cortisol measures and visceral adipose tissue and total fat mass (for example, r = 0.50 for UFC/CrCl and adipose tissue, and 0.61 for UFC/CrCl and total fat mass), and either no relationship or a weak negative linear relationship was observed between lean mass and cortisol measures (for example, r = –0.34 for UFC/CrCL and lean mass). The latter “may be because it is the adipose component that is associated with cortisol measures or because hypercortisolemia contributes to muscle wasting,” the investigators wrote (J. Clin. Endocrinol. Metab. 2015 July [ doi:10.1210/JC.2015-2078 ]).

They also noted that cortisol measures were negatively associated with bone mineral density across the weight spectrum between urinary free cortisol/creatinine clearance and lean body mass, suggesting that “relative hypercortisolemia may contribute to bone loss in the setting of both caloric restriction and excess.”

“Given the fact that obesity has reached epidemic proportions and significantly increases the risk of the metabolic syndrome and cardiovascular disease among other comorbidities, insight into the factors that contribute to obesity and/or its complications may have important therapeutic implications,” they concluded.

The authors reported having no disclosures.



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