Alterations of Cortisol Homeostasis May Link Changes of the Sociocultural Environment to an Increased Diabetes and Metabolic Risk in Developing Countries: A Prospective Diagnostic Study Performed in Cooperation With the Ovahimba People of the Kunene Region/Northwestern Namibia

Kann, Peter Herbert; Münzel, Mark; Hadji, Peyman; Daniel, Hanna; Flache, Stephan; Nyarangó, Peter; Wilhelm, Anneke

doi:10.1210/jc.2014-2625

Cited by 13 publications

(9 citation statements)

References 8 publications

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“…Namibia is a middle-income country in SSA with a population just over 2 million [ 18 , 19 ]. The population is described as young, with 57.8% under 25 years of age and only 3.5% aged 65 years or older [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of hypertension in Namibia: A national-level cross-sectional study

2018

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BackgroundHypertension has been identified as the single greatest contributor to the global burden of disease and mortality, with estimates suggesting that the highest levels of blood pressure have shifted from high-income countries to low-income countries in sub-Saharan Africa. While evidence suggests a remarkably high prevalence of hypertension among urban residents in Namibia, national estimates to inform on the country-level burden are lacking. This study estimates the prevalence and predictors of hypertension among Namibian adults.MethodsThe analysis is based on 1,795 women and 1,273 men aged 35–64 years from the nationally-representative 2013 Namibia Demographic and Health Survey. Odds radios and 95% confidence intervals were estimated using logistic regression.ResultsThe age-standardized prevalence of hypertension was 46.0% (men vs. women: 46.1% vs. 46.0%). Mean systolic and diastolic blood pressures for the total population were 128.8 mmHg (95% CI 127.8–129.7) and 83.1 mmHg (95% CI 82.5–83.7), respectively. Mean systolic blood pressure was significantly lower among women (men vs. women: 130.9 mmHg vs. 127.4 mmHg; p<0.001). There were no statistically significant differences in mean diastolic blood pressure between men and women. Older age, urban residence, and being either overweight or obese were positively associated with the odds of hypertension (p<0.01). For women, the odds of hypertension were also significantly increased for those who were diabetic (i.e. had a fasting blood glucose level greater than 7.0 mmol/L) and reduced for those with higher levels of education.ConclusionThe prevalence of hypertension among Namibian adults is high and associated with metabolic and socio-demographic factors. Future research examining disease comorbidity and behavioral risk factors could better inform on the disease burden and help target resources to optimize prevention and control.

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Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of hypertension in Namibia: A national-level cross-sectional study

2018

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“…Although the presence of larger adipose tissue depots may have been vital for human evolution (including cognitive expansion, reproduction and prolonged fasting), in an environment with excess caloric availability, this evolutionary advantage has now become a disadvantage and risk factor of modern public health disorders [10, 11]. An excellent model to test how modern life leads to obesity and hormonal imbalance are studies that describe the adverse effects of urbanization in developing countries [12] [13]. In a recent study, unfavorable habits of urbanization in a rural population of Namibia were dramatically associated with higher rates of obesity, metabolic syndrome, diabetes and hypertension.…”

Section: Obesity and Adrenal Dysregulation From An Evolutionary Perspmentioning

confidence: 99%

“…In a recent study, unfavorable habits of urbanization in a rural population of Namibia were dramatically associated with higher rates of obesity, metabolic syndrome, diabetes and hypertension. Interestingly, this abnormal phenotype was associated with cortisol circadian rhythm dysregulation, suggesting that adoption of this “modern” urbanized lifestyle can result in altered endocrine modulation[12]. …”

Section: Obesity and Adrenal Dysregulation From An Evolutionary Perspmentioning

confidence: 99%

Cortisol dysregulation in obesity-related metabolic disorders

Baudrand

Vaidya²

2015

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review The understanding of how adrenal function is challenged by the interplay of our genetic and environmental milieu has highlighted the importance of inappropriate cortisol regulation in cardiometabolic disorders. Increased adipose tissue in obesity is associated with hypothalamic-pituitary-adrenal axis over-activation, increased cortisol production at the local tissue level, and probably higher mineralocorticoid receptor activation in certain tissues. Recent findings Due to the clinical resemblance of obesity-related metabolic disorders with the Cushing syndrome, new studies have investigated the intracellular regulation and metabolism of cortisol, new measurements in scalp hair as a tool for long-term exposure and the cortisol-mineralocorticoid receptor pathway. Thus, current and future pharmacological interventions in obesity may include specific inhibition of steroidogenic and regulatory enzymes as well as antagonists of the mineralocorticoid and glucocorticoid receptors. Summary This review highlights recent investigations focusing on the role of dysregulated cortisol physiology in obesity as a potential modifiable mechanism in the pathogenesis of obesity related cardiometabolic disorders.

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“…However, issues include difficulties obtaining a complete 24-h urine sample and high intra-patient variability on a day-to-day basis (7). In addition, UFC cannot provide information on circadian fluctuations of cortisol or midnight cortisol levels, which have been shown to play a role in the morbidity of dysregulated cortisol secretion (8,9,10,11). Collection of late-night salivary samples is both simple and convenient for patients to carry out in their own homes, with samples being stable at room temperature for up to 2 weeks and easy to store (12,13).…”

Section: Introductionmentioning

confidence: 99%

Use of late-night salivary cortisol to monitor response to medical treatment in Cushing’s disease

Newell‐Price

Pivonello

Tabarin

et al. 2020

European Journal of Endocrinology

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Objective Monitoring of patients with Cushing’s disease on cortisol-lowering drugs is usually performed with urinary free cortisol (UFC). Late-night salivary cortisol (LNSC) has an established role in screening for hypercortisolism and can help to detect the loss of cortisol circadian rhythm. Less evidence exists regarding the usefulness of LNSC in monitoring pharmacological response in Cushing’s disease. Design Exploratory analysis evaluating LNSC during a Phase III study of long-acting pasireotide in Cushing’s disease (clinicaltrials.gov: NCT01374906). Methods Mean LNSC (mLNSC) was calculated from two samples, collected on the same days as the first two of three 24-h urine samples (used to calculate mean UFC [mUFC]). Clinical signs of hypercortisolism were evaluated over time. Results At baseline, 137 patients had evaluable mLNSC measurements; 91.2% had mLNSC exceeding the upper limit of normal (ULN; 3.2 nmol/L). Of patients with evaluable assessments at month 12 (n = 92), 17.4% had both mLNSC ≤ULN and mUFC ≤ULN; 22.8% had mLNSC ≤ULN, and 45.7% had mUFC ≤ULN. There was high variability in LNSC (intra-patient coefficient of variation (CV): 49.4%) and UFC (intra-patient CV: 39.2%). mLNSC levels decreased over 12 months of treatment and paralleled changes in mUFC. Moderate correlation was seen between mLNSC and mUFC (Spearman’s correlation: ρ = 0.50 [all time points pooled]). Greater improvements in systolic/diastolic blood pressure and weight were seen in patients with both mLNSC ≤ULN and mUFC ≤ULN. Conclusion mUFC and mLNSC are complementary measurements for monitoring treatment response in Cushing’s disease, with better clinical outcomes seen for patients in whom both mUFC and mLNSC are controlled.

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Alterations of Cortisol Homeostasis May Link Changes of the Sociocultural Environment to an Increased Diabetes and Metabolic Risk in Developing Countries: A Prospective Diagnostic Study Performed in Cooperation With the Ovahimba People of the Kunene Region/Northwestern Namibia

Cited by 13 publications

References 8 publications

Prevalence and predictors of hypertension in Namibia: A national-level cross-sectional study

Prevalence and predictors of hypertension in Namibia: A national-level cross-sectional study

Cortisol dysregulation in obesity-related metabolic disorders

Use of late-night salivary cortisol to monitor response to medical treatment in Cushing’s disease

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