Central obesity, depression and the hypothalamo–pituitary–adrenal axis in men and postmenopausal women

Abstract

OBJECTIVE: We examined the relationship of adiposity to pituitary ± adrenal responses to corticotrophin-releasing hormone (CRH) in men and postmenopausal women, controlling for the in¯uence of depression. DESIGN: Studies of CRH responses, cortisol metabolite levels and depression scores in relation to adiposity in men and postmenopausal women. SUBJECTS: Thirteen men: age (median, interquartile range) 62 y (52 ± 63), body mass index (BMI) 29.0 kgam 2 (26.3 ± 33.1), waist circumference (waist) 105 cm (97 ± 111), waist : hip ratio (WHR) 1.03 (0.98 ± 1.07), subscapular to triceps skinfold thickness ratio (STR) 2.0 (1.2 ± 2.4), total body fat (TBF) 25.4 kg (19.8 ± 28.8); and eight women: age 54 y (53 ± 62), BMI 30 kgam 2 (23 ± 41), waist 86 cm (79 ± 117), WHR 0.94 (0.87 ± 1.10), STR 1.0 (0.85 ± 1.07), TBF 35.0 kg (18.7 ± 48.8). MEASUREMENTS: A standard CRH test was conducted with additional basal samples taken for leptin and interleukin 6 (IL-6). Total urine cortisol metabolites (TCM) and the ratio of urinary cortisol : cortisone (FmaEm) metabolites were measured. Depression scores were measured by the General Health Questionnaire (GHQ-30) and Hospital Anxiety and Depression Scale (HAD) questionnaire. All subjects completed an overnight dexamethasone suppression test. RESULTS: The basal to peak percentage increments (%inc.) in adrenocorticotrophic hormone (ACTH) and cortisol in men correlated directly with STR (ACTH %inc. r 0.70, P`0.01; cortisol %inc. r 0.55, P 0.05); this relationship was independent of depression scores. In women, the ACTH area under incremental curve (AUIC) correlated negatively with STR (r À0.81, P`0.05). In men, but not in women, there was a signi®cant correlation between GHQ-30 score and ACTH AUIC (r 0.62, P`0.05) and cortisol AUIC (r 0.72, P`0.01). Depression scores were consistently and directly related to indices of obesity and central obesity. There were no signi®cant relationships in either sex between urinary TCM or FmaEm ratio and BMI, waist, WHR, TBF, STR or CRH responses. The urinary FmaEm ratio was higher in men than in women (median 0.74 vs 0.66, P`0.05). In men, but not in women, GHQ-30 scores correlated positively with urinary TCM (r 0.57, P 0.05) and HAD-depression scores were inversely related to the urine FmaEm ratio (r À0.65, P`0.05). All subjects suppressed normally with dexamethasone. CONCLUSIONS: Cortisol metabolite levels were increased in depression in men, but were not related to adiposity in either sex. We demonstrate that central obesity in men, but not postmenopausal women, is associated with an enhanced pituitary ± adrenal response to CRH and that this relationship is independent of depression score.

Superiority of skinfold measurements and waist over waist-to-hip ratio for determination of body fat distribution in a population-based cohort of Caucasian Dutch adults

“…Central skinfolds, mainly the SS skinfolds (30), are positively linked to cardiovascular risk factors in contrast to peripheral skinfolds, which are negatively related to cardiovascular disease (31,32). Skinfold ratios have been widely used for the assessment of fat distribution (17,19,20,33) and correlate well with several factors of cardiovascular disease (18). Our study shows that these skinfold ratios are moderately correlated with CFM-to-PFM ratio, as measured with DXA.…”

Indices of whole-body and central adiposity for evaluating the metabolic load of obesity

“…To assess central adiposity, the ratio of skinfold thickness measurements on the torso and the arm has also been widely used. [8][9][10][11] These indices appear to have been generated for convenience, rather than with the clear purpose of addressing allometric relationships within human body composition. For example, in an early application, Schaefer 12 used the ratio of limb skinfold to truncal skinfold in order to highlight marked sex differences in fat distribution in adult Inuit that were not apparent in terms of BMI.…”

Depression Predicts Increased Incidence of Adverse Health Outcomes in Older Mexican Americans With Type 2 Diabetes

“…The increased risk of negative diabetic outcomes may also be the result of biologic changes that occur as a result of depression, including neurohormonal or neurotransmitter abnormalities (25), or lowered immune functioning, or inhibited cortisol release, which in turn increase vulnerability to diabetes (26,27). It may also be possible that both depression and diabetes share common pathogenesis, such as actions of the autonomic or sympathetic nervous systems (28,29), polymorphism of genes associated with obesity, insulin resistance, and sensitivity to stress (30), reduction of glucose use and increased insulin resistance (31), common neuroendocrine pathways (32), or the disruption of the hypothalamicpituitary-adrenal axis (33). The link between depression and diabetes may also be the direct or indirect result of risk factors common to both conditions, such as obesity, inactivity, medication use, and other preexisting psychological and physical conditions (34).…”