Morning Salivary Cortisol Levels Research Articles

P5450Evening levels and circadian changes of salivary cortisol predict adverse events in heart failure patients with comorbid depression - a MOOD-HF substudy

Abstract Background Depression is frequent in heart failure (HF) and associated with adverse clinical outcomes. The randomized MOOD-HF trial showed that in depressed patients with systolic heart failure (HF) the selective serotonin reuptake inhibitor escitalopram (E) improved neither survival nor depression compared to placebo (P). The hypothalamic-pituitary-adrenocortical axis is known to be altered in depression or HF. This MOOD-HF substudy aimed to clarify whether circadian salivary cortisol levels (SCL) were predictive of adverse events in depressed MOOD-HF participants and whether outcomes differed according to treatment with E. Methods MOOD-HF participants (all suffering from symptomatic systolic HF with left ventricular ejection fraction (LVEF) <45% and current major depression) were eligible for the present analysis if providing samples for SCL determination (luminescence immunoassay) at baseline visit (BL) and if not on oral glucocorticosteroid therapy. Depression severity was determined with the Montgomery–Åsberg Depression Rating Scale (MADRS) and LVEF measured by echocardiography. Results In the total study cohort (146 patients on E, 147 on P) median morning SCL at BL was 0.210 μg/dL (IQR 0.141–0.338 μg/dL) and median evening (pm) SCL 0.067 μg/dL (0.036–0.128 μg/dL, p<0.001). Median circadian change was 0.124 μg/dL (0.044–0.239 μg/dL). In patients with BL pm-SCL above the median MADRS-score was 21.7±9.1 and LVEF 33.7±8.4% respectively, in patients with pm-SCL below the median these values were 19.6±9.1 and 36.5±7.8% (p=0.048; p=0.004). During 12 months follow-up the composite endpoint (all-cause death or rehospitalization) occurred least in E-treated patients with low pm-SCL and most often in E-treated patients with high pm-SCL (HR 2.02, 95% CI 1.12–3.65, p=0.010); patients on P had comparable event rates irrespective of BL pm-SCL (Figure A). Thus, numerically patients on E with low BL pm-SCL had lower event rates compared with corresponding P-treated patients (HR 0.76 (0.41–1.40, p=0.796)), while patients with high BL pm-SCL had higher event rates (HR 1.29 (0.74–2.24, p=0.799)) than corresponding P-treated patients. Patients with circadian SCL changes above the median receiving P experienced the composite primary endpoint least, while both subgroups with circadian SCL changes below the median and also patients with circadian SCL changes above the median on E had higher event rates (HR 0.66 (0.45–0.97, p=0.039), Figure B). Conclusion In depressed patients with systolic HF high pm-SCL are associated with more severe disease (depression and cardiac dysfunction). Extending primary MOOD-HF results indicating unfavourable outcomes related to E, the current findings suggest a SCL x treatment interaction with higher event rates in (sicker) patients with high pm-SCL and lower event rates in (less sick) patients with low pm-SCL when treated with the antidepressant. Low circadian changes of SCL were always associated with higher event rates. Acknowledgement/Funding BMBF (Grant 01 KG0702) and Lundbeck A/S Denmark

Association of Cortisol Levels With Neuropsychiatric Functions: A Mendelian Randomization Analysis.

Aim: The conflicting evidence as to whether a real association exists between cortisol levels and depression lends support to adopting a Mendelian randomization approach to investigate whether cortisol levels have a causal effect with depression.Methods: Single nucleotide polymorphisms (SNPs) associated with serum morning plasma cortisol level and salivary cortisol level from CORNET consortium (12,597 participants) were proposed as instrumental variables. The primary outcome was depression, and the secondary outcomes were neuroticism and cognitive performance. Summary-level statistics were extracted from the Social Science Genetic Association Consortium including the United Kingdom Biobank cohort (105,739 subjects). Multiple analysis methods (inverse-variance weighted method, max likelihood method, weighted median estimator, model-based estimation, heterogeneity-penalized method, and MR-Egger regression) were applied to test the stability of the summary causal estimate.Results: Weighted median analysis estimated that the effect of serum morning cortisol on depression score was 0.027 per standard deviation increase of cortisol (95% CI, 0.000–0.054; p = 0.043). Other sensitivity analysis suggested similar results suggesting the result was robust. No evidence of pleiotropy (MR-Egger intercept, −0.002; p = 0.739) was observed. The effect of serum cortisol on neuroticism was 0.030 (95% CI, 0.008–0.052; p = 0.006) by weighted median estimator. None of the methods observed the effect of serum cortisol level on cognitive function. As for the effect of salivary cortisol level, no method obtained a p-value lower than 0.05 in any of the outcomes.Conclusion: Mendelian randomization analysis provided evidence that a genetic predisposition to higher serum morning cortisol level was associated with increased depression score.

Low salivary cortisol levels in patients with rheumatoid arthritis exposed to oral glucocorticoids: a cross-sectional study set within UK electronic health records

BackgroundGlucocorticoids (GCs) suppress endogenous cortisol levels which can lead to adrenal insufficiency (AI). The frequency of GC-induced AI remains unclear. In this cross-sectional study, low morning salivary cortisol (MSC) levels...

Evidence for a physiologic home–school gap in children of Latina immigrants

The “Latino Health Paradox” denotes a well-established trend wherein foreign-born Latino immigrants arrive with protective health benefits which dissipate and sometimes reverse into health disparities in the second and subsequent generations. The origins and mechanism behind this paradox remain poorly understood. This study investigates whether physiological stress profiles in children of Latina immigrants (CoLIs) as compared with the children of Latina Americans (CoLAs) and of non-Latina Americans (ConLAs) might help explain how health advantages can be lost during acculturation to even result in health disparities. Because studies of ethnicity/nativity often confound poverty and ethnicity/nativity groups, we also examine differences in physiologic stress profiles by income. We focus on physiologic profile differences between ethnicity/nativity groups and by poverty category at home and in Early Childhood Education (ECE) environments. Using multi-level modeling, we compare morning and afternoon salivary cortisol levels between ECE and home environments in 256 children (32% CoLIs), while controlling for child, child care, and teacher characteristics. Results demonstrated that overall, cortisol on child care mornings was lower than on home mornings, and that among children living in poverty home and child care morning cortisol differed less than for children not living in poverty. We find that CoLIs exhibit a flatter slope on child care days than do ConLAs. We also find that among children in classrooms with lower average poverty exposure, cortisol decline across the day is steeper on child care days. Importantly, teacher language may act as a buffer to CoLIs on child care days, resulting in a steeper decline at child care. Implications for policy and practice, including supporting the availability of bilingual teachers are discussed.

Estimation of cortisol levels in patients with premalignant disorders and oral squamous cell carcinoma.

Introduction:Oral cancer has been a scourge on the human population that drastically affects the quality of life-causing chronic anxiety and depression leading to disturbance in hypothalamus pituitary axis reflected by cortisol hormone dysregulation. Stress hormones affect tumor progression at different levels such as initiation, tumor growth and metastasis. Cortisol dysregulation has been reported in other malignancies; however, a thorough review of English literature revealed only anecdotal studies investigating it in patients with oral squamous cell carcinoma (OSCC).Objectives:The objective of this study is to evaluate morning plasma and salivary cortisol levels in patients with OSCC, premalignant disorders (PMD's) and smokers and/or drinkers without any lesion (risk group) and control group and its correlation with Hospital Anxiety And Depression Scale (HADS-subjective) and Hamilton Rating Scale for Anxiety and Depression (HRSA, HRSD-objective).Materials and Methods:This cross-sectional study was carried out on 25 patients each of OSCC, PMD's, risk and control group. Self-administered HADS and clinician-rated HRSD, HRSA were applied to each patient. Morning unstimulated saliva and venous blood sample were collected between 08:00 and 11:00 h to avoid diurnal variations. Morning salivary and plasma cortisol levels were analyzed using enzyme-linked immunosorbent assay method.Results:Both morning plasma and salivary cortisol levels were significantly higher in patients in OSCC group as compared to other three groups in the study which were further supported by higher scores obtained from HADS, HRSA and HRSD scales.Conclusion:The study observed that there was marked dysregulation of both morning plasma and salivary cortisol levels along with higher scores of anxiety and depression in OSCC.

Abstract P273: Association Between 24-hr Urinary Cortisol and Severity of Obstructive Sleep Apnea in Patients With Resistant Hypertension

Background: Plasma cortisol levels have been found to be negatively associated with severity of obstructive sleep apnea (OSA) based on morning salivary cortisol levels. Studies on pediatric patients have suggested that salivary cortisol can be used as a biomarker for assessment of OSA severity and to analyze prognosis following treatment with continuous positive airway pressure (CPAP). We hypothesized that 24-hr urinary cortisol levels are associated with severity of OSA in patients with resistant hypertension (HTN). Methods: In this prospective study, 197 patients were recruited from University of Alabama at Birmingham resistant HTN clinic. Office blood pressure (BP), diagnostic polysomnogram (PSG), 24-hr urine analysis for cortisol were done in these patients as part of study protocol. Patients with a diagnosis of OSA who were already treated with CPAP were excluded. Results: Out of 116 patients who were analyzed based on inclusion criteria, 53.5% were female, 62.1% were African American and the mean baseline values were age 57.4 ± 10.6 in years, body mass index 34.9 ± 7.4 kg/m 2 , 24-hr urinary cortisol 12.1 ± 7.7 mcg, apnea-hypopnea index (AHI) 9.4 ± 13.0 events/hr. Regression analysis was done between 24-hr urinary cortisol and AHI, and the Pearson correlation coefficient was 0.0498 (p = 0.602). There was no significant correlation between 24-hr urinary cortisol level and increasing AHI. Conclusion: In this cross-sectional study, 24-hr urinary cortisol level was not significantly associated with increasing AHI, indicating that 24-hr urinary cortisol may not play a role in the severity of OSA in patients with resistant HTN.

Morning Salivary Cortisol in Young Children: Reference Values and the Effects of Age, Sex, and Acute Bronchiolitis

To identify morning salivary cortisol reference values in infancy and at 2 years of age and to investigate the influence of age, sex and acute bronchiolitis. In this South-East Norwegian cohort study, 308 children hospitalized with moderate to severe acute bronchiolitis in infancy in 2010-2011 were compared with 223 healthy controls included in 2012 by measuring morning salivary cortisol levels at inclusion and at 2 years of age. Samples were collected shortly after awakening after 6 am. The influences of age, sex, and acute bronchiolitis were assessed by regression analysis. In infancy, cortisol values were higher in acute bronchiolitis, with an age- and sex-adjusted weighted mean group difference of 13.9 nmol/L (95% CI 8.1-19.7; P < .0001). The median level in reference group was 23.7 nmol/L (95% CI 9.7-119.6). At 2 years of age, sex but not inclusion groups differed, with significantly higher values in girls. The weighted mean of all boys' cortisol levels was 32.4 nmol/L, (95% CI 30.5-34.3), and all girls' levels were 36.9 nmol/L (95% CI 34.7-39.2; P < .003). Salivary cortisol levels were higher at 2 years of age than in infancy in the reference group, were higher in girls than in boys at 2 years of age, and were higher in infants at the time of acute bronchiolitis than in healthy infants. ClinicalTrials.gov: NCT00817466.

Salivary cortisol level as a marker of adrenal function in children with systemic inflammatory response syndrome in Egypt.

Introduction: Pediatric systemic inflammatory response syndrome (SIRS) criteria is widely used to identify patients who need specialized, advanced therapies. Cortisol plays an important anti-inflammatory in SIRS. Adrenal status and use of corticosteroid in children with SIRS still controversial. Objective: to assess salivary in children with SIRS and its relation to outcome in PICU of Suez Canal University hospital. Methods: prospective case control study was carried out. We analyzed 45 patients with SIRS and45 healthy control children for morning salivary and total serum cortisol level Results: children with SIRS have significantly higher morning salivary and total serum cortisol level than control group (p=.00). Mortality was associated with higher levels of both salivary and total cortisol. Conclusions: Salivary cortisol can be used to estimate cortisol levels in pediatric with SIRS and can foretell outcome. Keywords: systemic inflammatory response syndrome, children, salivary, cortisol.

Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression.

Because chronic stress is an important risk factor for anxiety states and depressive disorders, we studied hypothalamus-pituitary-adrenal (HPA) axis and sympathetic system activity via changes in cortisol and alpha amylase activity levels in pediatric generalized anxiety disorder (GAD) patients (n=26) with comorbid depression and a healthy comparison group (n=26). Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA-axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in-patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.

The Trend in Morning Levels of Salivary Cortisol in Children With ADHD During 6 Months of Methylphenidate Treatment

Objective: To determine the trend in cortisol levels in children with ADHD treated with methylphenidate (MPH) and nontreated healthy controls over a 6-month period. Method: The morning salivary cortisol levels of 50 patients with ADHD (40 boys and 10 girls, mean age = 7.6 years) and 50 age- and gender-matched healthy controls were measured at baseline and at 1, 3, and 6 months from baseline. The neuropsychological performance of the ADHD patients was measured via administration of the Continuous Performance Test. Results: The cortisol levels of ADHD patients increased significantly after 1 month of MPH treatment before decreasing to an intermediate level, but were significantly positively correlated with neuropsychological performance throughout the 6-month treatment period. The cortisol levels of the controls did not change significantly over the 6-month period. Conclusion: MPH administration appears to positively influence the functioning of the hypothalamic–pituitary–adrenal axis in ADHD patients.

Effect of acupuncture on sleep quality and hyperarousal state in patients with primary insomnia: study protocol for a randomised controlled trial

IntroductionPrimary insomnia (PI) is commonly defined as a state of having disturbed daytime activities due to poor night-time sleep quality. Studies have demonstrated that it is a disorder of 24...

Effects of Meditation on Stress Levels of Physical Therapist Students

Background and Purpose. Due to the arduous nature of the professional (entrylevel) physical therapist (PT) education program, PT students often experience higher levels of stress than their age and gender-matched peers, which can negatively affect their academic performance and wellbeing. Therefore, finding methods to manage stress is important for students’ wellbeing and academic success. The purpose of this study was to investigate the effect of meditation on stress levels of students in a doctor of physical therapy program. Participants. Twenty-four PT students in their first and second year of an entry-level doctoral degree program participated in this study. Methods. This study examined the stress levels of 24 subjects via blood pressure, morning and evening salivary cortisol levels, and 3 different stress questionnaires (Perceived Stress Scale, General Anxiety Disorder 7, Stress Visual Analog Scale) using a quasi-experimental pretest-posttest design. The intervention was a twice-daily 20-minute beeja mantra-based meditation performed for 8 weeks. Results. All 24 students completed the study with average compliance of 91.6% ± 8.7% (mean ± SD) meditating at least once per day, and 77.3% ± 19.8% meditating twice per day. A paired t test was used to analyze the blood pressure readings, with systolic blood pressure decreasing by 2.9 ± 2.3 (standard error of the mean: SEM) mmHg (P = .022), and diastolic blood pressure decreasing by 4.6 ± 2.9 (SEM) mmHg (P = .005). Four subjects with prehypertensive systolic blood pressure readings prior to the meditation intervention moved into healthy normal range by the conclusion of the study. The Wilcoxon signed rank test was used to evaluate the questionnaires, which showed significantly decreased subjective stress levels (P < .05). No significant changes in mean morning (AM) or night (PM) salivary cortisol levels were found (P > .05). However, 9 of the 14 (64%) subjects who had at least 1 cortisol measurement outside of the normal range (established by ZRT Labs) at the start of the study had both AM and PM cortisol levels in the normal range following the intervention. Discussion and Conclusion. The results of this study show that an 8-week mantrabased meditation program significantly reduces blood pressure, significantly reduces perception of stress based on the subjective questionnaires, and that a 1-day AM/PM cortisol sample may not be sufficient to accurately analyze a subject's true daily cortisol level to show statistical change.

Cortisol and its effects on cognitive function in a sample of Egyptian school-aged children with attention-deficit hyperactivity disorder

Background Several studies have suggested that cortisol level influences the development and functioning of the brain in children and that it is implicated in a variety of processes including memory and attention. Objective This study was conducted to investigate the relation between cortisol level in children with attention-deficit/hyperactivity disorder (ADHD) and their cognitive function profile. Methods The participants of the study, held in Suez Canal University Hospital in Ismailia, were recruited from among those attending the childhood and adolescent psychiatry clinic. They were divided into two groups, the ADHD group [diagnosis based on Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) through a structured clinical interview], composed of 43 children (pure ADHD children with no comorbid conditions), and the control group, composed of 31 typically developing children. All of them participated voluntarily in this study. The participants' ages ranged from 6 to 12 years; both sexes were included. Early morning awakening salivary cortisol levels were collected on two different days 2 months apart. The Stanford-Binet intelligence test 4th edition, the Wisconsin Card Sorting Test, Conner's test, and the child behavioral checklist were administered on all participants. Results Early morning salivary cortisol levels in both groups showed a statistically significant difference. Comparison shows that there was a statistically significant difference in the mean total score and the mean subdomain score of Stanford-Binet intelligence test 4th edition and Wisconsin Card Sorting Test (total number of errors, perseverative errors) between ADHD children and the comparison group. These results were positively correlated with decrease in mean cortisol awakening response. Conclusion There are significant associations between salivary cortisol levels and cognitive and executive function impairment in children with ADHD.

Morning salivary cortisol with regard to gender in individuals with perceived facial pain

ABSTRACT BACKGROUND AND OBJECTIVES: Facial pain seems to be related to physiological responses to stress and sexual dimorphism. However, the relationship among facial pain, cortisol secretion and gender has been poorly investigated. This study aimed to investigate differences in morning salivary cortisol profile between males and females either with or without perceived facial pain symptoms. METHODS: Participated in the study 39 individuals reporting facial pain and 33 painless controls of both genders. Facial pain symptoms were evaluated with Axis II Research Diagnostic Criteria for Temporomandibular Disorders, which has supplied chronic pain scores. Saliva was collected in the morning to obtain cortisol peaks, being stored for further use. Salivary cortisol levels were evaluated by immunosorbent assay. Statistical analysis has included hypotheses tests and ANOVA with significance level of 5% and a binary logistic regression, which has tested the association between gender, cortisol and each facial pain symptom. RESULTS: There has been no association between facial pain and gender. Cortisol levels were similar among individuals with and without facial pain, regardless of gender. The adjusted model has shown that most symptoms were not associated to gender, regardless of cortisol levels. CONCLUSION: In individuals with and without facial pain symptoms, morning salivary cortisol levels regulation has been similar for both genders.

Anxiety Symptoms During Adolescence Predicts Salivary Cortisol in Early Adulthood Among Blacks; Sex differences.

Background:Although the link between psychological distress and altered cortisol level has been already shown; very limited information exists about this association among Black youth.Objectives:We tested sex differences in predictive role of symptoms of anxiety during adolescence on annual decline in morning salivary cortisol levels in early adulthood among Black youth.Patients and Methods:Data came from wave 1 (year 1994), wave 6 (year 2000), and wave 7 (year 2001) of the Flint adolescent study. In this study 176 Black youth (85 males and 91 females) were followed for 7 years from mean age of 15 at baseline to 22 at the end of follow up. Linear regression was used for data analysis with change in salivary cortisol from 2000 to 2001 as the dependent variable, symptoms of anxiety, at 1994 as independent variable, age, number of employed parents, depressive symptoms and alcohol use at 1994 as controls, and sex as the moderator.Results:Higher level of anxiety symptoms at 1994 was predictive of a higher decline in morning salivary cortisol from 2000 to 2001 for all youths, while the effects of baseline socio-economics, depressive symptoms, and alcohol use were controlled. Among female participants, anxiety symptoms at 1994 were predictive of a greater decline in morning salivary cortisol level from 2000 to 2001. The association was not found among males.Conclusions:Our findings suggest sex differences in the predictive role of anxiety symptoms during adolescence on the annual decline in cortisol level during early adulthood. While most research on this topic is among White middle class individuals, our findings shed more light on the longitudinal links between psychological distress and the hypothalamus-pituitary-adrenal (HPA) axis function among Black youth.

Salivary cortisol, brain volumes, and cognition in community-dwelling elderly without dementia.

We investigated the associations of morning and evening salivary cortisol levels with regional brain volumes and cognitive functioning in community-dwelling older persons without dementia. From the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we included 4,244 persons without dementia (age 76 ± 5 years, 58% women) who had 1.5T brain MRI, assessment of cognitive functioning, and saliva collected at home 45 minutes after awakening and at night. Linear regression analysis was used to estimate the cross-sectional relationship among cortisol levels, brain volumes, and cognitive functioning, adjusting for covariates. Higher evening cortisol was associated with smaller total brain volume (highest vs lowest tertile -16.0 mL; 95% confidence interval -19.7 to -12.2 mL, adjusted for age, sex, education, intracranial volume, smoking, steroid use, white matter lesions, and brain infarcts on MRI). The smaller volumes were observed in all brain regions, but were significantly smaller in gray matter than in white matter regions. Poorer cognitive functioning across all domains was also associated with higher evening cortisol. Higher levels of morning cortisol were associated with slightly greater normal white matter volume and better processing speed and executive functioning, but not with gray matter volume or with memory performance. In older persons, evening and morning cortisol levels may be differentially associated with tissue volume in gray and white matter structures and cognitive function. Understanding these differential associations may aid in developing strategies to reduce the effects of hypothalamic-pituitary-adrenal axis dysfunction on late-life cognitive impairment.

Maternal salivary cortisol levels during pregnancy are positively associated with overweight children

Animal and human studies suggest that programing of the hypothalamic-pituitary-adrenal (HPA) axis may be involved in the development of obesity, but human studies of biological indicators of HPA axis activity are lacking. We studied the association between levels of the stress hormone cortisol during pregnancy and overweight offspring during childhood into adolescence. Salivary samples from 655 Danish pregnant women with singleton pregnancies (1989-1991) were collected once in the morning and once in the evening in their second and third trimester. We followed the offspring from two to 16 years of age with at least one measurement of height and weight, and classified their body mass index into overweight and normal weight. The adjusted relative difference in median salivary cortisol (with 95% confidence interval (CI)) during pregnancy (the four samples), in second and third trimester (morning and evening samples) between overweight and normal weight offspring was estimated. Furthermore, the adjusted median ratio between morning and evening maternal salivary cortisol level was estimated for normal weight and overweight children. All the analyses were stratified into the equal age groups: 2-6, 7-11, and 12-16 years. We found non-significant higher maternal cortisol levels during pregnancy in offspring that were overweight at the age of 2-6, 7-11 and 12-16 years than in normal weight peers; adjusted relative difference in median salivary cortisol 11% (95% CI: -2; 25), 6% (95% CI: -7; 20), and 9% (95% CI: -4; 24), respectively. A statistically significantly higher level of maternal cortisol was found in the second trimester in 2-6-year-old and 12-16-year-old overweight offspring; relative difference 19% (95% CI: 3; 37), and 20% (95% CI: 3; 41), respectively. The median ratio between morning and evening maternal salivary cortisol level was similar for overweight and normal weight children; e.g. at age 2-6 years in third trimester 4.31 (95% CI: 4.05; 4.60)nmol/l and 4.28 (95% CI: 3.60; 5.09)nmol/l, respectively (P=0.93). Our findings suggest a relatively consistent association between pregnancy cortisol levels and overweight offspring, especially in the second trimester.

Blunted Diurnal Cortisol Pattern Is Associated With Frailty: A Cross-Sectional Study of 745 Participants Aged 65 to 90 Years

The role of neuroendocrine alterations in the etiology of frailty syndrome is still poorly understood. Hypothalamic-pituitary-adrenal axis dysregulation is a plausible candidate pathway contributing to frailty. Thus, we sought to examine the associations of diurnal cortisol secretion with frailty in older adults. A cross-sectional analysis was conducted among 745 study participants (age 65-90 years, mean age 75.1 years) of the population-based KORA Age study. Associations between salivary cortisol measures at awakening (morning 1 [M1]), 30 minutes after awakening (M2), and evening (E) and frailty criteria were determined. Lower cortisol levels in the first morning sample (M1) (P = .18) and M2 (P = .14) and increased E levels (P = .004) were observed in prefrail (35.17%, n = 262) and frail (3.36%, n = 25) individuals, in a dose-response manner. Frailty was strongly associated with smaller ratios of morning to evening levels; M1 to E ratio (P = .02) and M2 to E ratio (P = .003). Higher evening cortisol levels were associated with a 24% increased risk of a prefrail state (odds ratio, 1.22; 95% confidence interval, 1.03-1.44). A smaller morning to evening ratio was associated with an increased risk of low grip strength (1.42, 1.09-1.86) and gait speed (1.31, 1.02-1.68). Frailty status is associated with blunted cortisol reactivity as demonstrated by lower morning and higher evening salivary cortisol levels.

The impact of asthma control on salivary cortisol level in adult asthmatics.

Asthma is a chronic disease causing psychological stress which leads to the activation of hypothalamus-pituitary-adrenal axis. The purpose of this study is to compare morning salivary cortisol levels in persistent asthma patients according to their disease severities and control status. Total 206 adult asthma patients were recruited from four university hospitals. Spirometry, questionnaire of Asthma Quality of Life (AQOL) and Asthma Control Test (ACT) were completed, and saliva samples were collected prospectively to measure morning cortisol level. The mean patient age was 56.5±15.3 years with mean asthma duration of 9.1±11.1 years. Sixty five patents (31.6%) were classified as mild persistent asthma, and 141 patients (68.4%) were classified as moderate persistent asthma according to the Expert Panel Report 3. The mean predicted FEV1 was 88.8%±18.4%, and the methacholine PC20 was 9.6±8.5 mg/mL in all study population. The mean ACT score for all patients was 19.9±3.6, and there were 71 (34.5%) patients in poorly controlled and 135 (65.5%) in well controlled asthma. The poorly controlled asthma patients were characterized by significantly lower FEV1 (84.6%±17.6% vs 91.1%±18.5%, P=0.018), lower AQOL scores (46.0±13.9 vs 73.8±26.3, P<0.001), and lower salivary cortisol levels (0.14±0.08 vs 0.18±0.11 µg/dL, P=0.04) compared to well controlled asthma. The ACT score was significantly related to salivary cortisol levels (P=0.034) after adjusting for age. There was no significant difference in salivary cortisol levels (0.17±0.12 vs 0.16±0.08, P=0.725) when analyzed according to the dose of used corticosteroid and lung function. Asthma control status affects morning salivary cortisol level. Measuring the morning salivary cortisol level might be a simple and new way to assess asthma control status.

No Effect of Caloric Restriction on Salivary Cortisol Levels in Overweight Men and Women

ObjectiveThe effect of weight loss by diet or diet and exercise on salivary cortisol levels, a measure of hypothalamic pituitary adrenal activity, in overweight individuals is not known. The objective was to test the hypothesis that 24weeks of moderate caloric restriction (CR) (25%) by diet or diet and aerobic exercise would alter morning and diurnal salivary cortisol levels. Design and SettingRandomized control trial in an institutional research center. ParticipantsThirty-five overweight (BMI: 27.8±0.7kg/m2) but otherwise healthy participants (16M/19F). InterventionParticipants were randomized to either calorie restriction (CR: 25% reduction in energy intake, n=12), calorie restriction+exercise (CR+EX: 12.5% reduction in energy intake+12.5% increase in exercise energy expenditure, n=12) or control (healthy weight-maintenance diet, n=11) for 6months. Main outcome measureSalivary cortisol measured at 8:00, 8:30, 11:00, 11:30, 12:30, 13:00, 16:00 and 16:30. Morning cortisol was defined as the mean cortisol concentration at 08:00 and 08:30. Diurnal cortisol was calculated as the mean of the 8 cortisol measures across the day. ResultsIn the whole cohort, higher morning and diurnal cortisol levels were associated with impaired insulin sensitivity (morning: P=0.004, r2=0.24; diurnal: P=0.02, r2=0.15). Using mixed model analysis, there was no significant effect of group, time or sex on morning or diurnal cortisol levels. ConclusionA 10% weight loss with a 25% CR diet alone or with exercise did not impact morning or diurnal salivary cortisol levels.