Endocrine Abstracts

Background

Long-term glucocorticoids, as measured in scalp hair (HairGC), are associated with obesity and the metabolic syndrome (MetS). It is not known whether this represents a state of obesity or whether chronic hypercortisolism may influence the course or reversibility of obesity. In this study we longitudinally examine the relation between HairGC concentrations and metabolic syndrome parameters in patients with obesity who participate in a 1.5 year intensive combined lifestyle intervention (CLI).

Methods

A total of 99 adults with a body-mass index (BMI) ≥30 kg/m² (mean age 42, 75% females) were enrolled in the CLI at our academic obesity center. They received guidance on a healthy eating pattern, exercise and psychoeducation. Anthropometric measures, metabolic parameters (blood) and HairGC were assessed at baseline and at the end of the program (75 weeks). A hair sample of 3 cm closest to the scalp was cut and analyzed for cortisol (HairF) and cortisone (HairE) concentrations using liquid chromatography-mass spectrometry (LC/MS). Covariates for regression analyses were age, sex, ethnicity, smoking, alcohol intake, use of antidepressant and glucocorticoid drugs.

Results

Mean weight, BMI and waist circumference decreased from 117 kg, 39.9 kg/m², and 114 cm at baseline to 111 kg, 37.8 kg/m², and 107 cm after 75 weeks (all P < 0.001). Median HairF and HairE decreased from 3.60 pg/mg and 11.46 pg/mg at baseline to 2.37 and 9.36 pg/mg(P = 0.004 and P = 0.604 respectively). Median insulin levels and HOMA-IR significantly decreased from 140 pmol/l and 5.03 at baseline to 118 pmol/l and 4.31 after 75 weeks (P = 0.004, and P = 0.002 respectively). Baseline HairGC were not related to anthropometrics or the presence of MetS at baseline. However, baseline HairF was a significant predictor for the presence of MetS at 75 weeks (OR per quartile increase in baseline HairF was 1.78 (95% CI: 0.97–3.27), OR for the highest HairF quartile vs HairF in quartile 1–3 was 8.05 (95% CI: 1.64–39.55)). Baseline HairE was not associated with higher odds of MetS at 75 weeks.

Discussion/Conclusion

High baseline hair cortisol concentrations are associated with higher odds for no remission of the metabolic syndrome after an intensive combined lifestyle intervention. This may indicate that high baseline hair cortisol concentration may impair cardiometabolic improvement by a lifestyle intervention, although causality is yet to be proven. Further studies should assess whether such cases require an accelerated intensification of obesity treatment, e.g. by adding anti-obesity medicine to the lifestyle intervention.