Cortisol reactivity in patients with anorexia nervosa after stress induction

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Abstract
<jats:title>Abstract</jats:title><jats:p>There is a need of experimental studies on biomarkers in patients with anorexia nervosa (P<jats:sub>AN</jats:sub>), especially in the context of stress, in order to foster understanding in illness maintenance. To this end, the cortisol response to an acute stressor was investigated in <jats:italic>n</jats:italic> = 26 P<jats:sub>AN</jats:sub> (BMI: 19.3 ± 3.4 kg/m<jats:sup>2</jats:sup>), age, and gender matched to <jats:italic>n</jats:italic> = 26 healthy controls (HC; BMI: 23.08 ± 3.3 kg/m<jats:sup>2</jats:sup>). For this purpose, salivary cortisol parameters were assessed in two experimental conditions: (1) rest/no intervention and (2) stress intervention (TSST; Trier Social Stress Test). In addition, psychological indicators of stress were assessed (Primary Appraisal Secondary Appraisal, Visual Analogue Scale, and Trier Inventory for the assessment of Chronic Stress), as well as psychological distress, depression, and eating disorder (ED) symptoms. A 2 × 2 × 8 ANOVA demonstrated elevated cortisol levels in P<jats:sub>AN</jats:sub> in the resting condition. In the stress intervention no significant <jats:italic>group</jats:italic> effect in terms of <jats:italic>cortisol</jats:italic> (<jats:italic>F</jats:italic> (1, 50) = 0.69; <jats:italic>p</jats:italic> = 0.410; <jats:inline-formula><jats:alternatives><jats:tex-math>$$\eta _p^2 = 0.014$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow> <mml:msubsup> <mml:mrow> <mml:mi>η</mml:mi> </mml:mrow> <mml:mrow> <mml:mi>p</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> </mml:mrow> </mml:msubsup> <mml:mo>=</mml:mo> <mml:mn>0.014</mml:mn> </mml:mrow> </mml:math></jats:alternatives></jats:inline-formula>). A significant <jats:italic>condition</jats:italic> (<jats:italic>F</jats:italic> (1, 50) = 20.50; <jats:italic>p</jats:italic> = 0.000; <jats:inline-formula><jats:alternatives><jats:tex-math>$$\eta _p^2 = 0.291$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow> <mml:msubsup> <mml:mrow> <mml:mi>η</mml:mi> </mml:mrow> <mml:mrow> <mml:mi>p</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> </mml:mrow> </mml:msubsup> <mml:mo>=</mml:mo> <mml:mn>0.291</mml:mn> </mml:mrow> </mml:math></jats:alternatives></jats:inline-formula>) and <jats:italic>time</jats:italic> effect (<jats:italic>F</jats:italic>(2.71, 135.44) = 11.27; <jats:italic>p</jats:italic> = 0.000; <jats:inline-formula><jats:alternatives><jats:tex-math>$$\eta _p^2 = 0.20$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow> <mml:msubsup> <mml:mrow> <mml:mi>η</mml:mi> </mml:mrow> <mml:mrow> <mml:mi>p</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> </mml:mrow> </mml:msubsup> <mml:mo>=</mml:mo> <mml:mn>0.20</mml:mn> </mml:mrow> </mml:math></jats:alternatives></jats:inline-formula>) were revealed, as well as two significant interaction effects. First: <jats:italic>Condition</jats:italic> × <jats:italic>group</jats:italic> (<jats:italic>F</jats:italic> (1, 50) = 4.17, <jats:italic>p</jats:italic> = 0.046; <jats:inline-formula><jats:alternatives><jats:tex-math>$$\eta _p^2 = 0.077$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow> <mml:msubsup> <mml:mrow> <mml:mi>η</mml:mi> </mml:mrow> <mml:mrow> <mml:mi>p</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> </mml:mrow> </mml:msubsup> <mml:mo>=</mml:mo> <mml:mn>0.077</mml:mn> </mml:mrow> </mml:math></jats:alternatives></jats:inline-formula>) and second: <jats:italic>Condition</jats:italic> × <jats:italic>time</jats:italic> (<jats:italic>F</jats:italic> (2.71, 135.44) = 16.07, <jats:italic>p</jats:italic> = 0.000, <jats:inline-formula><jats:alternatives><jats:tex-math>$$\eta _p^2 = 0.24.$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow> <mml:msubsup> <mml:mrow> <mml:mi>η</mml:mi> </mml:mrow> <mml:mrow> <mml:mi>p</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> </mml:mrow> </mml:msubsup> <mml:mo>=</mml:mo> <mml:mn>0.24</mml:mn> <mml:mo>.</mml:mo> </mml:mrow> </mml:math></jats:alternatives></jats:inline-formula>). In terms of AUC<jats:sub>G</jats:sub>, no significant differences between both groups were exhibited. Regardless, significant results were evinced in terms of an increase (AUC<jats:sub>i</jats:sub>: <jats:italic>F</jats:italic>(1, 50) = 20.66, <jats:italic>p</jats:italic> = 0.015, <jats:inline-formula><jats:alternatives><jats:tex-math>$$\eta _p^2 = 0.113$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow> <mml:msubsup> <mml:mrow> <mml:mi>η</mml:mi> </mml:mrow> <mml:mrow> <mml:mi>p</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> </mml:mrow> </mml:msubsup> <mml:mo>=</mml:mo> <mml:mn>0.113</mml:mn> </mml:mrow> </mml:math></jats:alternatives></jats:inline-formula>), baseline to peak (+20 min post-TSST: <jats:italic>t</jats:italic><jats:sub>5</jats:sub> = 16.51 (9.02), <jats:italic>p</jats:italic> = 0.029) and reactivity (<jats:italic>M</jats:italic><jats:sub>PAN</jats:sub> = 0.73 vs. <jats:italic>M</jats:italic><jats:sub>HC</jats:sub> = 4.25, <jats:italic>p</jats:italic> = 0.036). In addition, a significant correlation between AUC<jats:sub>G</jats:sub> and BMI: <jats:italic>r</jats:italic> (24) = −0.42, <jats:italic>p</jats:italic> = 0.027 was demonstrated, but not between AUC<jats:sub>i</jats:sub> and BMI (<jats:italic>r</jats:italic> (24) = −0.26, <jats:italic>p</jats:italic> = 0.20). Psychological indices suggested higher levels of chronic and perceived stress in P<jats:sub>AN</jats:sub> relative to HC. However, stress perception in the stress condition (VAS) was comparable. Additional analyses demonstrated that ED-symptoms are highly correlated with psychological distress and depression, but not with BMI. In addition, it could be demonstrated that reactivity is rather related to ED-symptoms and psychological burden than to BMI. In conclusion, P<jats:sub>AN</jats:sub> showed elevated basal cortisol levels at rest and exhibited a blunted cortisol reactivity to the TSST as evinced by salivary cortisol parameters. Further, it was shown that weight recovery influences reversibility of hypercortisolemia, i.e., cortisol levels normalize with weight gain. However, HPAA (hypothalamus–pituitary–adrenal axis) irregularities in terms of reactivity persist even at a BMI ≤ 19.3 (±3.4). Our data suggest that pronounced psychological burden in P<jats:sub>AN</jats:sub>, have a greater impact on the HPAA functionality (secondary to the ED) than BMI itself.</jats:p>
Autoren
  • Ileana Schmalbach
  • Benedict Herhaus
  • Sebastian Pässler
  • Sarah Runst
  • Hendrik Berth
  • Silvia Wolff-Stephan
  • Katja Petrowski
DOI
10.1038/s41398-020-00955-7
eISSN
2158-3188
Ausgabe der Veröffentlichung
1
Zeitschrift
Translational Psychiatry
Sprache
en
Artikelnummer
275
Online publication date
2020
Status
Published online
Herausgeber
Springer Science and Business Media LLC
Herausgeber URL
http://dx.doi.org/10.1038/s41398-020-00955-7
Datum der Datenerfassung
2022
Titel
Cortisol reactivity in patients with anorexia nervosa after stress induction
Ausgabe der Zeitschrift
10

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CC-BY
Autoren
  • Ileana Schmalbach
  • Benedict Herhaus
  • Sebastian Pässler
  • Sarah Runst
  • Hendrik Berth
  • Silvia Wolff-Stephan
  • Katja Petrowski
Hosting institution
Universitätsbibliothek Mainz
Sammlungen
  • JGU-Publikationen
Resource version
Published version
DOI
10.1038/s41398-020-00955-7
File(s) embargoed
false
Open access
true
ISSN
2158-3188
Zeitschrift
Translational Psychiatry
Schlüsselwörter
  • 610 Medizin
  • 610 Medical sciences
Sprache
eng
Open access status
Open Access
Paginierung
275
Datum der Veröffentlichung
2020
Public URL
https://openscience.ub.uni-mainz.de/handle/20.500.12030/5799
Herausgeber
Nature Publishing Group
Herausgeber URL
https://doi.org/10.1038/s41398-020-00955-7
Datum der Datenerfassung
2021
Datum, an dem der Datensatz öffentlich gemacht wurde
2021
Zugang
Public
Titel
Cortisol reactivity in patients with anorexia nervosa after stress induction
Ausgabe der Zeitschrift
10

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