TY - JOUR
T1 - Diurnal salivary cortisol, glycemia and insulin resistance
T2 - The multi-ethnic study of atherosclerosis
AU - Joseph, Joshua J.
AU - Wang, Xu
AU - Spanakis, Elias
AU - Seeman, Teresa
AU - Wand, Gary
AU - Needham, Belinda
AU - Golden, Sherita Hill
N1 - Funding Information:
Grants: MESA was supported by contracts NO1-HC-95159 through NO1-HC-95165 and NO1- HC-95169 from the National Heart, Lung, and Blood Institute . MESA Stress Study was supported by RO1HL10161-01A1 and R21 DA024273 (PI: Dr. Diez-Roux). Dr. Joshua J. Joseph MD was supported by an institutional training grant from the National Institute of Diabetes, Digestive, and Kidney Diseases ( T32 DK062707 ).
Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2015/12
Y1 - 2015/12
N2 - Hypercortisolism is associated with insulin resistance (IR) and diabetes mellitus (DM); however, to our knowledge prior studies have not examined the association of diurnal cortisol curve features with measures of glycemia or IR in a population-based setting. Using log-transformed salivary cortisol data on 850 ethnically diverse men and women from the Multi-Ethnic Study of Atherosclerosis, we investigated the cross-sectional association of cortisol curve features with (1) glycemia in those with and without DM and (2) IR, in non-diabetic subjects. The log-transformed salivary cortisol curve features included wake-up cortisol, cortisol awakening response (CAR), early decline slope (30. min to 2. h post-awakening), late decline slope (2 h post-awakening to bedtime), overall decline slope (0. min to bedtime, excluding 30. min cortisol), bedtime cortisol and total area under the curve (AUC). Overall, following multivariable adjustment, among those with diabetes mellitus (DM), early decline slope, overall decline slope, bedtime cortisol, and AUC were significantly and positively associated with a 5.4% (95% CI: 1.3, 9.7), 54.7% (95% CI: 12.4, 112.9), 4.0% (95% CI: 1.6,6.4), and 6.8% (95% CI: 3.3,10.4) higher HbA1c per 1 unit increase in log cortisol feature, respectively. Cortisol curve features were not associated with HbA1c among non-diabetic participants; however, wake-up cortisol and AUC were associated with a 8.2% lower (95% CI: -13.3,-2.7) and 7.9% lower (95% CI: -14.6, -0.6) log HOMA-IR, respectively. This was attenuated by adjustment for waist circumference. Among participants with DM, cortisol curve parameters suggestive of higher hypothalamic-pituitary-adrenal (HPA) axis activity and dysfunction were associated with higher HbA1c. In non-diabetic participants, greater HPA activity was paradoxically associated with lower insulin resistance.
AB - Hypercortisolism is associated with insulin resistance (IR) and diabetes mellitus (DM); however, to our knowledge prior studies have not examined the association of diurnal cortisol curve features with measures of glycemia or IR in a population-based setting. Using log-transformed salivary cortisol data on 850 ethnically diverse men and women from the Multi-Ethnic Study of Atherosclerosis, we investigated the cross-sectional association of cortisol curve features with (1) glycemia in those with and without DM and (2) IR, in non-diabetic subjects. The log-transformed salivary cortisol curve features included wake-up cortisol, cortisol awakening response (CAR), early decline slope (30. min to 2. h post-awakening), late decline slope (2 h post-awakening to bedtime), overall decline slope (0. min to bedtime, excluding 30. min cortisol), bedtime cortisol and total area under the curve (AUC). Overall, following multivariable adjustment, among those with diabetes mellitus (DM), early decline slope, overall decline slope, bedtime cortisol, and AUC were significantly and positively associated with a 5.4% (95% CI: 1.3, 9.7), 54.7% (95% CI: 12.4, 112.9), 4.0% (95% CI: 1.6,6.4), and 6.8% (95% CI: 3.3,10.4) higher HbA1c per 1 unit increase in log cortisol feature, respectively. Cortisol curve features were not associated with HbA1c among non-diabetic participants; however, wake-up cortisol and AUC were associated with a 8.2% lower (95% CI: -13.3,-2.7) and 7.9% lower (95% CI: -14.6, -0.6) log HOMA-IR, respectively. This was attenuated by adjustment for waist circumference. Among participants with DM, cortisol curve parameters suggestive of higher hypothalamic-pituitary-adrenal (HPA) axis activity and dysfunction were associated with higher HbA1c. In non-diabetic participants, greater HPA activity was paradoxically associated with lower insulin resistance.
KW - Cortisol
KW - Glycemia
KW - Hypothalamic-pituitary-adrenal axis
KW - Insulin resistance
KW - Type 2 Diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=84947433587&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947433587&partnerID=8YFLogxK
U2 - 10.1016/j.psyneuen.2015.08.021
DO - 10.1016/j.psyneuen.2015.08.021
M3 - Article
C2 - 26356041
AN - SCOPUS:84947433587
SN - 0306-4530
VL - 62
SP - 327
EP - 335
JO - Psychoneuroendocrinology
JF - Psychoneuroendocrinology
ER -