Skip to main content Accessibility help
×
Home

Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition

  • Vinicius J. B. Martins (a1), Andrea P. O. Neves (a1), Márcia C. Garcia (a2), Regina C. Spadari (a2), Ana Paula G. Clemente (a3), Maria P. de Albuquerque (a1), Daniel J. Hoffman (a4) and Ana L. Sawaya (a1)...

Abstract

Undernutrition is a stressor with long-term consequences, and the effect of nutritional recovery on cortisol and thyroid hormone status is unknown. To investigate basal thyroid hormones and the cortisol response to a cold pressor test in children recovered from undernutrition, a cross-sectional study was undertaken on children (6–16 years) separated into four groups: control (n 41), stunted (n 31), underweight (n 27) and recovered (n 31). Salivary cortisol was collected over the course of 10 h: upon awakening, before and after an unpleasant and a pleasant stimulus. Cortisol upon awakening was highest in the stunted and lowest in the underweight groups: control=5·05 (95 % CI 3·71, 6·89) nmol/l, stunted=6·62 (95 % CI 3·97, 11·02) nmol/l, underweight=2·51 (95 % CI 1·75, 3·63) nmol/l and recovered=3·46 (95 % CI 2·46, 4·90) nmol/l (P=0·005). Girls had higher cortisol concentrations upon awakening compared with boys (P=0·021). The undernourished groups showed an elevated cortisol response both to the unpleasant stimulus and at the last measurement (16.00 hours) compared with that of the recovered group: AUC, control=2·07 (95 % CI 1·69, 2·45) nmol/l×30 min, stunted=2·48 (95 % CI 1·91, 3·06) nmol/l×30 min, underweight=2·52 (95 % CI 2·07, 2·97) nmol/l×30 min, recovered=1·68 (95 % CI 1·26, 2·11) nmol/l×30 min (P=0·042); and control=2·03 (95 % CI 1·75, 2·39) nmol/l×30 min, stunted=2·51 (95 % CI 1·97, 3·19) nmol/l×30 min, underweight=2·61 (95 % CI 2·16, 3·16) nmol/l×30 min, recovered=1·70 (95 % CI 1·42, 2·03) nmol/l×30 min (P=0·009). Lower free thyroxine (T4) was found in the recovered and stunted groups: control=1·28 (95 % CI 1·18, 1·39) pmol/l, stunted=0·98 (95 % CI 0·87, 1·10) pmol/l, underweight=1·10 (95 % CI 1·01, 1·21) pmol/l and recovered=0·90 (95 % CI 0·83, 0·99) pmol/l (P<0·001). Multivariate analysis showed a lower cortisol concentration along 10 h (06.00–16.00 hours) in the recovered compared with the other groups (P=0·017), and similar concentrations between the recovered and control group. In conclusion, the children with recovery in weight and height had a cortisol stress response similar to control but a lower basal free T4. Longitudinal studies are warranted to determine the extent of these endocrine changes after recovery of undernutrition and in adulthood.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: V. J. B. Martins, fax +55 11 5083 2108, email vifisio@yahoo.com.br

References

Hide All
1. Black, RE, Victora, CG, Walker, SP, et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
2. Martins, VJ, Toledo Florêncio, TM, Grillo, LP, et al. (2011) Long-lasting effects of undernutrition. Int J Environ Res Public Health 8, 18171846.
3. Florêncio, TT, Ferreira, HS, Cavalcante, JC, et al. (2004) Short stature, obesity and arterial hypertension in a very low income population in North-eastern Brazil. Nutr Metab Cardiovasc Dis 14, 2633.
4. Asao, K, Kao, WH, Baptiste-Roberts, K, et al. (2006) Short stature and the risk of adiposity, insulin resistance, and type 2 diabetes in middle age: the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994. Diabetes Care 29, 16321637.
5. Fernald, LC & Grantham-McGregor, SM (1998) Stress response in school-age children who have been growth retarded since early childhood. Am J Clin Nutr 68, 691698.
6. Romero, LM, Dickens, MJ & Cyr, NE (2009) The Reactive Scope Model – a new model integrating homeostasis, allostasis, and stress. Horm Behav 55, 375389.
7. Sesso, R, Barreto, GP, Neves, J, et al. (2004) Malnutrition is associated with increased blood pressure in childhood. Nephron Clin Pract 97, c61c66.
8. González-Barranco, J, Ríos-Torres, JM, Castillo-Martínez, L, et al. (2003) Effect of malnutrition during the first year of life on adult plasma insulin and glucose tolerance. Metabolism 52, 10051011.
9. Martins, PA, Hoffman, DJ, Fernandes, MT, et al. (2004) Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study. Br J Nutr 92, 819825.
10. Hoffman, DJ, Martins, PA, Roberts, SB, et al. (2007) Body fat distribution in stunted compared with normal-height children from the shantytowns of São Paulo, Brazil. Nutrition 23, 640646.
11. Grillo, LP, Siqueira, AF, Silva, AC, et al. (2005) Lower resting metabolic rate and higher velocity of weight gain in a prospective study of stunted vs nonstunted girls living in the shantytowns of São Paulo, Brazil. Eur J Clin Nutr 59, 835842.
12. Lunn, PG, Whitehead, RG, Hay, RW, et al. (1973) Progressive changes in serum cortisol, insulin and growth hormone concentrations and their relationship to the distorted amino acid pattern during the development of kwashiorkor. Br J Nutr 29, 399422.
13. Clark, PM, Hindmarsh, PC, Shiell, AW, et al. (1996) Size at birth and adrenocortical function in childhood. Clin Endocrinol (Oxf) 45, 721726.
14. Reynolds, RM, Walker, BR, Syddall, HE, et al. (2001) Altered control of cortisol secretion in adult men with low birth weight and cardiovascular risk factors. J Clin Endocrinol Metab 86, 245250.
15. Reynolds, RM (2013) Glucocorticoid excess and the developmental origins of disease: two decades of testing the hypothesis – 2012 Curt Richter Award Winner. Psychoneuroendocrinology 38, 111.
16. Orbak, Z, Akin, Y, Varoğlu, E, et al. (1998) Serum thyroid hormone and thyroid gland weight measurements in protein-energy malnutrition. J Pediatr Endocrinol Metab 11, 719724.
17. Kumar, S, Nadkarni, J & Dwivedi, R (2009) Thyroid hormone status in malnourished children. Indian Pediatr 46, 263264.
18. Lee, MJ, Pramyothin, P, Karastergiou, K, et al. (2014) Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity. Biochim Biophys Acta 1842, 473481.
19. McAninch, EA & Bianco, AC (2014) Thyroid hormone signaling in energy homeostasis and energy metabolism. Ann N Y Acad Sci 1311, 7787.
20. Cicchetti, D, Rogosch, FA, Gunnar, MR, et al. (2010) The differential impacts of early physical and sexual abuse and internalizing problems on daytime cortisol rhythm in school-aged children. Child Dev 81, 252269.
21. Van der Vegt, EJ, van der Ende, J, Kirschbaum, C, et al. (2009) Early neglect and abuse predict diurnal cortisol patterns in adults A study of international adoptees. Psychoneuroendocrinology 34, 660669.
22. Susman, EJ (2006) Psychobiology of persistent antisocial behavior: stress, early vulnerabilities and the attenuation hypothesis. Neurosci Biobehav Rev 30, 376389.
23. Carlson, M & Earls, F (1997) Psychological and neuroendocrinological sequelae of early social deprivation in institutionalized children in Romania. Ann N Y Acad Sci 807, 419428.
24. Miller, GE, Chen, E & Zhou, ES (2007) If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull 133, 2545.
25. Heim, C, Ehlert, U & Hellhammer, DH (2000) The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 25, 135.
26. Alves Vieira, MF, Ferraro, AA, Nascimento Souza, MH, et al. (2010) Height and weight gains in a nutrition rehabilitation day-care service. Public Health Nutr 13, 15051510.
27. das Neves, J, Martins, PA, Sesso, R, et al. (2006) Malnourished children treated in day-hospital or outpatient clinics exhibit linear catch-up and normal body composition. J Nutr 136, 648655.
28. Weisstaub, SG & Araya, QM (2003) Recuperación nutricional: Un desafío pendiente. (Catch up growth: an unresolved challenge). Rev Med Chile 131, 213219 (in Spanish).
29. Food and Agriculture Organization (2015) Nutrition. http://www.fao.org/food/nutrition-sensitive-agriculture-and-food-based-approaches/faq/en/ (accessed June 2015).
30. Frisancho, AR (2008) Evaluation of postnatal growth and nutritional status of children and adults using the NHANES III anthropometric reference. In Anthropometric Standards: An Interactive Nutritional Reference of Body Size and Body Composition for Children and Adults, 2nd ed., pp. 303331 [ AR and Frisancho, editor]. Ann Arbor, MI: University of Michigan Press.
31. Tanner, JM (1962) The development of the reproductive system. In Growth at Adolescence, 2nd ed., pp. 2839. Oxford: Blackwell Scientific Publications.
32. Word Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. Infants and Children. Technical Report Series, no. 854. Geneva: WHO.
33. Flaa, A, Sandvik, L, Kjeldsen, SE, et al. (2008) Does sympathoadrenal activity predict changes in body fat? An 18-y follow-up study. Am J Clin Nutr 87, 15961601.
34. Hanrahan, K, McCarthy, AM, Kleiber, C, et al. (2006) Strategies for salivary cortisol collection and analysis in research with children. Appl Nurs Res 19, 95101.
35. Perez, AIC, de Oliveira, TZ, de Moraes, MA, et al. (2013) Monitoring of nutritional status of users from Basic Health Units in the State of São Paulo by means of the Food and Nutritional Surveillance System (SISVAN). BEPA 10, 113 (in Portuguese).
36. Martins, VJ, Martins, PA, Neves, J, et al. (2008) Children recovered from malnutrition exhibit normal insulin production and sensitivity. Br J Nutr 99, 297302.
37. Martins, VJ, Neves, APO, Franco, MCP, et al. (2014) The impact of nutritional recovery with linear growth on the concentration of adipokines in undernourished children living in Brazilian slums. Br J Nutr 112, 937944.
38. Waterlow, JC (1992) Protein Energy Malnutrition, 1st ed. London: Edward Arnold.
39. Weaver, IC (2009) Epigenetic effects of glucocorticoids. Semin Fetal Neonatal Med 14, 143150.
40. Matsuda, S, Yamaguchi, T, Okada, K, et al. (2012) Day-to-day variations in salivary cortisol measurements. J Prosthodont Res 56, 3741.
41. Winnick, JJ, Ramnanan, CJ, Saraswathi, V, et al. (2013) Effects of 11β-hydroxysteroid dehydrogenase-1 inhibition on hepatic glycogenolysis and gluconeogenesis. Am J Physiol Endocrinol Metab 304, E747E756.
42. Schwabe, L, Haddad, L & Schachinger, H (2008) HPA axis activation by a socially evaluated cold-pressor test. Psychoneuroendocrinology 33, 890895.
43. van Stegeren, AH, Wolf, OT & Kindt, M (2008) Salivary alpha amylase and cortisol responses to different stress tasks: impact of sex. Int J Psychophysiol 69, 3340.
44. Kajantie, E, Phillips, DI, Osmond, C, et al. (2006) Spontaneous hypothyroidism in adult women is predicted by small body size at birth and during childhood. J Clin Endocrinol Metab 91, 49534956.
45. Ayala-Moreno, R, Racotta, R, Anguiano, B, et al. (2013) Perinatal undernutrition programmes thyroid function in the adult rat offspring. Br J Nutr 110, 22072215.
46. Joseph-Bravo, P, Jaimes-Hoy, L & Charli, JL (2015) Regulation of TRH neurons and energy homeostasis-related signals under stress. J Endocrinol 224, R139R159.
47. Slone-Wilcoxon, J & Redei, EE (2004) Maternal-fetal glucocorticoid milieu programs hypothalamic-pituitary-thyroid function of adult offspring. Endocrinology 145, 40684072.
48. Sawaya, AL, Martins, PA, Baccin Martins, VJ, et al. (2009) Malnutrition, long-term health and the effect of nutritional recovery. Nestle Nutr Workshop Ser Pediatr Program 63, 95105.
49. Martikainen, S, Pesonen, AK, Lahti, J, et al. (2013) Higher levels of physical activity are associated with lower hypothalamic-pituitary-adrenocortical axis reactivity to psychosocial stress in children. J Clin Endocrinol Metab 98, E619E627.
50. Garcia, MC, de Souza, A, Bella, GP, et al. (2008) Salivary cortisol levels in Brazilian citizens of distinct socioeconomic and cultural levels. Ann N Y Acad Sci 1148, 504508.

Keywords

Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition

  • Vinicius J. B. Martins (a1), Andrea P. O. Neves (a1), Márcia C. Garcia (a2), Regina C. Spadari (a2), Ana Paula G. Clemente (a3), Maria P. de Albuquerque (a1), Daniel J. Hoffman (a4) and Ana L. Sawaya (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed