Salivary Cortisol, Perceived Stress, and Metabolic Syndrome: A Matched Case-Control Study in Female Shift Workers

Abstract

Although the pathogenesis of metabolic syndrome (MetS) is complex and multifactorial, there is limited information if psychological factors, such as stress exposure, are involved in the etiology of MetS. Therefore, this study investigated the associations between MetS and cortisol levels and perceived stress levels among women shift workers in Southern Brazil. A matched case-control study was conducted, including 50 cases of MetS and 200 age-matched controls (±3 years, 4 for each case). Salivary cortisol levels were evaluated immediately after waking and one upon returning home from work. Perceived stress levels were measured by the Perceived Stress Scale with 10 items (PSS-10). Multivariate-adjusted associations between MetS and salivary cortisol levels and perceived stress levels were assessed by conditional logistic regression. Means±standard deviations of salivary cortisol levels were not significantly different between cases and controls either immediately after waking (5.37±4.10 vs. 6.03±5.39 nmol/l; p = 0.53) or after work (2.74±2.87 vs. 2.78±2.85 nmol/l; p = 0.93). There was no significant difference in perceived stress level between cases and controls (14.2±5.9 vs. 15.5±5.6; p = 0.15). No independent association was observed in the multivariate model between MetS and salivary cortisol level or perceived stress level after these exposures were stratified into tertiles. Overall, there was no difference between women with or without MetS in regard to the free salivary cortisol and perceived stress. Our results do not support an association between stress exposure and MetS among women shift workers.

Key words

cortisol - saliva - perceived stress - metabolic syndrome - women - shift work

• References

• 1 Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith Jr SC. International diabetes federation task force on e, prevention, hational heart l, blood i, american heart a, world heart f, international atherosclerosis s, international association for the study of O. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; american heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation 2009; 120: 1640-1645
• 2 Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010; 56: 1113-1132
• 3 Wu SH, Liu Z, Ho SC. Metabolic syndrome and all-cause mortality: a meta-analysis of prospective cohort studies. Eur J Epidemiol 2010; 25: 375-384
• 4 Kragelund C, Kober L, Faber J, Steffensen R, Hildebrandt P. Metabolic syndrome and mortality in stable coronary heart disease: relation to gender. Int J Cardiol 2007; 121: 62-67
• 5 Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology 2005; 30: 1-10
• 6 Anagnostis P, Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP. Clinical review: The pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metab 2009; 94: 2692-2701
• 7 Pasquali R, Vicennati V, Cacciari M, Pagotto U. The hypothalamic-pituitary-adrenal axis activity in obesity and the metabolic syndrome. Ann N Y Acad Sci 2006; 1083: 111-128
• 8 Almadi T, Cathers I, Chow CM. Associations among work-related stress, cortisol, inflammation, and metabolic syndrome. Psychophysiology 2013; 50: 821-830
• 9 Jang YM, Lee EJ, Kim DL, Kim SK, Song KH. The Association between midnight salivary cortisol and metabolic syndrome in korean adults. Diabetes Metab J 2012; 36: 245-250
• 10 Stalder T, Kirschbaum C, Alexander N, Bornstein SR, Gao W, Miller R, Stark S, Bosch JA, Fischer JE. Cortisol in hair and the metabolic syndrome. J Clin Endocrinol Metab 2013; 98: 2573-2580
• 11 Ward AM, Fall CH, Stein CE, Kumaran K, Veena SR, Wood PJ, Syddall HE, Phillips DI. Cortisol and the metabolic syndrome in South Asians. Clin Endocrinol (Oxf) 2003; 58: 500-505
• 12 Abraham SB, Rubino D, Sinaii N, Ramsey S, Nieman LK. Cortisol, obesity, and the metabolic syndrome: a cross-sectional study of obese subjects and review of the literature. Obesity (Silver Spring) 2013; 21: E105-E117
• 13 DeSantis AS, DiezRoux AV, Hajat A, Golden SH, Jenny NS, Sanchez BN, Shea S, Seeman TE. Associations of salivary cortisol levels with metabolic syndrome and its components: the multi-ethnic study of atherosclerosis. J Clin Endocrinol Metab 2011; 96: 3483-3492
• 14 Esteghamati A, Morteza A, Khalilzadeh O, Noshad S, Novin L, Nakhjavani M. Association of serum cortisol levels with parameters of metabolic syndrome in men and women. Clin Invest Med 2011; 34: E131-E137
• 15 Park SB, Blumenthal JA, Lee SY, Georgiades A. Association of cortisol and the metabolic syndrome in Korean men and women. J Korean Med Sci 2011; 26: 914-918
• 16 Räikkönen K, Matthews KA, Kuller LH. Depressive symptoms and stressful life events predict metabolic syndrome among middle-aged women: a comparison of world health organization, adult treatment panel iii, and international diabetes foundation definitions. Diabetes Care 2007; 30: 872-877
• 17 Frisman GH, Kristenson M. Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population. Eur J Cardiovasc Nurs 2009; 8: 207-215
• 18 Räikkönen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence?. Metabolism 2002; 51: 1573-1577
• 19 Yoo HL, Eisenmann JC, Franke WD. Independent and combined influence of physical activity and perceived stress on the metabolic syndrome in male law enforcement officers. J Occup Environ Med 2009; 51: 46-53
• 20 Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6: 121-127
• 21 Taylor JM. Psychometric analysis of the ten-item perceived stress scale. Psychol Assess 2015; 27: 90-101
• 22 Hellhammer DH, Wust S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology 2009; 34: 163-171
• 23 Levine A, Zagoory-Sharon O, Feldman R, Lewis JG, Weller A. Measuring cortisol in human psychobiological studies. Physiol Behav 2007; 90: 43-53
• 24 Wang F, Zhang L, Zhang Y, Zhang B, He Y, Xie S, Li M, Miao X, Chan EY, Tang JL, Wong MC, Li Z, Yu IT, Tse LA. Meta-analysis on night shift work and risk of metabolic syndrome. Obes Rev 2014; 15: 709-720
• 25 Wang XS, Armstrong ME, Cairns BJ, Key TJ, Travis RC. Shift work and chronic disease: the epidemiological evidence. Occup Med (Lond) 2011; 61: 78-89
• 26 Boivin DB, Boudreau P. Impacts of shift work on sleep and circadian rhythms. Pathol Biol (Paris) 2014; 62: 292-301
• 27 Puttonen S, Harma M, Hublin C. Shift work and cardiovascular disease – pathways from circadian stress to morbidity. Scand J Work Environ Health 2010; 36: 96-108
• 28 Canuto R, Pattussi MP, Macagnan JB, Henn RL, Olinto MT. Metabolic syndrome in fixed-shift workers. Rev Saúde Pública 2015; 49: 30
• 29 Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24: 385-396
• 30 Cohen S, Williamsom GM. Perceived stress in a probability sample of united states. In: Spacapan S, Oskamp S. (eds.) The social psychology of health: claremont symposium on applied social psychology. Newbury Park, CA: Sage; 1988: 31-67
• 31 Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology 2003; 28: 916-931
• 32 Ortega-Montiel J, Posadas-Romero C, Ocampo-Arcos W, Medina-Urrutia A, Cardoso-Saldana G, Jorge-Galarza E, Posadas-Sanchez R. Self-perceived stress is associated with adiposity and atherosclerosis. The GEA Study. BMC Public Health 2015; 15: 780
• 33 Canuto R, Garcez AS, Olinto MT. Metabolic syndrome and shift work: a systematic review. Sleep Med Rev 2013; 17: 425-431
• 34 Kudielka BM, Buchtal J, Uhde A, Wust S. Circadian cortisol profiles and psychological self-reports in shift workers with and without recent change in the shift rotation system. Biol Psychol 2007; 74: 92-103
• 35 Adam EK, Kumari M. Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology 2009; 34: 1423-1436
• 36 Reis RS, Hino AA, Rodrigues-Añez CR. Perceived stress scale: reliability and validity study in Brazil. J Health Psychol 2010; 15: 107-114
• 37 Raff H, Raff JL, Duthie EH, Wilson CR, Sasse EA, Rudman I, Mattson D. Elevated salivary cortisol in the evening in healthy elderly men and women: correlation with bone mineral density. J Gerontol A Biol Sci Med Sci 1999; 54: M479-M483
• 38 Dahlgren A, Kecklund G, Theorell T, Akerstedt T. Day-to-day variation in saliva cortisol – relation with sleep, stress and self-rated health. Biol Psychol 2009; 82: 149-155