Stress and Obesity: Are There More Susceptible Individuals?

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cortisol 627 provide latest insights with respect to multiple types of stressors.Recent FindingsIncreased long-term cortisol levels, as measured in scalp hair, are strongly related to abdominal obesity and to specific mental
cortisol 793 to abdominal obesity and to specific mental disorders. However, not all obese patients have elevated cortisol levels. Possibly, the interindividual variation in glucocorticoid sensitivity, which is partly genetically
cortisol 1647 evidence is mounting that stress, and particularly, an increase of the glucocorticoid stress hormone cortisol plays a role in the development of obesity. However, it seems that not all individuals respond to stress
cortisol 1998 we will explain how individual susceptibility to stress and obesity is determined, with a focus on cortisol , one of the main hormones involved in the biological stress response. Cortisol, a glucocorticoid (GC)
cortisol 2658 (CVD).Interestingly, in our modern society, the obesity pandemic coincides with an increase in factors that enhance cortisol production, such as chronic stress, consumption of food with a high glycemic index, and a reduced amount
cortisol 3036 is supported by recent studies demonstrating significant correlations between obesity and long-term cortisol levels, as measured in scalp hair, in both adults [[], []••, []] and children [[]]. This article
cortisol 3191 adults [[], []••, []] and children [[]]. This article will briefly discuss this novel technique of cortisol measurement and its implications in stress-related research in the past decade and in the future [[]].
cortisol 5603 [[]••].Catecholamines are also linked to the hypothalamic-pituitary-adrenal (HPA) axis with its end-product cortisol , which responds within minutes to hours and supports the action of catecholamines. Following an acute
cortisol 6974 At this point, CRH release from the PVN is inhibited by several mechanisms that are mainly driven by cortisol , thereby reducing its own production [[]••]. The glucocorticoid receptor (GR) is crucial for this
cortisol 8070 panic attacks and psychoses [[]].Chronic StressThe main effectors in chronic stress are GC, such as cortisol . The effects of GC are, at a cellular level, exerted through two intracellular receptors, the mineralocorticoid
cortisol 8388 GCs, the presence of 11-beta-hydroxysteroid dehydrogenase type II (11βHSD2), which locally converts cortisol to inactive metabolites, prevents a glucocorticoid action in various tissues, such as the kidneys and
cortisol 9206 balance, and cell proliferation and survival [[]].The biological effects of increased levels of endogenous cortisol have a substantial overlap with the effects of chronic exposure to exogenous synthetic glucocorticoids,
cortisol 9448 biological actions through the same receptor [[]••]. However, synthetic glucocorticoids are not bound to cortisol binding globulin in the plasma and are not metabolized by 11βHSD2 [[]••].Consequences of Chronic
cortisol 9867 mechanisms, not only speculations have been made about the effect of CRH [[]], but also its end product cortisol has been hypothesized to have a pathophysiological role in stress-related mental disorders such as anxiety
cortisol 10058 disorders such as anxiety and depression [[], []]. Currently, the relatively novel technique of hair cortisol concentration (HCC) measurement [[]] has also been implemented in research of mental disorders and conditions
cortisol 10288 related to stress [[]]. This unique and recently developed and optimized technique measures long-term cortisol levels using scalp hair [[], []] and thus overcomes the limitations of serum, saliva of urine cortisol
cortisol 10391 cortisol levels using scalp hair [[], []] and thus overcomes the limitations of serum, saliva of urine cortisol analysis that represents “snapshots” of cortisol levels instead of a consistent measurement of chronic
cortisol 10444 overcomes the limitations of serum, saliva of urine cortisol analysis that represents “snapshots” of cortisol levels instead of a consistent measurement of chronic cortisol levels. Studying the correlation between
cortisol 10507 analysis that represents “snapshots” of cortisol levels instead of a consistent measurement of chronic cortisol levels. Studying the correlation between mental states and traits and chronic cortisol levels is important,
cortisol 10594 measurement of chronic cortisol levels. Studying the correlation between mental states and traits and chronic cortisol levels is important, as this may be an important determinant in the vicious circle of stress and obesity
cortisol 10969 who had stress ongoing at the time of study exhibited a 43% increase of HCC [[]••]. Also, hyper cortisol ism was found in scalp hair in patients reporting severe symptoms of burnout [[]]. Interestingly, Jackson
cortisol 11465 way, weight discrimination by itself may contribute to progression of the obese state by increasing cortisol levels.Furthermore, Karlen et al. found that children with more psychosocial exposures during pregnancy
cortisol 11854 however, a past trauma corresponded with lower HCC [[]••, []–[]], whereas in the acute phase, cortisol levels were raised [[]]. For example, a recent study shows that permanently staying asylum seekers have
cortisol 12260 disorder (PTSD) and those without PTSD [[]]. Possibly, a traumatic experience temporarily raises systemic cortisol levels, which fade over the course of time leading to subsequent lower HCC.Regarding other mental disorders,
cortisol 12741 association [[], []] or lower HCC [[], []]. Regarding depressive symptoms, strong correlations with cortisol have been described [[], []], whereas others found no association [[], []]. The use of diverse populations
cortisol 14150 []]. In this case, the prolonged effects of the effector molecules of the stress system, including cortisol , norepinephrine, and CRH, can lead to disorders in the aforementioned target tissues, including a broad
cortisol 17605 the main cause of the obesity pandemic. However, considering the abovementioned effects of chronic cortisol exposure, evidence is mounting that cortisol is also a kingpin in this pandemic. The effects of long-term
cortisol 17650 However, considering the abovementioned effects of chronic cortisol exposure, evidence is mounting that cortisol is also a kingpin in this pandemic. The effects of long-term exposure to extremely elevated levels of
cortisol 17761 also a kingpin in this pandemic. The effects of long-term exposure to extremely elevated levels of cortisol are demonstrated by Cushing’s syndrome (CS). This is a condition characterized by pathologically elevated
cortisol 17878 demonstrated by Cushing’s syndrome (CS). This is a condition characterized by pathologically elevated cortisol levels, usually caused by a pituitary or adrenal adenoma. In CS, the excess of cortisol can lead to
cortisol 17966 pathologically elevated cortisol levels, usually caused by a pituitary or adrenal adenoma. In CS, the excess of cortisol can lead to a variety of clinical manifestations, such as abdominal obesity, hypertension, abnormal
cortisol 18447 may remain [[]]. This, at least partial, reversibility of the CS indicates that this presumed hyper cortisol ism could provide promising future treatment opportunities for the metabolic syndrome.However, when studying
cortisol 18654 studying the relation between GC and human obesity, conflicting results were found with respect to cortisol levels in obesity [[]–[]]. The diagnostic tests that were previously used, for measuring cortisol
cortisol 18754 cortisol levels in obesity [[]–[]]. The diagnostic tests that were previously used, for measuring cortisol in serum, saliva or urine, are difficult to interpret when applied to measure subtle hypercortisolism
cortisol 18853 cortisol in serum, saliva or urine, are difficult to interpret when applied to measure subtle hyper cortisol ism in “common” obesity. This is mainly due to the circadian rhythm of cortisol, its pulsatile secretion,
cortisol 18936 measure subtle hypercortisolism in “common” obesity. This is mainly due to the circadian rhythm of cortisol , its pulsatile secretion, and relatively short half-life in plasma (approximately 66 min) [[]], as
cortisol 19167 variations due to changing circumstances like acute stress. As previously mentioned, scalp hair analysis of cortisol overcomes these limitations.Correlations Between Long-Term Cortisol and ObesityIt has been demonstrated
cortisol 19333 Long-Term Cortisol and ObesityIt has been demonstrated that, on average, obese individuals have higher hair cortisol levels [[]] The meta-analysis of Stalder et al. also found consistent evidence for a relationship between
cortisol 19483 et al. also found consistent evidence for a relationship between HCC and BMI (9.8% increase of hair cortisol for each 2.5-point increase in BMI) [[]••]. Afterwards, several cohort studies have confirmed the
cortisol 19773 Interestingly, also in a large cohort study of more than 3000 6-year-old children, those with the highest hair cortisol concentrations had an almost 10-fold increased risk of obesity [[]]. In the latter study, cortisol was
cortisol 19872 cortisol concentrations had an almost 10-fold increased risk of obesity [[]]. In the latter study, cortisol was specifically correlated to an increase of abdominal fat mass, which is similar to the effect of
cortisol 19981 was specifically correlated to an increase of abdominal fat mass, which is similar to the effect of cortisol in CS. In addition to these cross-sectional findings, HCC also correlated to a more persistent obesity
cortisol 20135 findings, HCC also correlated to a more persistent obesity over time [[]]. So, on average, long-term cortisol levels are elevated in obese individuals, and seem in particular related to increased abdominal fat
cortisol 20539 [[]•, []]. This could be further enhanced by an increased expression of 11βHSD1 leading to more active cortisol [[]].Potential Mechanisms and Treatment Targets of Elevated Cortisol in ObesityThis brings up the question
cortisol 20689 Targets of Elevated Cortisol in ObesityThis brings up the question what causes the increased chronic cortisol levels in the majority of patients with obesity and whether there are more susceptible individuals.
cortisol 20835 with obesity and whether there are more susceptible individuals. Despite the elevated average chronic cortisol levels in obesity, not all individuals with obesity have higher HCC. When taking a closer look at the
cortisol 21077 can be observed that, within the obese group, roughly half of the obese patients appear to be normo cortisol istic, whereas the others can be categorized as hypercortisolistic [[]]. One can be speculate that hypercortisolistic
cortisol 21138 of the obese patients appear to be normocortisolistic, whereas the others can be categorized as hyper cortisol istic [[]]. One can be speculate that hypercortisolistic obesity may represent more abdominal obesity
cortisol 21189 normocortisolistic, whereas the others can be categorized as hypercortisolistic [[]]. One can be speculate that hyper cortisol istic obesity may represent more abdominal obesity and is more tightly linked to the metabolic syndrome
cortisol 21410 cardiovascular diseases. This concept is supported by studies showing that persons with the highest hair cortisol had the highest risk of metabolic syndrome [[]] and cardiovascular diseases [[]]. It is conceivable
cortisol 21538 risk of metabolic syndrome [[]] and cardiovascular diseases [[]]. It is conceivable that these “hyper cortisol istic” obese persons could benefit more from cortisol reducing treatment strategies than “normocortisolistic”
cortisol 21593 diseases [[]]. It is conceivable that these “hypercortisolistic” obese persons could benefit more from cortisol reducing treatment strategies than “normocortisolistic” obese individuals. Studies to elucidate
cortisol 21645 “hypercortisolistic” obese persons could benefit more from cortisol reducing treatment strategies than “normo cortisol istic” obese individuals. Studies to elucidate this issue are ongoing.There are several mechanisms
cortisol 21796 elucidate this issue are ongoing.There are several mechanisms that can potentially contribute to higher cortisol levels in individuals with obesity. First of all, there could be an overactivity of the HPA axis, including
cortisol 22423 TNF-alpha, and IL-1β can influence the HPA axis [[]]. Thirdly, it is conceivable that the different cortisol levels may be due to individual variation in enzymes that are involved in cortisol metabolism, such
cortisol 22506 that the different cortisol levels may be due to individual variation in enzymes that are involved in cortisol metabolism, such as 11-β-hydroxysteroid dehydrogenases enzymes type 1 and 2 (11βHSD1 and 11βHSD2).
cortisol 22709 11βHSD2). The enzyme 11βHSD1 catalyzes the regeneration of the inactive cortisone to its active form cortisol . It was found to have a significantly higher expression in adipose tissue of obese individuals versus
cortisol 23080 be decreased [[], []]. Moreover, in obesity, there may also be other enzymes responsible for altered cortisol levels or altered effects of cortisol, that include 5α and 5β reductases [[]] and bile acids [[]].
cortisol 23118 obesity, there may also be other enzymes responsible for altered cortisol levels or altered effects of cortisol , that include 5α and 5β reductases [[]] and bile acids [[]]. Also, severe liver steatosis could play
cortisol 23289 Also, severe liver steatosis could play a role, as the activity of hepatic enzymes responsible for cortisol clearance and regeneration is altered in patients with hepatic steatosis [[]].In the past years, several
cortisol 23851 [[]]. It is conceivable that these agents could be more potent if they are used selectively in hyper cortisol istic patients with obesity. Future studies need to confirm this hypothesis.Also, GR antagonists, such
cortisol 24140 simultaneously with metyrapone in men with type 2 diabetes [[]]. Other potential strategies to target hyper cortisol ism include non-pharmacological options such as mindfulness, which has been studied in patients with
cortisol 24971 glucocorticoid action is the GR, also known as nuclear receptor subfamily 3, group C, member 1, or NR3C1. When cortisol binds to the GR, it becomes activated and moves into the nucleus. In the cytoplasm, a multiprotein complex,
cortisol 29362 context of stressful circumstances, such as poverty or unemployment, the effects of the stress hormone cortisol may cause extra harm in individuals carrying the N363S variant. Thus, genetic variations in the GR-gene
cortisol 31464 be accomplished in different ways due to the various properties of glucocorticoids. High levels of cortisol can, for example, increase appetite with a preference for “comfort food” and cause white adipose
cortisol 31925 Furthermore, exogenous glucocorticoid administration increases the intrahepatic conversion of cortisone to cortisol thereby potentially contributing to the vicious circle [[]]. This relationship between (chronic) stress
cortisol 32282 Biological factors, such as carrying glucocorticoid sensitive GR gene variants, or a disrupted diurnal cortisol rhythm by decreased sleep and/or shift work, can potentially lead to higher glucocorticoid effects and
cortisol 32657 with high glycemic index, excessive alcohol use, and chronic pain, all possibly leading to increased cortisol levels and higher body weight. [[], []].Fig. 1Conceptual model of the interplay between the stress system
cortisol 33460 example, weight stigma are known not only to experience more stress [[]] but also to have higher long-term cortisol levels [[]]. Additionally, persons with obesity are more likely to suffer from mental (e.g., depression)
cortisol 33698 (e.g., OSAS, chronic pain due to weight load) which can in turn lead to chronic stress and/or higher cortisol levels. This can even be exaggerated by the use of certain medications indicated for obesity-related
dexamethasone 26094 methods have been used to study glucocorticoid sensitivity: in vivo by, e.g., very low dose (0.25 mg) dexamethasone suppression tests, and in vitro, e.g., by glucocorticoid receptor transactivation or transrepression
Select Disease Character Offset Disease Term Instance
adrenal adenoma 17928 condition characterized by pathologically elevated cortisol levels, usually caused by a pituitary or adrenal adenoma . In CS, the excess of cortisol can lead to a variety of clinical manifestations, such as abdominal obesity,
diabetes mellitus 15299 are associated with clinical parameters comprising the MetS: dyslipidemia and hypertension and type 2 diabetes mellitus , which can ultimately lead to cardiovascular diseases [[]•].As mentioned previously, exogenous synthetic
diabetes mellitus 23535 potential of 11βHSD1 inhibitors and found modest effects on glycemic control in patients with type 2 diabetes mellitus , however not enough to compete with existing medication [[], []]. The effect on other features of the
metabolic syndrome 2476 glucocorticoids, like in Cushing’s syndrome or when using high doses of exogenous GC, develop abdominal obesity, metabolic syndrome (MetS), and eventually cardiovascular diseases (CVD).Interestingly, in our modern society, the obesity
metabolic syndrome 15665 in clinical practice, associations between the use of synthetic corticosteroids and obesity and the metabolic syndrome are found. Interestingly, obese patients visiting an outpatient clinic for obesity had used corticosteroids
metabolic syndrome 16048 general population that use of both systemic and the local types was associated with the presence of metabolic syndrome , as well as an higher BMI. However, causality still has to be proven. Suggestive of a causal relation
metabolic syndrome 18522 that this presumed hypercortisolism could provide promising future treatment opportunities for the metabolic syndrome .However, when studying the relation between GC and human obesity, conflicting results were found with
metabolic syndrome 21282 that hypercortisolistic obesity may represent more abdominal obesity and is more tightly linked to the metabolic syndrome and cardiovascular diseases. This concept is supported by studies showing that persons with the highest
metabolic syndrome 21443 is supported by studies showing that persons with the highest hair cortisol had the highest risk of metabolic syndrome [[]] and cardiovascular diseases [[]]. It is conceivable that these “hypercortisolistic” obese persons
metabolic syndrome 23655 however not enough to compete with existing medication [[], []]. The effect on other features of the metabolic syndrome , including hypertension, dyslipidemia, and obesity, was thus far also modest [[]]. It is conceivable
metabolic syndrome 27149 was linked to increased central obesity and BMI, as well as other parameters that are related to the metabolic syndrome , including insulin resistance and increased blood pressure [[], []]. Roerink et al. recently found that
obesity 336 (ppub): /2018AbstractPurpose of ReviewStress has long been suspected to be interrelated to (abdominal) obesity . However, interindividual differences in this complex relationship exist. We suggest that the extent
obesity 705 FindingsIncreased long-term cortisol levels, as measured in scalp hair, are strongly related to abdominal obesity and to specific mental disorders. However, not all obese patients have elevated cortisol levels. Possibly,
obesity 1256 systemic corticosteroids.SummaryStress may play a major role in the development and maintenance of obesity in individuals who have an increased glucocorticoid exposure or sensitivity. These insights may lead
obesity 1402 glucocorticoid exposure or sensitivity. These insights may lead to more effective and individualized obesity treatment strategies.IntroductionObesity is a rapidly increasing pandemic with major consequences for
obesity 1691 particularly, an increase of the glucocorticoid stress hormone cortisol plays a role in the development of obesity . However, it seems that not all individuals respond to stress in the same way. This poses the question
obesity 1959 biological response to stress. In this review, we will explain how individual susceptibility to stress and obesity is determined, with a focus on cortisol, one of the main hormones involved in the biological stress
obesity 2467 glucocorticoids, like in Cushing’s syndrome or when using high doses of exogenous GC, develop abdominal obesity , metabolic syndrome (MetS), and eventually cardiovascular diseases (CVD).Interestingly, in our modern
obesity 2590 syndrome (MetS), and eventually cardiovascular diseases (CVD).Interestingly, in our modern society, the obesity pandemic coincides with an increase in factors that enhance cortisol production, such as chronic stress,
obesity 2862 reduced amount of sleep [[], []]. This suggests a vicious circle, where increased glucocorticoid action, obesity , and stress interact and amplify each other [[]]. This hypothesis is supported by recent studies demonstrating
obesity 3014 [[]]. This hypothesis is supported by recent studies demonstrating significant correlations between obesity and long-term cortisol levels, as measured in scalp hair, in both adults [[], []••, []] and children
obesity 3655 mental/physical stress but also exposure to exogenous stress hormones) and their relationships with obesity . In addition, existing literature explaining interindividual differences in these complex relationships
obesity 3852 relationships will be discussed. All these concepts are then integrated in a conceptual model with obesity , chronic stress, and increased glucocorticoid action as its key components.StressStress, both physical
obesity 10700 cortisol levels is important, as this may be an important determinant in the vicious circle of stress and obesity [[]•].Recently, Stalder et al. reported in a meta-analysis that perceived chronic stress is associated
obesity 13726 reuptake inhibitors (SSRIs) are associated with higher HCC in most studies ([[]–[]]. As depression and obesity are strongly related in a bidirectional manner, unraveling the shared pathophysiological mechanisms
obesity 15165 mass and visceral fat accumulation that is seen in increased GC exposure [[]]. The subsequent visceral obesity and loss of muscle mass are associated with clinical parameters comprising the MetS: dyslipidemia and
obesity 15649 surprising that in clinical practice, associations between the use of synthetic corticosteroids and obesity and the metabolic syndrome are found. Interestingly, obese patients visiting an outpatient clinic for
obesity 15759 and the metabolic syndrome are found. Interestingly, obese patients visiting an outpatient clinic for obesity had used corticosteroids in the last 3 months nearly twice as often as non-obese controls [[]]. We
obesity 16785 profile [[]]. This will be further discussed below.If future research will show that the relation between obesity and corticosteroid use is causal, it may have large consequences for public health, as a substantial
obesity 17528 years, an imbalance between energy intake and energy expenditure was regarded the main cause of the obesity pandemic. However, considering the abovementioned effects of chronic cortisol exposure, evidence is
obesity 18043 adenoma. In CS, the excess of cortisol can lead to a variety of clinical manifestations, such as abdominal obesity , hypertension, abnormal glucose tolerance, and proximal muscle weakness [[]]. The striking resemblance
obesity 18598 treatment opportunities for the metabolic syndrome.However, when studying the relation between GC and human obesity , conflicting results were found with respect to cortisol levels in obesity [[]–[]]. The diagnostic
obesity 18673 relation between GC and human obesity, conflicting results were found with respect to cortisol levels in obesity [[]–[]]. The diagnostic tests that were previously used, for measuring cortisol in serum, saliva or
obesity 18881 or urine, are difficult to interpret when applied to measure subtle hypercortisolism in “common” obesity . This is mainly due to the circadian rhythm of cortisol, its pulsatile secretion, and relatively short
obesity 19837 children, those with the highest hair cortisol concentrations had an almost 10-fold increased risk of obesity [[]]. In the latter study, cortisol was specifically correlated to an increase of abdominal fat mass,
obesity 20085 cortisol in CS. In addition to these cross-sectional findings, HCC also correlated to a more persistent obesity over time [[]]. So, on average, long-term cortisol levels are elevated in obese individuals, and seem
obesity 20738 up the question what causes the increased chronic cortisol levels in the majority of patients with obesity and whether there are more susceptible individuals. Despite the elevated average chronic cortisol levels
obesity 20854 whether there are more susceptible individuals. Despite the elevated average chronic cortisol levels in obesity , not all individuals with obesity have higher HCC. When taking a closer look at the sample of obese
obesity 20888 individuals. Despite the elevated average chronic cortisol levels in obesity, not all individuals with obesity have higher HCC. When taking a closer look at the sample of obese individuals, it can be observed that,
obesity 21203 others can be categorized as hypercortisolistic [[]]. One can be speculate that hypercortisolistic obesity may represent more abdominal obesity and is more tightly linked to the metabolic syndrome and cardiovascular
obesity 21240 hypercortisolistic [[]]. One can be speculate that hypercortisolistic obesity may represent more abdominal obesity and is more tightly linked to the metabolic syndrome and cardiovascular diseases. This concept is supported
obesity 21832 are several mechanisms that can potentially contribute to higher cortisol levels in individuals with obesity . First of all, there could be an overactivity of the HPA axis, including increased CRH and ACTH. This
obesity 23015 liver of obese patients, however, the activity of 11βHSD1 seems to be decreased [[], []]. Moreover, in obesity , there may also be other enzymes responsible for altered cortisol levels or altered effects of cortisol,
obesity 23717 []]. The effect on other features of the metabolic syndrome, including hypertension, dyslipidemia, and obesity , was thus far also modest [[]]. It is conceivable that these agents could be more potent if they are
obesity 23879 these agents could be more potent if they are used selectively in hypercortisolistic patients with obesity . Future studies need to confirm this hypothesis.Also, GR antagonists, such as mifepristone, lowered
obesity 27080 polymorphism, associated with an increase in glucocorticoid sensitivity, was linked to increased central obesity and BMI, as well as other parameters that are related to the metabolic syndrome, including insulin resistance
obesity 31206 ObesityIntegrating the abovementioned aspects, a conceptual model for the interplay between the stress system and obesity in which individual patient characteristics play a central role has been proposed (Fig. 1). The end
obesity 31669 adipose tissue to redistribute to the abdominal region [[]•], which may ultimately lead to abdominal obesity [[]]. Interestingly, it had been observed that glucocorticoids may decrease the sensitivity to adrenergic
obesity 32042 potentially contributing to the vicious circle [[]]. This relationship between (chronic) stress and obesity mediated by increased glucocorticoid action may in some persons be greater by exposure to factors enhancing
obesity 32451 lead to higher glucocorticoid effects and thus make certain persons more prone to weight gain, and obesity . Moreover, the same holds for other environmental and behavioral factors, such as intake of food with
obesity 32776 higher body weight. [[], []].Fig. 1Conceptual model of the interplay between the stress system and obesity . Various individual characteristics are proposed to play a role in initiating a vicious circle of increased
obesity 33048 chronic stress as well as increased net glucocorticoid effect by either endogenous or exogenous GCs) and obesity in a bidirectional manner. Abbreviations: GC, glucocorticoid; SNP, single nucleotide polymorphism; OSA,
obesity 33202 glucocorticoid; SNP, single nucleotide polymorphism; OSA, obstructive sleep apneaOn the other hand, obesity per se can also lead to increased chronic stress to varying degrees depending on certain individual
obesity 33509 more stress [[]] but also to have higher long-term cortisol levels [[]]. Additionally, persons with obesity are more likely to suffer from mental (e.g., depression) and physical disorders (e.g., OSAS, chronic
obesity 33792 higher cortisol levels. This can even be exaggerated by the use of certain medications indicated for obesity -related comorbidities, such as corticosteroids for arthrosis or asthma.Thus, in this and many other
obesity 33968 asthma.Thus, in this and many other ways, a vicious circle may be formed that maintains chronic stress, obesity , and increased GC action, leading to even more weight gain and/or impeding weight loss.ConclusionsSummarizing
obesity 34218 concluded that there are more susceptible individuals in the bidirectional relation between stress and obesity . This can be partly traced back to a third key player affecting stress and obesity: increased glucocorticoid
obesity 34301 between stress and obesity. This can be partly traced back to a third key player affecting stress and obesity : increased glucocorticoid action. The latter is influenced by individual GC sensitivity and altered
obesity 34582 mental disorders in recent studies.Future studies may yield more insight into the vicious circle of obesity , stress, and increased GC action, which may lead to more, individualized treatment strategies that integrate
obesity 34699 and increased GC action, which may lead to more, individualized treatment strategies that integrate obesity and stress
type 2 diabetes mellitus 15292 mass are associated with clinical parameters comprising the MetS: dyslipidemia and hypertension and type 2 diabetes mellitus , which can ultimately lead to cardiovascular diseases [[]•].As mentioned previously, exogenous synthetic
type 2 diabetes mellitus 23528 the potential of 11βHSD1 inhibitors and found modest effects on glycemic control in patients with type 2 diabetes mellitus , however not enough to compete with existing medication [[], []]. The effect on other features of the

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