Body image; Perceived stress; Obese women; BMI; WHR. Overweight and obesity brings about change in body shape and size of individuals making them to look odd and creates problems in decent dressing due to unavailability of suitable dress designs and brands.

Furthermore, stress eating, binge eating and other types of emotional eating include poor knowledge on internal physiological states and failure to distinguish between hunger and emotional causes []. Diet and exercise have traditionally been the major ways in controlling and treating obesity. It is known that stress is a cause and also consequence of overweight and obesity [9].

Overweight and obesity may lead to body image issues and causes stress owing to dissatisfaction of self among women, there are social and major emotional complications due to obesity.

Over weight and obese persons frequently feel anxious, stressful and isolate from society because of their body image issues [10].

Women who are overweight or obese prone to have greater body dissatisfaction than those who are slim and normal. In addition, they seem to have lower self-esteem and higher perceived stress [11]. The weight reduction intervention programmes should include stress assessment and alleviation as part of weight loss initiatives.

An explorative study with Quan-Qual design was used for the study, it was undertaken in November with an objective to examine the body image perception and perceived stress levels among obese women having a Body mass Index above 31aged between 21 to 50 years in Chittoor district of Andhra Pradesh.

From the sample drawn for participation in a doctoral research project having Institutional Ethical Clearance IEC , around obese women, who were willing to participate in the study were chosen. Around 19 women having co-morbidities were excluded and 4 members could not attend the assessment sessions due to personal reasons, hence they were eliminated, thus the total sample comprised of obese women.

For assessing perceives stress levels a five point rating scale consisting of ten items was developed Example: How often you were upset because of your body size? How frequently you felt, if you had a slim body you could have been happy?

How many times you have avoided parties and functions for fear of comments? In addition, to examine the body dissatisfaction, the sample were asked to perceive their body image as; below average, Average, above average and good.

The results of the study was analyzed using SPSS software Most nutritional behavioral weight loss interventions may not aim at alleviation of psychological stress as a priority in case, stress may be one factor influencing the modest success of long-term weight reduction management [12, 13].

In the present study the body image and perceived stress levels among the sample was examined using a 10 item five point Likert type of scale developed for the purpose. The scores ranged from 10 to 50 and based on the scores the sample were divided in to low less than 16 , moderate 17 to 33 and high above The table 1 and figure 1, indicates the body image and stress levels of obese women as perceived by them.

Studies have indicated that being conscious or mindful eating reduced stress and such intervention were successful in increasing mindfulness and responses to bodily sensations, lowering anxiety levels and reducing emotional eating in response to external cues. The association among the age of the sample and stress levels was examined using chi-square test see table 2 , which indicates that among the 21 years age group majority This reflects that irrespective of age obese persons perceived stress.

The Body mass Index BMI is the measurement used as an index to classify adults into underweight, normal, overweight, obese groups. It also is widely used as a tool for screening obese as a risk screening obese as a risk factor for the prevalence of several health problems.

Anthropometric measures such as the body mass index BMI and waist and circumference are broadly used as appropriate indices of adiposity, yet there are limits in their estimates of body fat [14]. The waist circumference and hip circumference was used to calculate Waist Hip Ratio WHR of women.

This measurement is valuable to examine android and ganoids obesity, as the greater WHRs is a health risk issues in both men and women. It is important waist hip ratio should be less than 0.

The relationship between WHR and stress levels of obese women was examined using chi-square test the results were presented in table 4, which reveals that a Table 2: Association between age of obese women and their perceived stress levels.

Table 3: Relationship between the BMI and perceived stress levels of obese women. Table 4: Association between waist hip ratio and perceived stress levels among obese women. A malaise of body shape and size is endemic in women and called as a normative discontent.

Mass media may influence the ideal concept of beauty, health, and wellness. Since childhood, boys and girls have exposure to body stereotype that has a tremendous psychosocial influence. Dolls, movie characters, models, dancers, and superheroes portrayed a specific ideal body shape.

For example, Barbie is a reference model for girls [14]. Which also reveals that perceived stress scores were independent of the variable -age of women, which is supported by the study results of [15] who found that young girls and older women had similar body dissatisfaction, but more adolescent girls had a higher drive for thinness and greater influences from society to their body image.

As shown in table 4, majority of the women under the categories of moderate and high health risk with regard to their WHR indicated elevated stress levels. Note: the analysis was performed in the first of the 5 imputed data sets. Analyses stratified by sex yielded results similar to the results in the total sample for ΔTTL, speaking against a sex difference for this biomarker Table 4.

However, 2 divergent results for D-ROM were observed in males and females. However, these sex differences for ΔD-ROM were not consistently observed for all weight measures and could be random findings because of multiple testing.

In this large cohort study of older adults, BMI, WC, and WHR were not associated with D-ROM levels. On the contrary, all weight measures were statistically significantly, inverse linearly associated with TTL.

The null result for D-ROM in our study is not supported by other studies, which used urinary 8-epi-prostaglandin F2α 8-epi-PGF2α to measure lipid peroxidation [ 11, 25 ]. In the Framingham study, 8-epi-PGF2α was associated with the BMI [ 11 ], and in a Japanese cohort of older adults, 8-epi-PGF2α was correlated with the visceral fat area [ 25 ].

As 8-epi-PGF2α is considered the most reliable biomarker of OS [ 26 ], we do not doubt the results of the cited studies and rather think that our study with D-ROM lacked statistical power.

However, our results for TTL, a proxy for the antioxidative capacity of tissues, are in agreement with previous cross-sectional studies, which have linked abdominal obesity to a decreased antioxidant capacity [ ]. We add to this evidence by presenting the first longitudinal analysis to address the association of weight measures with TTL and observed an inverse association between BMI, WC, and WHR with TTL.

Associations with TTL were comparably strong for BMI and WC, which were also highly correlated in our study sample. Results for WHR were a little weaker, which was in line with a lower correlation between BMI and WHR.

This points into the direction that both general body fatness best measured by BMI [ 30 ] and visceral fat mass best measured by WC [ 31 ] have a relevant association with TTL.

This longitudinal association speaks for a causal relationship, and there is biological evidence that links visceral fat to a decreased antioxidant capacity of tissues. Decreased activity of antioxidant enzymes was successfully demonstrated in white adipose tissue of visceral fat within the accumulated fat of mouse models [ 10 ].

White adipose tissue is regarded as an endocrine organ and can produce adipocytokines [ 32 ]. Additionally, proinflammatory cytokines like TNF-α, IL-1, and IL-6 are produced by visceral body fat. These, in turn, augment OS by increased generation of ROS and nitrogen [ 33 ].

Taken together, this endocrine function of accumulated visceral body fat is an important source for systemic OS and subsequently decreased antioxidant capacities. Nevertheless, further studies are warranted to find the exact mechanisms that lower the redox defense mechanisms in obese individuals.

In addition, a randomized clinical trial would be helpful to corroborate our findings. Such a trial could have great public health relevance because TTL decreases with age, which we also detected in a previous analysis of our study [ 7 ].

An effective measure that can reduce the age-related TTL decrease could be a measure for healthy aging because TTL was shown to be associated with cardiovascular mortality [ 7 ]. These thoughts are in line with the accumulating evidence that caloric restriction may increase longevity [ 34 ].

The major strength of our study is its prospective design, which we achieved by considering repeated measurements at 2 time points.

However, it would have further strengthened the results and statistical power if we could have included more time points with repeated measurements in our study.

Another advantage was the large sample size of our study, which enhanced the statistical power. The most important limitation of our study is its observational design. Although we adjusted for all available potential confounders in our study, residual confounding by factors we did not adjust for cannot be fully excluded.

Finally, we would like to state that the study results can only be generalized to older Caucasian adults, aged 57—83 years, i. the participants of our study sample.

In conclusion, this first longitudinal analysis of weight measures and OS biomarkers supports the hypotheses that body fat measures are relevantly associated with a decreasedantioxidant defense capacity of the organism. We showed that these associations are inversely linear in older adults among whom almost no one was anorectic , which suggests the rule: the leaner the individual, the better the antioxidant defense capacity.

Clinical trials are needed to corroborate if weight reduction in obese, older adults can effectively increase TTL and subsequently increase life expectancy.

Participants have given their written informed consent. The study was approved by the Ethics Committees of Medical Faculty of the University of Heidelberg and the Medical Association of Saarland, and was conducted in line with the Declaration of Helsinki.

This study was funded by a grant from the German Research Foundation grant No. The ESTHER study was funded by grants from the Ministry for Social Affairs, Health, Women, and Family Affairs of the Saarland Saarbrücken, Germany , the Ministry of Science, Research, and Arts of Baden-Württemberg Stuttgart, Germany , the Federal Ministry of Education and Research Berlin, Germany , and the Federal Ministry of Family Affairs, Senior Citizens, Women, and Youth Berlin, Germany.

The funders were not involved in any way in this project — neither study design, execution, analysis, data interpretation, nor writing of the manuscript. conducted the statistical analyses.

wrote the first draft of the paper, and B. edited it. contributed to the measurement of the OS biomarkers. reviewed the draft of the manuscript and contributed to the interpretation of the results and the discussion. Sign In or Create an Account.

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Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume 13, Issue 1. Materials and Methods. Statement of Ethics. Disclosure Statement. Funding Sources.

Author Contributions. Article Navigation. Research Articles January 27 Longitudinal Associations of Body Mass Index, Waist Circumference, and Waist-to-Hip Ratio with Biomarkers of Oxidative Stress in Older Adults: Results of a Large Cohort Study Subject Area: Endocrinology , Further Areas , Gastroenterology , General Medicine , Nutrition and Dietetics , Psychiatry and Psychology , Public Health.

Ankita Anusruti ; Ankita Anusruti. a Division of Clinical Epidemiology and Aging Research, German Cancer Research Center DKFZ , Heidelberg, Germany. b Network Aging Research, Heidelberg University, Heidelberg, Germany. This Site. Google Scholar. Eugène H.

Jansen ; Eugène H. This question was formulated: Did you feel any stress during this hour? The perception of stress was registered on a yes-no nominal scale. Such reports during the hours preceding the salivary collections and at the time of collection were used for comparisons with the results of salivary cortisol measurements to obtain a measurement of stress-related cortisol secretion.

Careful oral and written instructions were provided to avoid misunderstanding, and the feasibility of the procedures was tested before the study in about 40 men, who were not included in the results.

Dexamethasone suppression test. This test was performed on the next day after the diurnal cortisol measurements. The participants were given two Salivettes and one tablet of dexamethasone Decadron, MSD, Sweden of 0.

They were asked to chew the cotton swab in the morning — h for 45—60 s. At h on the second day, the dexamethasone tablet was taken, and the following morning the salivary sampling was repeated. The decrease in salivary cortisol level after dexamethasone administration was calculated as the mean of the two noninhibited morning cortisol levels before diurnal curve and before dexamethasone test minus the cortisol level after dexamethasone intake.

The dose of 0. Hormones, glucose, and serum lipids. Total serum testosterone was determined by a nonextraction method, where testosterone bound to BSA at C testosteronecarboxymethylether-BSA was used as the antigen Testosterone I RIA, ICN Biomedicals, Costa Measa, CA. Insulin-like growth factor I IGF-I was determined by hydrochloric acid-ethanol Insulin was measured by RIA Pharmacia Insulin RIA , Kabi Pharmacia Diagnostics, Uppsala, Sweden.

Glucose was determined by a commercially available enzymatic method 18 , and serum lipids were determined as described by Wiklund et al. Blood pressure. Two blood pressure measurements were taken, on the right arm with the participants sitting, with a random-zero mercury sphygmomanometer Blood pressure was measured after 5 min of rest and with a 5-min interval and before blood samples were taken.

Heart rate was recorded simultaneously. The individual mean systolic and diastolic blood pressures were calculated as the mean of the two measurements. Physical health status and current medication. In addition, information about their current use of medication names and doses was obtained.

Standard methods were used to calculate the descriptive statistics. This coefficient δ i is thus an expression of the stress-related cortisol secretion for each individual. Sixty-eight In such cases the stress variable becomes a constant, and the coefficient δ of covariability is not possible to calculate.

As the variance in cortisol secretion is a measurement of the functional status of the HPA axis 21 , the greatest weight in the analysis was given to the within-individual cortisol variance ν i. The inversion reciprocal of the variance was performed to give the smallest variance a greater weight in the analyses.

Before entering the variables into the analyses, a distribution fitting test was completed. The Kolmogorov-Smirnov goodness of fit test 22 showed that the variables were not compatible with a Gaussian normal distribution.

Hypothesis testing on the differences in mean rank was performed using the Wilcoxon matched paired, signed rank test Nonparticipation analyses were performed using tests appropriate to the scale of measurement of each variable 11 , Throughout this report, all confidence intervals and P values are two sided.

The data analyses were accomplished with SPSS software SPSS for Windows, release 7. Information from questionnaires was available from all of these men. Fifty-five However, these subjects did not differ statistically in regard to the anthropometric, endocrine, metabolic, and hemodynamic measurements presented here.

Table 1 presents the physical health status and current use of medication in the total population. Six 2. Antidepressant drugs were used by 6 2. Figure 1 shows the average arithmetic mean of the cortisol values during the day.

The values were highest in the morning, and lunch was associated with an elevation of about 1-h duration. Salivary cortisol levels nanomoles per L over a day continuous line. Lunch was given at h.

Results are given as arithmetic means and sd s in parentheses. Sagittal recumbent trunk diameter and diastolic blood pressure were positively connected to stress-related cortisol secretion borderline significance.

Table 4 shows the results of the correlations, weighted by the within-individual cortisol variance ν i , between stress-related cortisol secretion and anthropometric, endocrine, metabolic, and blood pressure measurements.

A positive, significant relationship was found between stress-related cortisol secretion and sagittal recumbent trunk diameter, testosterone, fasting insulin and glucose, cholesterol, LDL cholesterol, as well as diastolic blood pressure.

Table 5 illustrates such associations between stress-related cortisol secretion and anthropometric, endocrine, metabolic, and blood pressure measurements. Fasting insulin and glucose, triglycerides, cholesterol, and LDL cholesterol were also found to be strongly associated with stress-related cortisol secretion.

Furthermore, systolic and diastolic blood pressure as well as heart rate showed positive relationships. As indicated by the confidence bands around the fitted regression line, the probability that the true fitted line in the population falls between the bands is 0. In this study perceived stress was reported and analyzed in relation to salivary, free, active cortisol over a working day under conditions of everyday life in a population of middle-aged men.

Cortisol levels were, as expected, higher in the morning, on the average, and were elevated after a standardized lunch, confirming previous information 5. Cortisol concentrations in serum and saliva have been shown to correlate strongly 13 , as also demonstrated in our laboratory not shown , verifying the usefulness of measurements of salivary cortisol.

Furthermore, this sampling method made it possible to measure cortisol concentrations under the everyday conditions that the participants were experiencing without the interference of invasive procedures in the artificial surroundings of a research laboratory.

Reports in parallel with the cortisol sampling allowed an evaluation of the relationship between perceived stress and cortisol concentration and was designed to follow the reactions in the natural milieu of the participants. The variability of the cortisol values in individuals was dominated by the difference between morning and evening values, as shown in Fig.

A high variability is thus a sign of the typical normal diurnal curve, with peaks in the morning and low values in the evening. The HPA axis is regulated by feedback inhibition from central glucocorticoid receptors, which, when occupied by glucocorticoids, diminish or totally inhibit the activity of the axis.

This can be tested by administration of dexamethasone and subsequent measurements of inhibition of cortisol secretion.

The variability of diurnal cortisol secretion and the degree of dexamethasone suppression after a dose of 0. This means that high morning and low evening values of cortisol, indicating an intact HPA axis, were followed by effective dexamethasone suppression.

In contrast, a flattened diurnal curve was associated with higher levels of cortisol after dexamethasone administration. Thus, normal or diminished plasticity of HPA axis regulation was found, using two different, independent methods.

A flattened diurnal cortisol curve as well as a diminished dexamethasone suppression are both considered to be consequences of frequently repeated or chronic challenges of the HPA axis by factors such as environmental stress 21 , Cortisol concentrations in saliva were measured repeatedly in relation to perceived stress.

The relationship between these two variables was calculated over the day as an average index of stress-related cortisol secretion. A high index indicates that a given degree of perceived stress is associated with an elevated cortisol response due to HPA axis activation and vice versa.

Such stress-related cortisol secretion would be expected to be different depending on the status of the HPA axis. This initial characterization of the HPA axis summarized above, showing that normal or deficient diurnal regulation correlated with normal or deficient feedback control, provided such an opportunity.

Therefore, when associations were sought between stress-related cortisol secretion and anthropometric, endocrine, metabolic, and hemodynamic variables, the basic status of the HPA axis was weighted into these analyses.

Significant associations were then found with signs of both a normal and a blunted activity of the HPA axis. These results suggest that the perceived stress-related cortisol secretion measured under ordinary living conditions during a random working day is related to various disadvantageous anthropometric, endocrine, and hemodynamic factors.

It seems particularly striking that when the HPA axis has been adapted to blunted activity with poor feedback control, these associations became uniformly stronger. Provided that the day of measurements was representative, this might be interpreted to mean that perceived stress with subsequent HPA axis activation is associated with problems in the homeostasis of several somatic systems.

The observation that this is more pronounced with signs of a poorly regulated HPA axis might mean that the exposure to perceived stress had been more frequent or severe during the period preceding the examination, leading to the adaptations of the HPA axis observed, which are those observed after prolonged stress.

This might presumably also result in a sensitization of the axis to the perceived stress, with the consequence of pronounced stress-related cortisol secretion 21 , In combination with abdominal obesity, this is apparently also the case after the physiological challenge of eating.

Previous work has indicated that morning cortisol levels are low in obesity, in general 26 , including central obesity 16 , 17 , and the diurnal curve is consequently more flattened. This is occurring while cortisol turnover is higher than normal 26 and seems to result in an occasionally elevated net output of cortisol in abdominal obesity, as measured by urinary free cortisol The strong relationships between the measurements of HPA axis activity and measurements of abdominal WHR and D obesity BMI shown here are thus in general agreement with previous studies of the net results of HPA axis activity in abdominal obesity.

Other indicators of a dysregulation of the HPA axis in abdominal obesity are high secretion of cortisol after laboratory stress tests 17 , 27 , elevated cortisol secretion after lunch, as reported here, ACTH levels after administration of CRH 28 , 29 , and cortisol concentrations after challenges with ACTH 17 , The results reported here are thus consistent with previous work suggesting a dysregulation of the HPA axis in abdominal obesity.

Such dysregulation is apparent in a disturbed diurnal regulation of HPA activity and a hyperresponsiveness or hypersensitivity to various challenges of psychological, physiological, or endocrine nature, occasionally resulting in elevated total net secretion and urinary output of cortisol.

As neither perceived daily stress, laboratory stress tests, nor food intake produces maximal stimulation of the HPA axis, it seems highly likely that the axis is hypersensitive, rather than hyperresponsive, in abdominal obesity. It should be noted that the associations between stress-related cortisol and other variables were less evident without statistical weighting of the status of the HPA axis.

It should also be noted that some of the correlations shifted direction in comparisons between high and low cortisol variabilities, suggesting a change of relationships. Clearly, however, low cortisol variability shows stronger associations than high variability with anthropometric, endocrine, metabolic, and hemodynamic parameters.

The endocrine associations deserve attention. Without weighting for diurnal cortisol secretion pattern, IGF-I, indicating GH secretion 30 , showed a significant negative relationship, whereas associations with testosterone were not significant.

With signs of normal HPA axis regulation high variability , this shifted to a nonsignificant relationship with IGF-I. Finally, with a low variability in diurnal cortisol secretion, strong negative relationships were found with both testosterone and IGF-I.

These shifts in associations with the status of the HPA axis suggest the following interpretation. With normal HPA axis status, perceived stress might be followed by elevation of testosterone values, whereas with signs of a perturbed HPA axis, regulation of both GH and testosterone secretion is severely inhibited.

This has been found to follow chronic HPA axis activation Statistical path-analytic models as well as subgrouping of the material according to endocrine status suggest that poor regulation of the HPA axis is followed by decreased testosterone and IGF-I values Rosmond R.

Björntorp, to be published , giving support to the interpretation that HPA axis perturbations are followed by decreased testosterone and GH secretion Other statistical findings in this report might be possible to interpret mechanistically.

This might also be a consequence of low testosterone and GH secretion, with or without HPA axis dysregulation 7. Furthermore, the endocrine perturbations might cause or amplify insulin resistance 6. There is evidence that insulin resistance might be followed by both dyslipidemia and elevated blood pressure

Furthermore, stress eating, binge eating and other types of emotional eating include poor knowledge on internal physiological states and failure to distinguish between hunger and emotional causes []. Diet and exercise have traditionally been the major ways in controlling and treating obesity.

It is known that stress is a cause and also consequence of overweight and obesity [9]. Overweight and obesity may lead to body image issues and causes stress owing to dissatisfaction of self among women, there are social and major emotional complications due to obesity. Over weight and obese persons frequently feel anxious, stressful and isolate from society because of their body image issues [10].

Women who are overweight or obese prone to have greater body dissatisfaction than those who are slim and normal. In addition, they seem to have lower self-esteem and higher perceived stress [11].

The weight reduction intervention programmes should include stress assessment and alleviation as part of weight loss initiatives. An explorative study with Quan-Qual design was used for the study, it was undertaken in November with an objective to examine the body image perception and perceived stress levels among obese women having a Body mass Index above 31aged between 21 to 50 years in Chittoor district of Andhra Pradesh.

From the sample drawn for participation in a doctoral research project having Institutional Ethical Clearance IEC , around obese women, who were willing to participate in the study were chosen.

Around 19 women having co-morbidities were excluded and 4 members could not attend the assessment sessions due to personal reasons, hence they were eliminated, thus the total sample comprised of obese women.

For assessing perceives stress levels a five point rating scale consisting of ten items was developed Example: How often you were upset because of your body size? How frequently you felt, if you had a slim body you could have been happy? How many times you have avoided parties and functions for fear of comments?

In addition, to examine the body dissatisfaction, the sample were asked to perceive their body image as; below average, Average, above average and good. The results of the study was analyzed using SPSS software Most nutritional behavioral weight loss interventions may not aim at alleviation of psychological stress as a priority in case, stress may be one factor influencing the modest success of long-term weight reduction management [12, 13].

In the present study the body image and perceived stress levels among the sample was examined using a 10 item five point Likert type of scale developed for the purpose. The scores ranged from 10 to 50 and based on the scores the sample were divided in to low less than 16 , moderate 17 to 33 and high above The table 1 and figure 1, indicates the body image and stress levels of obese women as perceived by them.

Studies have indicated that being conscious or mindful eating reduced stress and such intervention were successful in increasing mindfulness and responses to bodily sensations, lowering anxiety levels and reducing emotional eating in response to external cues. The association among the age of the sample and stress levels was examined using chi-square test see table 2 , which indicates that among the 21 years age group majority This reflects that irrespective of age obese persons perceived stress.

The Body mass Index BMI is the measurement used as an index to classify adults into underweight, normal, overweight, obese groups. It also is widely used as a tool for screening obese as a risk screening obese as a risk factor for the prevalence of several health problems.

Anthropometric measures such as the body mass index BMI and waist and circumference are broadly used as appropriate indices of adiposity, yet there are limits in their estimates of body fat [14]. The waist circumference and hip circumference was used to calculate Waist Hip Ratio WHR of women.

This measurement is valuable to examine android and ganoids obesity, as the greater WHRs is a health risk issues in both men and women. It is important waist hip ratio should be less than 0.

The relationship between WHR and stress levels of obese women was examined using chi-square test the results were presented in table 4, which reveals that a Table 2: Association between age of obese women and their perceived stress levels.

Table 3: Relationship between the BMI and perceived stress levels of obese women. Table 4: Association between waist hip ratio and perceived stress levels among obese women. A malaise of body shape and size is endemic in women and called as a normative discontent.

Mass media may influence the ideal concept of beauty, health, and wellness. Since childhood, boys and girls have exposure to body stereotype that has a tremendous psychosocial influence.

Dolls, movie characters, models, dancers, and superheroes portrayed a specific ideal body shape. For example, Barbie is a reference model for girls [14].

Which also reveals that perceived stress scores were independent of the variable -age of women, which is supported by the study results of [15] who found that young girls and older women had similar body dissatisfaction, but more adolescent girls had a higher drive for thinness and greater influences from society to their body image.

As shown in table 4, majority of the women under the categories of moderate and high health risk with regard to their WHR indicated elevated stress levels. Furthermore, statistically significant association was found between WHR values and perceived stress levels of obese women.

It is well known that body image issues are higher among obese women than non-obese persons. In such cases the stress variable becomes a constant, and the coefficient δ of covariability is not possible to calculate.

As the variance in cortisol secretion is a measurement of the functional status of the HPA axis 21 , the greatest weight in the analysis was given to the within-individual cortisol variance ν i. The inversion reciprocal of the variance was performed to give the smallest variance a greater weight in the analyses.

Before entering the variables into the analyses, a distribution fitting test was completed. The Kolmogorov-Smirnov goodness of fit test 22 showed that the variables were not compatible with a Gaussian normal distribution.

Hypothesis testing on the differences in mean rank was performed using the Wilcoxon matched paired, signed rank test Nonparticipation analyses were performed using tests appropriate to the scale of measurement of each variable 11 , Throughout this report, all confidence intervals and P values are two sided.

The data analyses were accomplished with SPSS software SPSS for Windows, release 7. Information from questionnaires was available from all of these men. Fifty-five However, these subjects did not differ statistically in regard to the anthropometric, endocrine, metabolic, and hemodynamic measurements presented here.

Table 1 presents the physical health status and current use of medication in the total population. Six 2. Antidepressant drugs were used by 6 2. Figure 1 shows the average arithmetic mean of the cortisol values during the day.

The values were highest in the morning, and lunch was associated with an elevation of about 1-h duration. Salivary cortisol levels nanomoles per L over a day continuous line. Lunch was given at h. Results are given as arithmetic means and sd s in parentheses. Sagittal recumbent trunk diameter and diastolic blood pressure were positively connected to stress-related cortisol secretion borderline significance.

Table 4 shows the results of the correlations, weighted by the within-individual cortisol variance ν i , between stress-related cortisol secretion and anthropometric, endocrine, metabolic, and blood pressure measurements.

A positive, significant relationship was found between stress-related cortisol secretion and sagittal recumbent trunk diameter, testosterone, fasting insulin and glucose, cholesterol, LDL cholesterol, as well as diastolic blood pressure.

Table 5 illustrates such associations between stress-related cortisol secretion and anthropometric, endocrine, metabolic, and blood pressure measurements. Fasting insulin and glucose, triglycerides, cholesterol, and LDL cholesterol were also found to be strongly associated with stress-related cortisol secretion.

Furthermore, systolic and diastolic blood pressure as well as heart rate showed positive relationships. As indicated by the confidence bands around the fitted regression line, the probability that the true fitted line in the population falls between the bands is 0.

In this study perceived stress was reported and analyzed in relation to salivary, free, active cortisol over a working day under conditions of everyday life in a population of middle-aged men.

Cortisol levels were, as expected, higher in the morning, on the average, and were elevated after a standardized lunch, confirming previous information 5. Cortisol concentrations in serum and saliva have been shown to correlate strongly 13 , as also demonstrated in our laboratory not shown , verifying the usefulness of measurements of salivary cortisol.

Furthermore, this sampling method made it possible to measure cortisol concentrations under the everyday conditions that the participants were experiencing without the interference of invasive procedures in the artificial surroundings of a research laboratory.

Reports in parallel with the cortisol sampling allowed an evaluation of the relationship between perceived stress and cortisol concentration and was designed to follow the reactions in the natural milieu of the participants.

The variability of the cortisol values in individuals was dominated by the difference between morning and evening values, as shown in Fig. A high variability is thus a sign of the typical normal diurnal curve, with peaks in the morning and low values in the evening. The HPA axis is regulated by feedback inhibition from central glucocorticoid receptors, which, when occupied by glucocorticoids, diminish or totally inhibit the activity of the axis.

This can be tested by administration of dexamethasone and subsequent measurements of inhibition of cortisol secretion. The variability of diurnal cortisol secretion and the degree of dexamethasone suppression after a dose of 0. This means that high morning and low evening values of cortisol, indicating an intact HPA axis, were followed by effective dexamethasone suppression.

In contrast, a flattened diurnal curve was associated with higher levels of cortisol after dexamethasone administration. Thus, normal or diminished plasticity of HPA axis regulation was found, using two different, independent methods. A flattened diurnal cortisol curve as well as a diminished dexamethasone suppression are both considered to be consequences of frequently repeated or chronic challenges of the HPA axis by factors such as environmental stress 21 , Cortisol concentrations in saliva were measured repeatedly in relation to perceived stress.

The relationship between these two variables was calculated over the day as an average index of stress-related cortisol secretion. A high index indicates that a given degree of perceived stress is associated with an elevated cortisol response due to HPA axis activation and vice versa.

Such stress-related cortisol secretion would be expected to be different depending on the status of the HPA axis. This initial characterization of the HPA axis summarized above, showing that normal or deficient diurnal regulation correlated with normal or deficient feedback control, provided such an opportunity.

Therefore, when associations were sought between stress-related cortisol secretion and anthropometric, endocrine, metabolic, and hemodynamic variables, the basic status of the HPA axis was weighted into these analyses.

Significant associations were then found with signs of both a normal and a blunted activity of the HPA axis. These results suggest that the perceived stress-related cortisol secretion measured under ordinary living conditions during a random working day is related to various disadvantageous anthropometric, endocrine, and hemodynamic factors.

It seems particularly striking that when the HPA axis has been adapted to blunted activity with poor feedback control, these associations became uniformly stronger. Provided that the day of measurements was representative, this might be interpreted to mean that perceived stress with subsequent HPA axis activation is associated with problems in the homeostasis of several somatic systems.

The observation that this is more pronounced with signs of a poorly regulated HPA axis might mean that the exposure to perceived stress had been more frequent or severe during the period preceding the examination, leading to the adaptations of the HPA axis observed, which are those observed after prolonged stress.

This might presumably also result in a sensitization of the axis to the perceived stress, with the consequence of pronounced stress-related cortisol secretion 21 , In combination with abdominal obesity, this is apparently also the case after the physiological challenge of eating.

Previous work has indicated that morning cortisol levels are low in obesity, in general 26 , including central obesity 16 , 17 , and the diurnal curve is consequently more flattened.

This is occurring while cortisol turnover is higher than normal 26 and seems to result in an occasionally elevated net output of cortisol in abdominal obesity, as measured by urinary free cortisol The strong relationships between the measurements of HPA axis activity and measurements of abdominal WHR and D obesity BMI shown here are thus in general agreement with previous studies of the net results of HPA axis activity in abdominal obesity.

Other indicators of a dysregulation of the HPA axis in abdominal obesity are high secretion of cortisol after laboratory stress tests 17 , 27 , elevated cortisol secretion after lunch, as reported here, ACTH levels after administration of CRH 28 , 29 , and cortisol concentrations after challenges with ACTH 17 , The results reported here are thus consistent with previous work suggesting a dysregulation of the HPA axis in abdominal obesity.

Such dysregulation is apparent in a disturbed diurnal regulation of HPA activity and a hyperresponsiveness or hypersensitivity to various challenges of psychological, physiological, or endocrine nature, occasionally resulting in elevated total net secretion and urinary output of cortisol.

As neither perceived daily stress, laboratory stress tests, nor food intake produces maximal stimulation of the HPA axis, it seems highly likely that the axis is hypersensitive, rather than hyperresponsive, in abdominal obesity.

It should be noted that the associations between stress-related cortisol and other variables were less evident without statistical weighting of the status of the HPA axis. It should also be noted that some of the correlations shifted direction in comparisons between high and low cortisol variabilities, suggesting a change of relationships.

Clearly, however, low cortisol variability shows stronger associations than high variability with anthropometric, endocrine, metabolic, and hemodynamic parameters.

The endocrine associations deserve attention. Without weighting for diurnal cortisol secretion pattern, IGF-I, indicating GH secretion 30 , showed a significant negative relationship, whereas associations with testosterone were not significant.

With signs of normal HPA axis regulation high variability , this shifted to a nonsignificant relationship with IGF-I. Finally, with a low variability in diurnal cortisol secretion, strong negative relationships were found with both testosterone and IGF-I. These shifts in associations with the status of the HPA axis suggest the following interpretation.

With normal HPA axis status, perceived stress might be followed by elevation of testosterone values, whereas with signs of a perturbed HPA axis, regulation of both GH and testosterone secretion is severely inhibited.

This has been found to follow chronic HPA axis activation Statistical path-analytic models as well as subgrouping of the material according to endocrine status suggest that poor regulation of the HPA axis is followed by decreased testosterone and IGF-I values Rosmond R. Björntorp, to be published , giving support to the interpretation that HPA axis perturbations are followed by decreased testosterone and GH secretion Other statistical findings in this report might be possible to interpret mechanistically.

This might also be a consequence of low testosterone and GH secretion, with or without HPA axis dysregulation 7. Furthermore, the endocrine perturbations might cause or amplify insulin resistance 6.

There is evidence that insulin resistance might be followed by both dyslipidemia and elevated blood pressure This chain of events suggests a central role of perturbations in the HPA axis in the development of a number of complications. An activation of the central sympathetic nervous system may also be involved, because the central regulation of this system and that of the HPA axis are tightly coupled Such involvement is suggested by the positive relationships between HPA axis activity and blood pressure as well as heart rate.

Although we are aware that statistical associations do not give information about causality, the observations summarized above strongly suggest that cortisol secretion as a response to perceived stress is a powerful factor regulating disease-generating events in the periphery.

This seems to be particularly the case when the HPA axis functions with low reactivity and poor feedback control. This indicates that it is necessary to follow the acute reactions of the HPA axis following perceived stress to detect the associations reported in this work.

Both are characterized by a perturbed HPA axis status, centralization of body fat, and abnormal endocrine, metabolic, and hemodynamic features. Socio-economic handicaps, repeatedly described in subjects with abdominal obesity 8 — 12 , provide an environment in which stress reactions would be expected to be frequent.

Via adaptations of the regulatory systems of the HPA axis, this seems then to be followed by risk factors for prevalent disease. The results presented here might elucidate the long sought mechanism by which psychological and socio-economic factors influence somatic disease, particularly since these factors are also involved in the population studied here 11 , It is hoped that the new methodology developed and reported here will provide better possibilities to examine putative pathogenetic factors causing the perturbations of HPA axis regulation associated with such risk factors.

The authors thank in alphabetic order Christina Jonsteg, George Lappas, Katarina Romanus, Erik Tengdahl, and Inga-Lill Åhs for excellent technical assistance.

This work was supported by the Swedish Medical Research Council K97—19X—35A. Folkow B. Acta Med Scand. Hallbäck M. Acta Physiol Scand. Henry JP , Grim CE. J Hypertens. Google Scholar. Ann Behav Med. Laatikainen TJ. Ann Med. Björntorp P. Int J Obes Relat Metab Disord.

Lapidus L , Bengtsson C , Hällström T , Björntorp P. One practical question to ask is how waist circumference should be measured. Landmarks include the umbilicus, the midpoint between the lowest rib and the iliac crest, and just above the iliac crest.

Advantageously, Ross et al. So exercise professionals are encouraged to use the anatomical landmark that works best with their clients. The measurement should be taken at the end of expiration, when the diaphragm is in its neutral position; during an inspiration the diaphragm descends into the abdominal cavity, enlarging the waist circumference measurement.

A spring-loaded tape measure is recommended use any Web search engine to obtain one , as the tension in this simple, inexpensive tool remains constant, providing consistency across all anthropometric measurements.

With waist-to-hip ratio, the waist is measured at its narrowest part, between the lowest rib and the iliac crest, and the hip circumference is taken at the widest area of the hips, at the greatest protuberance of the buttocks.

The next step is simply to divide the waist measurement by the hip measurement. Welborn and Dhaliwal and Srikanthan, Seeman and Karlamangla confirm this and cite several other investigations that show waist-to-hip ratio being the superior clinical measurement for predicting cardiovascular disease risk.

It is inspiring that there is a plethora of research on these anthropometric measurements. BMI is a reliable way to tell if body weight is putting a person at generalized health risk.

Much research denotes that waist-to-hip ratio is the superior health risk—categorizing indicator. Many fitness professionals are highly skilled at body composition measurement techniques, such as skinfolds. In completing and explaining the anthropometric and body composition measures for clients, professionals can provide supplementary educational information about reducing cardiometabolic health risks and improving quality of life.

Insulin resistance is a condition in which the body produces insulin but the muscle, fat and liver cells do not react with it, and the glucose cannot enter the cell. The pancreas unsuccessfully tries to resolve the problem by producing more insulin.

The result is excess glucose buildup in the bloodstream, an antecedent to diabetes. Thus, most people with insulin resistance have high levels of insulin and glucose circulating in their blood. Waist is measured at the narrowest point of the midsection, between the bottom rib and the top of the hip bone.

Attie, A. Adopocyte metabolism and obesity. Journal of Lipid Research, 50, S— Hainer, V. Treatment modalities of obesity: What fits whom? Diabetes Care, 31 Suppl. Maffeis, C. Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children.

Journal of Pediatrics, 2 , — National Institute of Diabetes and Digestive and Kidney Diseases. Weight and waist measurement: Tools for adults. htm circumf ; retrieved June 26, Ness-Abramof, R.

Waist circumference measurement in clinical practice.